Putting Your Best ‘Face’ Forward

If you want a youthful glow with your appearance, you have options. Surgical and nonsurgical procedures offer a variety of benefits to help lift, smooth and brighten your skin.

Juan Brou, a board certified plastic surgeon with Premier Plastic Surgery and Aesthetics in Oklahoma City, says a facelift is “still the gold standard of facial rejuvenation.” However, he adds that with today’s treatments, you can potentially correct and even prevent issues that a facelift is meant to fix.

“The aging changes that a facelift targets are laxity of the skin leading to wrinkles on the cheeks and anterior neck with the classic formation of jowls and turkey necks,” Brou says. “Now, we don’t need to wait that long. Innovations on skin care and sun protection can delay the aging of the skin and sometimes reverse sun damage.

“Many office peel treatments are available to take it even further. Diverse lasers are designed to reverse these changes and fillers can be used in injectable form to correct volume loss that, together with skin laxity, causes the aging changes.”

He says other new technologies include directing various forms of energy, such as ultrasound and radiofrequency, to tighten the skin. Also, different types of barbed sutures provide temporary lifts.

With the goal of making nonsurgical procedures regenerative, Tim R. Love, a board certified plastic surgeon of Tim R. Love Plastic Surgery and Aesthetics in Oklahoma City, uses NanoFat injections derived from a patient’s own stem cells, mononuclear cells and fiberblasts. The NanoFat is combined with FACEtite and Fractora radio-frequency microneedling procedures to enhance outcomes.

“The NanoFat is injected into the dermal layer of skin to supplement healing and stimulate collagen production,” Love says. “For patients not in need of a traditional facelift, InMode’s FACEtite has become a real go-to device that delivers ‘surgical results without the scars.’

“It uses radio frequency-assisted liposuction in a safe and effective mode to melt fat while tightening skin and soft tissue overlying areas traditionally treated with liposuction alone. It’s ideal for unwanted jowls and neck fat and is comfortably performed in our office setting with the patient lightly sedated. Results have been shown to shrink skin and soft tissue up to 40%.”

Brou says another product used to eliminate expression wrinkles and maintain a youthful look is a neuromodulator. Most commonly known by the brand name Botox, a neuromodulator disrupts the communication between nerves and muscles and causes paralysis at the injection site – and its popularity continues to grow. According to the American Society of Plastic Surgeons, 2018 marked the highest number of botulinum toxin type A injections, with more than 7.4 million shots.

Brou says crow’s feet, those wrinkles around the corner of your eyes, are best corrected with a neuromodulator because there is no surgical procedure that addresses it specifically. Other issues, such as an eyelid droop, require surgery.

“Eyelid surgery is an area for which there’s no minimally invasive substitute for surgery,” Brou says. “When the skin laxity is bad enough to obstruct vision, then the solution is surgical.”

Plastic Surgery Safety

Anyone undergoing plastic surgery wants to do so with minimal risks. Brou says at least 20% of his educational materials address safety issues.

Any surgery has a potential for complications, but they are minimized through increased knowledge and advanced technology. For example, Brou says one of his main concerns in the post-operative care of abdominoplasty (a tummy tuck) is preventing blood clots inside deep veins, also known as deep vein thrombosis or thromboembolism.

“The danger of these clots is that they can become loose and float all the way to the lungs, producing pulmonary embolism, which is a serious condition that can lead to death,” Brou says. “We now know that this can occur with other operations and is related to the length of the procedure as well as how soon the patient is up and about.”

In the past, a patient may have stayed in bed for several days and remained immobile, which increase the risk of blood clots.

“Nowadays, we are much smarter at identifying risks factors for the formation of blood clots, such as smoking, estrogen therapy, obesity, diabetes, recent surgeries, recent trauma or fractures, history of previous blood clots, history of cancer and history of factor V Leiden thrombophilia,” Brou says. “These conditions increase the risks of formation of blood clots. These patients now will receive anticoagulation therapy after the surgery and will be monitored closely.”

For patients without risk factors, Brou still takes precautions by using sequential compression devices during surgery to stimulate blood flow and prevent the formation of blood clots. Patients are also commonly encouraged to get up and move around as soon as possible after surgery.

“Anticoagulation therapy also has undergone significant improvements with oral agents that are easily administered and have a safer therapeutic range with fewer side effects,” he says. “Awareness of these complications makes it possible to detect them early and treat them successfully, if they do occur, minimizing the negative impact on the patient.”

Being informed before any plastic surgery is critical. The American Society of Plastic Surgeons (plasticsurgery.org) has a list of questions to ask your surgeon before making the commitment.

Recovery Time

While a quick fix may be everyone’s desire, your body needs time to heal after any type of surgery.

“Estimations of recovery time depend on the extent and involvement of the procedure as well as the age and physical condition of the patient,” Brou says. “Noninvasive and minimally invasive procedures are very popular because they have very short recovery times. In some cases, such as in injectables, the patient can go right back to work.”

Brou says surgical procedures, particularly those to the face, may take a long time to look socially presentable, even though the patient feels well enough to return to a normal routine.

“In the case of a facelift, this may take two to four weeks,” he says. “But the results will look their best in three months. In the case of eyelid surgery, the patient will feel great in a few days but [the site] may look operated [on] for two weeks and will look its best in two months.” 

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