While many surgeons have their own pet names for the latest rejuvenative procedures that they offer, there are some basic principles that all of the procedures share in common. As an informed consumer, look past the eponyms and hype and focus on the procedures themselves, what the benefits and risks are of each and whether your expectations conform to the reality of what is being offered.

In the field of facial rejuvenation, try to begin with an understanding of what the underlying problem is and how each proposed procedure affects that problem. As a surgeon, when a patient asks me to “Tell me what I need,” I prefer to begin by asking what the particular concerns are that brought them to see me in the first place. Some of my women patients respond in a very general way, such as “I’m beginning to see my mother in the mirror and need some help.” Others are far more specific and focus on issues such as prominent frown lines (“I feel like I always look angry”), bags under the eyes (“I always look exhausted”) or wrinkles in the neck with visible jowls and bands.  Whatever the patient’s concerns, it is critical that the treatment plan address each specific issue.

Traditionally, facial rhytids and loss of tone in the neck, jowls associated with aging or localized fatty deposits were treated with surgery, and in fact, many face-lifts are still commonly done. According to the latest statistics from the American Society of Plastic Surgeons, more than 100,000 of these procedures were performed in the last year. With that said, recognize that many facelifts being done are no longer that traditional, and surgeons can often use techniques that shorten the scars and decrease the downtime after surgery. In well-selected patients, local anesthesia alone can be both comfortable and safe. So-called mini lifts, lifestyle lifts, temporal lifts, S lifts or other procedures can all be combined with ancillary treatments such as lasers, peels, fillers and relaxants to achieve the desired result. The challenge is to be sure you understand exactly what is involved before proceeding and how long each of the treatments is expected to last.

In my own practice, I begin my facial consultations by analyzing the face in terms of symmetry, overall quality of the skin, changes in contour associated with aging or sun damage and the presence of unwanted bulges or depressions. After analysis of the problem areas, I begin to discuss potential approaches with the patient to address these concerns.

Fortunately, we have many treatments and interventions to offer our patients in addition to or instead of surgery. Starting with fine lines and sun damage, we can consider topical treatments and light peels, advancing to dermabrasion, deeper peels and laser treatments if needed. For many of our younger patients, this is all that is required. When the problem is more prominent lines from muscular activity, Botox, Dysport, and Xeomin can all be considered. If there is loss of substance, such as the deeper lines between the nose and the side of the lips, the nasolabial fold, fillers can be part of the plan, ranging from Juvaderm and Restylane to Radiesse, Sculptra or even the patient’s own fat, harvested from elsewhere.

The art of cosmetic plastic surgery is to put these disparate tools together and design a unique plan that addresses each individual patient’s concerns and needs.  The only thing left is to then come up with a catchy name for the treatment plan. Oh, and next month, we’ll discuss “the mommy makeover.”

For questions or comments, please write mrosenberg@nwhc.net.

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