Aesthetic Decisions

In the world of aesthetic medicine and surgery there are many options and often contradictory recommendations concerning technologies for facial rejuvenation.  How do we help our patients make optimal decisions in this environment?  We just return to basics-  make a precise anatomical diagnosis and recommend the minimal targeted intervention to address the problem. Perhaps most importantly we combine the best procedures that are specific to the problem or patient concerns.

At a basic level, patients frequently come for aging face concerns such as neck laxity, platysma banding, and “jowls” which are best addressed with some version of a face or neck lift. If you listen closely however they may be under the impression the rhytids (wrinkles) in the cheek or laxity around the mouth will be resolved with the lift. A plan to address the patient’s global concerns might involve laser resurfacing simultaneously, for example.

We like to analyze the face from superficial to deep-

The most superficial layer of the skin is the epidermis commonly referred to in our practice as the ”canvas of the face”.  A facelift will tighten the skin and underlying  muscles but won’t treat the “canvas.”  Our  master estheticians have many quality procedures to improve skin texture, pore size, discoloration and more – these include  Vi-peels, Hydrafacials, microdermabrasions, Intense Pulse Light/Broad Band Light also known as Fotofacial, and they do  non-ablative lasering with Fraxel Re:store which addresses melasma, actinic keratosis, fine lines and acne scarring .   More extensive resurfacing procedures that involve removing all the epidermis and some of the dermis are “ablative”.  In our practice, this usually involves using a fractionated CO2 laser, or a chemical peel such as TCA or phenol.  Both involve about a 10-day healing period where a new epidermis is formed from the remaining skin and deeper skin appendages.

Non-surgical tightening procedures e.g. Ultherapy or Profound work at deeper levels and create overall rejuvenation, lifting, toning and tightening of the face,   Ulthera is focused ultrasound energy and works on the tissues beneath the skin while Profound is radiofrequency energy.  See Dr Patel’s’ blog on Profound for more information.

The best option for any patient frequently involves using multiple modalities. Because the techniques work at various anatomical levels they can be combined to magnify the results of any single intervention.

As in any field of medicine a precise diagnosis plus a broad experience with the available treatment options lead to the optimal outcomes.