Non-surgical facial rejuvenation strategy

Facelifts have been available for aging patients for more than a century. Originally, only skin in front of the ear was removed, often creating wide scars in front of the ear with minimal lifting.

As techniques evolved, better and more complex procedures were developed. Eventually, deep-plane facelifts, which lift deeper structural layers, were developed in the 1980s. However, no procedure stops the aging process. To maintain a youthful appearance, additional nonsurgical options are often requested.

Many patients want to avoid the postoperative course, downtime and expense of a facelift. Also, some aging skin problems are not addressed as well surgically as they are with nonsurgical options, such as wrinkles around the mouth, skin quality and volume loss, which is a major cause of sagging in the aging face. Because facelift patients still may need nonsurgical treatments after surgery for optimal results, some people choose nonsurgical options instead of undergoing surgery.

The strategies for nonsurgical options, based on patients’ goals and needs, are:

• Tightening sagging skin — This is one area where surgical facelifts perform best, especially in older patients. The nonsurgical options that result in actual skin lifting are lifting threads and certain lasers that vaporize tiny holes in the skin, called coring, thus removing skin. Lifting threads are dissolvable threads with tiny barbs that attach to and lift skin. They also increase volume by stimulating new collagen and elastin.

• Resurfacing — This is usually done with heat from RF (radiofrequency) devices or lasers. There are many excellent types of lasers. The latest lasers are fractional lasers, meaning they heat and/or vaporize tiny holes in the skin, thus removing skin from the entire face without scarring. In addition, heat tightens skin. To understand how heat shrinks skin, think of bacon in a frying pan.

CO2 lasers such as the Helix are more aggressive but involve more downtime. A new concept is the UltraClear laser, which can microcore skin and may be equivalent to CO2 lasers with less discomfort and recovery time. This is a cold laser and may be more suitable for summertime. Both lasers have very light energy modes for mild resurfacing and minimal recovery time.

• Remodeling with volumizing — Youthful faces are well-volumized. Aging results in the loss of both fat and bone. In their 20s and 30s, people may hear, “You’ve lost your baby fat.” The problem is that people continue losing volume, and like a beach ball that loses air, sagging occurs. Thus, volume must be replaced. For this, fillers such as Juvéderm and Restylane products are used.

Fillers that also stimulate collagen production include Sculptra and Radiesse. The newest such filler is Renuva, which stimulates your own fat production for volume that lasts five years or more.
The newest technology for nonsurgical skin lifting is the Everesse.

This radiofrequency device thickens and tightens skin with no numbing, needles, pain or recovery time. Everesse RF stimulates increased collagen and elastin production with large amounts of energy. When combined with lifting threads, collagen and elastin production increases further, resulting in more skin lifting. This device changes the shape of the face and improves skin quality for a more youthful appearance. With no downtime, these treatments are ideal for a summertime lift.

Combination therapy appears to be the wave of the future in minimally invasive procedures.

Dr. Ronald Finger, MD, FACS is a board-certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com.