Choosing the Right Weapons to Combat Facial Aging

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When to select surgical versus non-surgical options among topics on tap at ASAPS meeting

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With so many choices for facial contouring and rejuvenation, which procedures should plastic surgeons choose to give their patients the best results, and when? What patients are the best candidates for non-surgical procedures? Led by moderator Sherrell J. Aston, MD, panelists Fritz E. Barton, Jr., MD, Trevor Born, MD, Val S. Lambros, MD, and Alexis Verpaele, MD, will discuss these and other questions during “The Continuum of Facial Rejuvenation – When to Transition from Non-Surgical to Surgical” at the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Vancouver, Canada.

“Over the past 10 years, the border for the transition from non-surgical to surgical facial rejuvenation techniques has become less distinct. In this panel, we will explore issues such as identifying the best candidates for non-surgical modalities, selecting the procedures most likely to produce consistent results, and picking the ideal time for a patient to transition to a surgical procedure,” said Dr. Aston, of New York, NY. “We’ll also touch on topics such as what to do when, in the surgeon’s opinion, the patient has achieved the maximum results possible with non-surgical facial rejuvenation, but refuses surgical treatments, whether there are non-surgical options available for improving the neck that deliver a significant long-term benefit, and helping patients make the cost-benefit analysis.”

Traction, or pulling on skin as with the facelift, has been the traditional tool for making faces look better. This powerful tool has withstood the test of time, but it does not answer all the problems of the aging face.

“We need all treatments to address the continuum of facial aging. It isn't necessarily something that needs to be addressed with surgery,” said Dr. Lambros, of Newport Beach, CA. “A sizable number of faces age by getting thinner or hollow. This can be improved by filling the face, and can both precede and supplement facelifts. Having a ’fill tool‘ is a huge addition to the aesthetic problems of the aging face.”

Non-surgical tools such as neurotoxins, focused ultrasound and radiofrequency devices, and the assorted fillers, lasers, and chemical peels can be used to target wrinkles and creases and re-establish or create facial contour and volume. Such procedures can be used to reduce the need for surgical facial rejuvenation procedures or complement the results of such procedures.

“In my opinion, fillers are an adjunct to surgical rejuvenation, not a substitute for it,” said Dr. Barton, of Dallas, TX.

Patients’ goals, budgets, and ability to take “downtime” for healing are among the many considerations plastic surgeons weigh when working with patients to select a facial rejuvenation procedure. Managing patient expectations about outcomes and helping them sort through what can be an overwhelming amount of information is also an important part of the surgeon’s role.

“There are so many choices for facial contouring/rejuvenation, with different products, devices and combinations. Part of the challenge we are facing is all of the ’noise’ from the Internet,” said Dr. Born, of New York, NY. “The oversupply of information—and often misinformation—can cause confusion for patients, increases the demand for ’perfection,’ and contributes to the pressure on surgeons to provide what is being touted as the ’latest‘ treatment, even though it may not yet be proven.”

"Plastic surgeons nowadays are much more than just doctors; they also need to be their patients' ‘beauty consultant’. They need to be able to support their patients all the way through their aging process,” said Alexis Verpaele, MD of Belgium. “Offering non-surgical services like skin care treatments, injectables and non-invasive laser procedures is a way to show patients that we are there to help with all of their beauty concerns not just for surgical intervention. There is a tremendous advantage in mastering all the available tools in the spectrum of cosmetic treatments, and plastic surgeons are placed the best to fulfill this role."

Non-surgical facial rejuvenation procedures comprised four of the five most common non-surgical cosmetic procedures performed in plastic surgery offices in 2011, according to ASAPS. Botulinum toxin type A injection was the most common non-surgical cosmetic treatment, with over 2.6 million procedures in 2011. Hyaluronic acid injection, microdermabrasion, and IPL laser treatment were also among the top five.


The Continuum of Facial Rejuvenation – When to Transition from Non-Surgical to Surgical

Saturday, May 5th, 7:30-9:00 am
Moderator:     Sherrell J. Aston, MD
Panelists:     Fritz E. Barton, Jr., MD
Trevor Born, MD
Val S. Lambros, MD
Alexis Verpaele, MD

PRESENTERS are available for interviews.

The American Society for Aesthetic Plastic Surgery (ASAPS) is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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