For the last one or two decades, most plastic surgeons have felt that there is something missing from addressing facial aging with a purely surgical approach. This is especially true for most men who do not want the stigmatizing appearance of an overdone facelift with the results that we have seen on many celebrities. Most of the patients that I see not only want a much more natural appearance but also would like to reverse the aging process with a more meaningful and subtle approach, as well as truly regenerate tissue which surgery alone does not.
Over the past 10 to 15 years a totally new direction in facial rejuvenation and actual restoration of facial tissues has developed utilizing mostly all non-surgical techniques, treatments, and technology. I have developed this concept for my own practice using a “Baby Steps” approach with treatments and procedures that can all be done in the comfort of my office under minimal or no anesthesia, at a much lower cost, downtime, or anxiety over the procedures. I still incorporate a few small but “mini” surgical procedures that are very easily done under local anesthesia. But most importantly, with the development of numerous energy devices and a greater understanding of how to truly restore facial tissues, including skin, connective tissue, and muscle, we can truly claim that we have entered a new era of regenerative medicine for plastic surgery.
The first and most universal step that both men and women of all ages need to adopt is a medical level skin program, very similar to a good dental program that requires a few steps in the morning and evening like tooth brushing and flossing. For your skin, it involves deep cleansing, application of medicated and restorative skin products that have a true and verifiable action on the skin, and occasional more aggressive office-based treatments with energy devices such as lasers, pulsed light, radiofrequency and ultrasound devices, and microneedling devices. A diligent program can truly restore and regenerate more youthful skin at the cellular and molecular level of all layers of the skin.
The second step involves restoration of lost volume that occurs by atrophy of some of the facial fat that is in small compartments under the skin and around our facial muscles that give our faces its youthful shape and appearance as well as structural support. Because this volume loss begins at a fairly early age, typically in our 30s, using commercial fillers in one or two syringe amounts is not only not very effective but extremely cost-ineffective. It only makes sense to restore lost fat with one’s own fat, which is done in an in-office procedure utilizing a mini-liposuction and reinjection approach. This procedure is done under minimal sedation and is very rewarding because of its immediate appearance that restores significant amounts of volume, shape and even lift.
It is a truly regenerative procedure in that the fat we harvest from our own areas of excess contains a very high number of adult stem cells. There is a growing body of strong scientific evidence that shows these stem cells become very active immediately and have very positive, regenerative effects on the skin as well as other tissue layers in the face. With the judicious use of other, permanent commercial fillers we can even restore or create bone structure at a deeper level to enhance an overall better facial shape and appearance.
The last and final consideration after the skin and volume loss are addressed is any areas of skin laxity or true skin excess. This typically occurs with sagging of the brow, eyelid skin, cheeks, or neck. We now have nonsurgical minimally invasive energy devices that can not only reduce and improve the skin laxity in most of these areas but can truly improve and regenerate a tighter and more youthful collagen layer in the areas and tissues that are treated.
These techniques and devices are improving yearly and may one day replace the need for any actual surgery. It is my opinion and one that is growing among both plastic surgeons, as well as other aesthetic specialties that performing a series of these regenerative procedures, maybe much more meaningful and restorative than a single surgical procedure. It is even more exciting that many of these treatments and energy device procedures can be applied in non-facial areas to significantly improve the quality, tone, and laxity in areas such as the décolleté, abdomen, upper arms, and inner thigh and knee skin.
It is becoming clearly evident that we have entered into a new era of regenerative and restorative medicine that is very applicable in plastic surgery of the face and other areas of the body and will only improve with time.
Jeffrey J Ptak MD
Silhouette Surgical Spa