© Thieme Medical Publishers
18 December 2009 (online)
The best facial plastic surgeons can perform wonders on the face and neck. Combining modalities such as rhinoplasty, rhytidectomy, and platysmal banding, they can remodel the aging face to restore some of the positioning and attributes seen in early years. However, limitations with what may be achieved surgically exist, and even the best surgery will not fix the surface of the skin, address scars, or replace lost volume. These deficits are best treated with modalities that are familiar to the facial plastic surgeon but also to other specialties. For instance, fractional laser resurfacing, cosmeceuticals, and injections with botulinum toxins and fillers are all used by some facial plastic surgeons, but the extent to which they are routinely included is less than it might be for optimal patient outcomes. There are many reasons why this occurs, but frequently this is the result of the intense focus of one specialty on its strengths. This issue of Facial Plastic Surgery explores modalities that are readily available to the facial plastic surgeon—either as products or procedures that he or she may use or perform or as a referral to a colleague.
There is ample evidence to suggest that injections with botulinum toxins are helpful perioperatively to minimize the formation of rhytides treated surgically or with lasers. Their synergy with fillers has also been amply documented, and part of this supplement of the journal provides an update on these molecules that should facilitate understanding of what can and cannot be accomplished with them.
Lasers and light sources have been a part of facial plastic surgery for decades, and they remain one of the pillars for facial rejuvenation. This supplement has information from leaders in dermatology who have contributed to the knowledge of how these energies interact with the skin and what they are or are not good at treating. Their role in facial rejuvenation is significant, and for those surgeons that are not including them in their practices, the ability to recommend and understand a particular light-based treatment will help the dialogue with patients and assure them of appropriate referrals that will be logical and help to optimize their outcomes. This will be of particular benefit for patients who have outstanding surgical outcomes but are still defined by the surface of their skin as being “old.”
Collagens have evolved in the past few years. Porcine collagen has replaced bovine and human analogues, and the cross-linking technology is significantly better than older modalities. In addition to providing structural filling for certain areas, future versions of Evolence (i.e., Evolence Breeze) will be able to fill fine lines. These products are likely to be part of pan-facial rejuvenation. In addition to the collagens, other fillers that are currently available or soon to be available for use in the United States are increasingly used to fill lines, lift faces, and address areas that require volume. Poly-l-lactic acid (PLLA) has recently been approved, and its unique ability to restore volume to the cheeks, temples, and other areas complements other treatments.
Topical products including cosmeceuticals and prescription medications may help to fix or maintain the appearance of the skin by reducing pigment irregularity, improving light reflectance, and stimulating collagen. Frequently, these are the easiest yet least common means to maintain and optimize patient appearance. In addition, they serve to bond the patient to the practice and afford the physician a unique opportunity to interact with patients and determine the degree of success and happiness achieved after a surgical procedure.
The suite of modalities available to improve esthetic outcomes seems to grow at an exponential rate. Some of these are marginally useful, whereas others can make the difference between a patient that is or is not satisfied. This supplement is designed to help the facial plastic surgeon have a better understanding of some of the nonsurgical rejuvenation techniques available today. Whether or not they are included in one's practice or form the basis for a referral to another specialty, it is important that one has these pieces of the esthetic vocabulary in their conversation with esthetic patients.