Facial Plastic Surgery: When to Start

David A. Bray, MD, FACS

by David A. Bray, MD, FACS | August 16, 2010 @ 01:00PM

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Today, many patients are encouraged to begin facial improvement procedures at a younger and younger age. This trend toward lesser and safer procedures has the added benefit of being extremely rewarding at low cost. At as early as 30 to 35 years of age, many patients, men and women, would benefit from minimized versions of more extensive traditional surgical procedures. The purpose of casing into facial plastic procedures at a younger age is to allow the patient to enjoy the benefits of facial enhancement as they go through the aging process.

Today's young professionals visit the facial plastic surgeon for skin care treatments almost as often as they visit their hairdressers. These men and women seek procedures to strengthen and firm their skin and to maintain or regain their youthful texture. Two of the most effective techniques available are alpha hydroxy acid peels and microdermabrasion. Alpha hydroxy acids work not by burning or irritating the skin but by the ability for the free acid's active molecules to penetrate the skin and force new cell growth. When used on a long-term basis in conjunction with prescription strength take home products, these acids will definitely freshen facial skin. We have been able to offer the highest strength alpha hydroxy acid with little or no risk of irritation or redness. Thus, the popularity of the "lunchtime peel."

The second technique, microdermabrasion, is the most rapidly growing skincare procedure today. Invented in Italy, approximately five years ago, microdermabrasion is a findel light facial sanding of the face, neck, and chest areas. The overall results are complication free and are very exciting. It must be remembered that both of these skin care techniques require long term commitment, as would any other facial treatments, such as sun block, moisturizers, and even the daily commitment to vitamins.

Once the patient has skin care under control, they are now ready for minimally invasive surgical procedures. Today, we advocate the use of procedures such as injectable collagen and Botox for the removal of frown lines, crow's feet and forehead wrinkles. Injectable collagen has been used to plump wrinkles in tens of thousands of cases. Although it tends to be absorbed, it allows the patient a temporary, economical solution to problems before more serious surgical decisions are made. Botox, or injectable botulinum toxin, is the most rapidly growing procedure in the world of facial plastic surgery today. The results, although temporary, are truly remarkable with low risk.

Nasal corrective surgery, or Rhinoplasty, is the first surgical procedure considered at a young age. The results, in skilled hands, are excellent and very rewarding. A skilled Rhinoplasty surgeon has a low complication rate. Clearly, the focus of one's face is their eyes. The most successful Rhinoplasty enhances the eyes more than any other single feature. But if at the age of 30 or 35 your eyes are beginning to appear tired, baggy or droopy, some form of corrective upper or lower eyelid surgery is desirable. Eyelid surgery, or Blepharoplasty, is a highly successful procedure and can often be performed in a single stand alone procedure, giving the patient that well-rested, wide awake, happy, look.

Other examples of procedures designed to delay the signs of aging would be neck liposuction, minilift, and modified eyebrow surgery. Neck liposuction is often successful in the younger patient as a stand alone procedure. Many times, the 30 to 35 year old patient; (male or female), will notice a tired, sad, droopy look to the cheek and jowl area. A minilift will successfully return the youthful fullfaced look at minimal cost and minimal risk. Drooping of the eyebrow, centrally at the nose, creates an angry look that is often solved temporarily by Botox but better by browlifting. The lateral aspect of the eyebrow and temple skin is drastically swept upward creating a youthful and dynamic result.

After having enjoyed the result of all these procedures in multiple combinations as the patient reaches the 50 plus range, more extensive procedures are indicated while still maintaining good skin care. Again, eyelid surgery is the hallmark generally accompanied by complete forehead, face, and neck lifting. Clearly, these procedures are more arduous and require more downtime but yield phenomenal results, especially for the patient who has maintained his/her youthful look through smaller procedures performed at a younger age.

It has become very popular in the press to report catastrophic news. Patient death, loss of vision, and irreparable facial scarring are virtually unheard of in plastic surgery, but are unfortunately more common in extensive body surgery. The safety and well-being of the facial plastic surgery patient is of paramount importance.

After performing some of the major surgical procedures just described, more comprehensive skin care surgery may be desired. Laser treatment of aging spots, spider veins, and even the resurfacing of wrinkled skin are safer today than ever before. The downtime associated with all of these procedures is far less than ever before and the best news of all is that the pain and discomfort often anticipated is greatly exaggerated. In today's rapidly advancing world of technology for facial rejuvenation, nothing can improve on the concept of beginning with appropriate procedures at an early age with a competent facial plastic surgeon. It is his/her responsibility to carry the burden of selecting the correct procedure at the correct age and not mislead patients into risky and worthless procedures. 

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