What’s New in Facial Rejuvenation

We are now all too familiar with the hoopla surrounding television’s “Extreme Makeovers.”  But is aggressive, possibly risky surgery lasting hours really necessary?  Is it what people really want?  The answer is both yes and no.

On one hand it is desirable to concede that with one six to eight hour operation you can have an entire makeover from head to toe; however, on the other hand maybe lesser aggressive, more subtle procedures may be more amenable to most people.

Only the potential client or patient can decide that with the expertise of their surgeon.  There are a number of alternative procedures that have evolved over the last few years which can enhance one’s appearance, reduce the signs of aging, and make one feel more refreshed and better about them self.

With the development and refinement of these procedures we as aesthetic surgeons are starting to realize that facial rejuvenation is a process, and if that process is begun gradually over a period of time, the results are better, longer-lasting and avoid many of the stigmata of overdone facial surgery.  With facelifts and eyelifts those effects include the wind-tunnel effect, from overstretched facial skin, and the surprised or sunken-in appearance of the eyes after aggressive eyelid surgery.

These newer more refined procedures involve replacing tissues that tend to atrophy or diminish with aging.  Look at a baby or a young child’s face, notice how plump the cheeks look and how the skin around the eyes are full, not sinking into their skull.

Fat tissue is naturally lost in the face over time from a combination of sun damage, exposure to chemicals, stress, medications, hormonal changes, weight fluctuations, and natural aging.  Companies are spending millions of dollars in the cosmetic marketplace to replace this lost element.  First there was silicone, which is not a great idea given all the controversy surrounding breast implants; collagen, an excellent product with considerable shortcomings, and now Juvederm™, Voluma™, and Restylane™ natural filler material that requires no skin testing like collagen does, and can be done in an office visit.

Another excellent solution has been the refinement of fat grafting or what we sometimes call “fat transfers,” in which we harvest fat from one site in the body, prepare it, and inject it into another site to replace that lost tissue.  One major advantage is that the material is your own so there is absolutely no chance of rejection or transmission of some infectious disease, but the downside is that is requires a short anesthetic with a two to three day recovery process depending on the amount of fat injected .  One other issue is that there is still some variability with the long-term take rate, but that has been improved with the addition of a natural blood product prepared at the time of the procedure.  This is considerably more palatable for those contemplating something nice but not that extreme makeover.

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