Plastic and reconstructive surgery have obviously come a long way since they were first performed by the ancient Egyptians some 3,600 years ago. But while the science and technology used have made great advances since then, some of the basic principles remain the same.
Facial aesthetic medicine encompasses everything from skincare and injectables to laser treatments and surgical procedures. Since each patient is different, each of those elements can be personalized to that patient’s individual needs and wants. And it can be done at almost any age and gender – while historically things like Botox and injectable dermal fillers were seen as appealing primarily to women, a lot more men are now doing it.
There is a wide range of options that focus on specific aspects of the face and neck, and a patient’s concerns. Some of these can be done in an office setting and others are better suited for the operating room, but in general, surgery is similar to injectables because it targets specific anatomic structures for rejuvenation. Examples include brow lift, upper and lower eyelid surgery (blepharoplasty), cheek implants, chin implants, facelift, neck lift, rhinoplasty, liposuction, and much more.
Lasers are used to resurface specific layers of skin. Non-ablative, or less invasive, lasers heat the underlying layer of skin – the dermis – to stimulate collagen production. Ablative lasers destroy the outer layer of skin – the epidermis – to regenerate younger-looking skin. Lasers can also be used to target for specific concerns like sunspots, rosacea, scars, and spider veins.
There are other therapies like IPL (intense pulsed light) for skin maintenance that are good options for younger patients. But, again, laser procedures are used discriminately. Not all lasers can be used on every skin type.
As for Botox, many people don’t realize that it is actually a brand name, like “Kleenex” or “Xerox.” People use those words as generics, but they actually refer to a specific product. Botulinum toxin is an injectable neurotoxin used to reduce fine lines and wrinkles by effectively paralyzing or freezing the muscle beneath the injection spot – the forehead, under the eyes, the cheeks, etc.
Dermal fillers, as the name implies, are used to fill in wrinkles or to “plump up” features like lips and cheeks, or even to reshape certain parts of the face like the nose or cheeks.
The dosage and placement are of course very important. For a first-time patient, I usually start with the standard dose recommended by the manufacturer and, if that doesn’t have the desired effect, we can titrate the dose. But it also depends upon what the patient wants. All of our faces age with time, so it’s really a matter of what the patient is looking for.
Words of Caution
It is also important to note that, if a patient is pregnant, Botox and fillers are not recommended, as there hasn’t been enough research done to tell if those procedures are safe or not. With surgery, if someone has a heart condition, is on blood-thinning medications, or otherwise is at an increased risk of bleeding, they may not be the best candidate. Again, you have to treat patients on a case-by-case basis – there is no cookie-cutter approach.
What is needed, regardless of age, is a determination of whether the patient is medically fit to undergo a procedure. Are they allergic to what’s in a given injectable? When it comes to certain laser skin treatments, a patient may need to stop certain medications six months prior to treatment.
The same holds true for reconstructive surgery. In addition to doing my own aesthetic and reconstructive procedures, I will be doing joint cases with the other surgeons in our Otolaryngology/ENT department. For example, I will be doing complex facial reconstruction after cancer resection/removal. The cancer resection will be done by my colleagues, and I will do the reconstruction.
For patients who are undergoing sinus surgery and who need specialized structural support inside their noses for their breathing, my colleagues will be doing the sinus surgery, and I will be doing the surgery for nasal structural support. Again, these procedures are tailored for each individual patient.
Every face is unique and has different needs for rejuvenation, and even both sides of the same face may have minor structural differences. Therefore, it is imperative to consult with a provider who has the proper expertise to provide personalized care. It’s also important to consider the amount of time needed to complete a procedure, particularly when it comes to surgery – there can be several weeks’ worth of recovery time.
Keep in mind that medicine can “reverse” the effects of aging to a degree, but unfortunately it can’t stop the process of aging for any of us.
You should also be aware that there may be several people in a given community who offer injections and laser treatments, but there are risks involved with each procedure. I always emphasize that you should put your trust in a trained, certified professional.