By Parviz Hiroshi Goshtasby, M.D., F.A.C.S., a.k.a. “Dr. Go”
As you have probably seen, there are many advertisements and enticements these days in the media and Internet touting the latest and greatest cosmetic surgery procedures. Many of these claim fabulous results without pain and no downtime. One such example of the many procedures I have seen is the ‘lunchtime lift’, in which patients are reportedly able to come in during a lunch break, have a minimally invasive procedure performed in less than an hour, and go back to work with no scars or pain and with results comparable to a complete facelift.
Having completed a fully accredited plastic and reconstructive surgery fellowship training, I can report that such extravagant claims are sadly a myth. Numerous variants of these minimally invasive facelift procedures have been described, whether with limited tissue undermining, skin excision, or with the use of surgical threads to ‘lift’ the face, but most of these techniques have been shown to be ineffective and with limited, temporary results at best. Many of these false campaigns are advertised by self-reported cosmetic surgeons with little to no plastic surgery training. I am a big proponent of seeking a consultation with a fully trained board-certified plastic and reconstructive surgeon.
The Growth and Popularity of Dermal Fillers & Injectables
One area of facial rejuvenation that has really exploded in the past few years that can have significant, immediate tangible effects in less than an hour are injectable agents. Although as a plastic surgeon, I greatly enjoy operating to create aesthetic rejuvenation for my patients, the advent of these injectable agents over the past decade has truly revolutionized and filled (pun intended!) a niche in the cosmetically minded consumer market. The patient population that it really appeals to that I personally have seen grow significantly in my private practice in Newport Beach, CA is the mid-30s to late-50s population who are beginning to see the ravaging effects of aging, sagging facial skin that is exacerbated by the beautiful sunny weather here in Southern California. These patients are starting to see wrinkles and creases form in the forehead, glabella (mid-brow), crow’s feet area, cheek folds, and the marionette lines of the lower mouth. Although these early signs of aging progressively give patients a tired appearance, they are not quite candidates yet for a full facelift or other surgical procedure.
Enter injectable agents, which for all intents and purposes are remarkable in that they can be injected in the office in less than an hour with virtually no downtime, negligible pain, and a minimal complication rate. Too good to be true? I thought so initially when I was first exposed to these products during my plastic and reconstructive surgery training. However, having been injecting for several years now, I have been continually impressed with the results I am able to achieve for my patients with a very high satisfaction rate. Ultimately, a thorough discussion of the concerns and goals of each patient are essential for an excellent outcome. To the patient and public, the large variety of products available can become overwhelming and confusing; a consultation with your plastic surgeon should elucidate which products can be best for you.
As a brief overview, injectables can be broadly grouped into the neurotoxin category and the soft tissue fillers category. These products do completely different things that target specific problem areas of the face, which is important to understand. Neurotoxins, including the well-known Botox®, and the other competitors Xeomin® and Dysport®, are all purified derivatives of Botulinum toxin type A that aim to paralyze hyperactive muscles of the face that lead to the wrinkles and creases that form with aging. Common areas to inject are the glabella to prevent the “number 11” sign between the brows, the crow’s feet area of the outer eyelid creases, and forehead furrows. The paralysis can require up to a week to take full effect, and results typically last for around 2-3 months. The art of injecting comes with experience with the key being to provide a softened, rejuvenated look without the unaesthetic stigmata of a ‘frozen’ face.
Soft Tissue Fillers
The other category of injectable agents is soft tissue fillers. The most commonly used of these include Juvederm® and Restylane®, which are both hyaluronic acids; Radiesse®, which is a calcium hydroxyapetite gel; and Sculptra®, which is poly-L-lactic acid. With time, we gradually lose soft tissue fullness from the loss of facial fat volume and the progressive laxity and sagging of our facial skin, giving an aged and weary look. Each variant of filler has a different density and viscosity with its particular range of indications, but they are mainly used to restore lost volume in the face and help smooth out deep creases or wrinkles for aesthetic rejuvenation. Common areas to inject are the tear trough creases (nasojugal folds), the ‘smile lines’ around the upper mouth (nasolabial folds), and lower mouth (marionette lines), augmenting the cheek bones, and creating fuller, more voluptuous lips. Temporal hollowing or depressed facial volume can also be restored with the aid of these fillers. Hand rejuvenation by plumping up the back of the hands with fillers is also increasing in popularity. The results are immediate and can last 6-9 months, with some effects frequently seen over a year.
Schedule a Consultation with a Board-Certified Plastic Surgeon
Although cosmetic surgery has been steadily increasing over the past few years, the growth of injectable agents has really taken off by comparison. History has typically shown faster growth in the ‘immediate gratification’ markets – items such as lipstick, chocolate and alcohol sales, and other things that can provide a quick boost and pick-me-up to elevate consumer spirits. Injectables are no exception. With the ease of office treatment, minimal pain and downtime, and instant tangible results, treated patients are among the happiest of all cosmetic patients. If you are interested in learning more about these effective facial rejuvenation products, I encourage you to contact my office to further discuss which options may be right for you. Although it seems that everyone and anyone these days is injecting to make a profit, these product injections are real procedures with possible risks and complications requiring a thorough knowledge of the facial anatomy, and I encourage each of you to explore and evaluate the credentials and training background for every injector you encounter. Beware of offices that use nurses or other unqualified medical personnel to do your injections, which can lead to a higher rate of complications. Your choice of a board-certified plastic surgeon to perform your injection is critical in achieving an outstanding outcome. You deserve a treat, so give us a call today!