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Facial Aesthetics: State-of-the-Art

Our understanding and ability to treat facial aging has taken a quantum leap forward over the past decade.

In the past, facial rejuvenation was accomplished primarily by surgical techniques that corrected facial laxity. Increasingly aggressive operations that manipulated the layers of the facial soft tissues came into vogue.

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A rebuttal to the “nuclear bomb” facelift that necessitated a recovery period of several weeks has been gaining momentum in the last few years. The response is to perform smaller, less invasive and better-focused procedures that target only the features that have aged most. As we continue to study and learn the specifics of aging of sub-units of the face such as the eyebrow, the cheek or the lip, very elegant and refined mini-operations are assuming a larger role.

Increasingly, these smaller procedures are requested by patients at a younger age with the intention of not waiting for the signs of aging to overwhelm the face. Even one step further, many individuals in the media and entertainment world are requesting procedures to prevent changes in their appearance from developing. Specifically, they want an operation which will strengthen the tissues so that changes do not occur and they do not want to look different after the surgery.

Another revolution is occurring simultaneously in non-invasive facial rejuvenation. As we become more aware of the myriad causes of facial aging, our techniques broaden to include optimization of skin health with topical and systemic medications, resurfacing modalities to address sun damage, and volume restoration with a variety of temporary fillers to treat losses in the subcutaneous tissue fullness as well as discrete wrinkles and creases produced from facial expression.

The first generation of products, medications, lasers, etc., frequently did not live up to their claims. Many doctors and patients were disappointed with the results. Research continues to improve upon past achievements.

The current treatments are much improved, though few of these are perfected. As plastic surgeons, we continue to use our state-of-the-art knowledge and experience to guide patients in selecting the best therapies.

Sheldon M. Lincenberg, MD, FACS, is a Mayo Clinic trained, board certified Plastic and Reconstructive Surgeon practicing in Atlanta, Georgia.

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