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March 2012 Plastic & Reconstructive Newsletter >>
Facial Rejuvenation: Nonsurgical and Surgical Options
Understand the full spectrum of facial rejuvenation options, and how they may be combined and personalized to give each patient the most natural results.
Many first-line facial rejuvenation treatments can be performed with cosmetic laser techniques. These noninvasive procedures are performed in the outpatient clinic, and require little to no anesthesia or downtime. They include:
Because the type of procedures and number of treatments required varies for each patient, physicians create a personalized plan based on individual needs.
Injectible Botulinum Toxin and Dermal Fillers
Other ways patients can reduce facial wrinkles without surgery include botulinum toxin (BOTOX®) or dermal filler injections.
BOTOX® is a purified protein that prevents muscle contraction. When injected into the correct muscle(s), it can temporarily soften frown lines, crow’s feet, forehead wrinkles, and skin bands on the neck.
Filler gels temporarily restore facial volume, enhancing shallow contours and softening deep facial creases, such as nasiolabial folds or marionette lines. Juvederm™ and Restylane® contain hyaluronic acid, a natural substance found in soft connective tissue. Radiesse™ contains calcium hydroxylapatite, a mineral-like compound found naturally in human bone.
Most people are good candidates for BOTOX® and/or fillers. Patients who are pregnant or breastfeeding, have severe medication allergies, or have active infections on or near the injection site, however, should not undergo these procedures. Patients with ALS, myasthenia gravis, or Lambert-Eaton syndrome are at an increased risk of serious side effects of BOTOX® and should consider another alternative.
BOTOX® and filler injections are performed in the outpatient setting and take just a few minutes, depending on the number of injections needed. No anesthesia is used, there is no recovery or downtime, and patients usually see results within one week.
Side effects of BOTOX® include temporary bruising or headaches, which should subside in one two days. Side effects of fillers include minor redness, swelling, or bruising at the injection site, which usually fades within a few days. Other complications of fillers include small lumps, under-filled areas, and asymmetry. Patients should avoid rubbing the treated area, so as not to disturb the filler material.
BOTOX® re-treatment is usually needed after 4 to 6 months. Filler results may last from 4 months to 1 to 2 years, depending on the material used.
Patients considering BOTOX® or fillers should consult with a plastic surgeon to determine the best treatment for their individual needs. Often, these procedures are performed together and/or with other skin rejuvenation procedures to give patients the best results.
Autologous Fat Grafting
Like injectible fillers, autologous fat grafting is another safe, effective, and well-tolerated technique for restoring facial volume—without any risk of allergic reaction or rejection.
Because fat grafting is a more extensive procedure, prospective patients must be thoroughly evaluated by a plastic surgeon. Candidates should be in good health and not have a history of abnormal postoperative bleeding or swelling.
Fat grafting is usually performed under local “twilight” anesthesia. Fat is first harvested with a suction cannula; common donor sites include the periumbilical, lumbar, and trochanteric areas; the thigh; and medial sites of the knee and arm. The fat is then spun in a centrifuge to remove impurities, and re-injected as a grid of threads into the areas where augmentation is desired.
Swelling is the most common postoperative side effect, but it usually resolves within several weeks. Patients may also have temporary bruising or numbness in the donor and recipient areas. Because the body reabsorbs some of the injected fat after the procedure, the surgeon may overfill the treated area, but this also settles after a few weeks.
Face lifts are most effective for patients with jowls, deep lines or folds around the mouth, deep wrinkles in the cheeks, or loose skin, wrinkles, or fatty tissue in the neck. They cannot remove sagging eyebrows, excess skin and fatty deposits in the upper and lower eyelids, or wrinkles around the mouth.
As with any surgical procedure, patients considering a face lift should undergo a thorough preoperative workup. Because many patients seeking face lifts are middle-aged or older, it’s important to identify any chronic conditions that may preclude surgery, such as cardiac or respiratory disease, diabetes, or obesity.
Surgical techniques vary, but all face lifts remove excess fat, tighten underlying muscle, and redrape the facial skin (1). For some patients, the surgeon may reposition deeper tissues to improve facial contours.
Increasingly, volume augmentation with fat grafting is performed at the same time as a face lift. Combining these procedures can minimize the amount of surgical intervention needed, which in turn leads to a quicker and easier recovery with less downtime.
Face lifts are performed as outpatient surgery under general anesthesia or IV sedation. Initial side effects include temporary bruising, swelling, and feelings of facial numbness, tenderness, tightness or dryness. Recovery time varies, but patients usually return to work approximately 10 to 14 days after surgery, and feel most comfortable after about 3 weeks.
Risks associated with the procedure include nerve injury, infection, bleeding, excessive scarring, and asymmetry or change in hairline.
Consultation and More Information
For more information about nonsurgical and surgical facial rejuvenation services, or to contact us, click here.
1. Warren RJ, Aston SJ, Mendelson BC. Face lift. Plast Reconstr Surg. 2011 Dec;128(6):747e-64e.