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Articles

Facial Rejuvenation Without Surgery

Roy Kim, M.D.

article courtesy Roy Kim, M.D.

CLICK HERE to visit the website of Roy Kim, M.D.

As a plastic surgeon, my patients often ask me what can be done to stave off a facelift, neck lift, eyelid lift and forehead lift surgery. I hope that the following strategies and treatments can help your patients with similar goals.

The aging face is due to many factors, including merely the passage of time, sleep patterns, smoking and expression lines. It's very important to realize what kind of skin you have. Ethnic heritage determines how soon you may develop wrinkles and also how susceptible you are to sun damage. Previous sun damage is not only an important determinant to skin cancer, it also causes wrinkles at an earlier age. An estimated 80 percent of sun-damaged adult skin is due to sun exposure before the age of 18. Just like your mother says ˇ use sunscreen!

Sunscreen should be at least sun protection factor (SPF) 30. There are minimal benefits to higher SPFs. Proper sunscreen application means applying sunscreen to all affected areas, allowing it to be absorbed on the skin and completely dry before outdoor activities. It is important to note that waterproof sunscreen will only last for 80 minutes when applied properly. As you can imagine, compliance and repeated applications of sunscreen throughout a sunny day is key to getting appropriate protection from the sun's rays.

A good skin-care regimen is very important to your skin's health. Any product that increases gentle exfoliation allows your skin to look its best. Gentle chemical exfoliants, such as glycolic skin cleanser, are important to achieve daily exfoliation. Generally, higher strength exfoliants are not available at the pharmacy or spa, but only at a physician's office.

Other prescription drugs are useful in achieving optimal skin tone. Hydroquinone is a skin-bleaching agent that is useful for skin color abnormalities due to aging, sun exposure and acne. Retin-A has been around for several decades and is useful for removing fine wrinkles and increasing collagen in the dermis. It also encourages more organized collagen layers in the dermis, resulting in better feeling, more youthful appearing skin.

Routine skin care is important, and skin peels can be used as well to achieve longer lasting results. Various chemicals and concentrations can be used, but it is important to realize that certain chemicals and higher concentrations have potential permanent complications and should be applied only under the direction of an experienced physician. Common chemical peels include glycolic peels, tirchloroacetic acid (TCA), and phenol.

Higher strength chemical peels, as well as certain types of chemical peels, cause a tremendous amount of erythema (redness) and skin slough. Patients may need a week or two out of the the public eye to recuperate from these types of chemical peels.

Microdermabrasion is a technology that applies fine crystals under air pressure to the face via a tube. The crystals are immediately suctioned after contact with the face. The result is an overall finer appearance over the skin, with smoother skin and fewer wrinkles. Microdermabrasion treatments generally need several treatments over several weeks for optimal results. The treatments are typically done in a salon or spa.

Exfoliation on a larger scale can be achieved by facial resurfacing. Dermabrasion, mechanical removal of varying depths of skin, has been used for several decades. Recent advances include laser resurfacing and coblation or cold ablation. All these technologies not only exfoliate the skin, but also induce the collagen in the dermis to become more organized. The skin that does grow back is smoother, has fewer fine wrinkles, has more organized and thicker collagen and has a more consistent skin tone and color uniformly throughout the face.

Carbon Dioxide laser resurfacing ablates single layers of skin, but does so in different ways, depending on the manufacturer. The CO2 laser can emit light intense enough to vaporize the outermost layer of skin. Recovery time can occasionally be long, however and include redness and skin slough over several weeks.

Possible side effects from more aggressive skin rejuvenation procedures include redness, bruising and hyperpigmentation. More serious side effects can result in permanent scarring. It is important that patients feel completely comfortable with their physicians prior to commencement of treatment.

Botox˘, or botulinum toxin A, is a temporary muscle paralytic. It has achieved recent increased media exposure and the Food and Drug Administration (FDA) and has approved it use in the forehead area between the eyebrows to eliminate wrinkle lines. It is being used on an "off-label" basis for forehead wrinkles and in the "crow's feet" or periorbital area. Botox is injected by a needle in to the muscles that cause wrinkling or worry lines, and lasts three to six months, depending on the patient and the Botox concentration.

Filler agents also can be used for old scars, acne scars, or the nasolabial fold regions. The most popular filler agent in the United States is collagen. This is injected by needle into the area desired to be filled and lasts anywhere from two to six months. Collagen is a potential allergen and patients must be tested before an initial injection to make sure that no allergy exists.

It is very helpful to work with physicians as well as estheticians to achieve quick recovery after procedures. Good estheticians also can work with patients to apply camouflage makeup after procedures.

Dr. Kim is on the editorial board of San Francisco Medicine and is also a member of the SFMS board of directors. He is board-certified by the ABPS/ American Board of Plastic Surgery, and is also a member of the ASPS/ American Society of Plastic Surgeons, and the CMA/ California Medical Association.


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