Facial rejuvenation: Surgical versus non-surgical

The aging face has multiple components and individual patterns which are directly affected by both genetics and our environment. Typically, our areas of facial aging are genetically programmed and we will likely age in the pattern of our parents. Our environment, which includes sun exposure and tobacco use, can potentiate premature aging and skin damage. Facial rejuvenation strives to reverse the affects of aging and can take the form of a non-invasive form with skin care, a non-surgical rejuvenation form such as volumetric fillers (hyaluronic acid based fillers (Juvederm®)), neuro-modulators (Botox®), and chemical or laser skin resurfacing, and surgical rejuvenation which includes facelifts, eyelid surgery (blepharoplasty) and browlifts. Most patients are attracted to the non-surgical facial rejuvenation and would like to exchange fillers for surgery. This is one of the most common topics that I discuss with my facial rejuvenation patients. I approach this question with an anatomic approach to the face and focus on the areas of the face that concern the patient. The majority of patients present with one to three complaints about their face and addressing these should direct an individualized approach to facial rejuvenation. The degree of aging in each area as well as the patients’ budget and ability to take time from work or public eye also factor in heavily on the modality of rejuvenation. Skin care should be a ubiquitous treatment for every patient seeking facial cosmetic procedures. Skin care products such as Vitamin A containing products (Retin A), exfoliants (glycolic acid), moisturizers and sun screens can be utilized by every patient group under the guidance of a plastic surgeon or aesthetician. Defining a facial rejuvenation plan in conjunction with active skin care can optimize the ultimate results. Non-invasive fillers are excellent for perioral rejuvenation and mid face volume augmentation. The choices do include temporary gel fillers to longer lasting fat injections. They are distributed by volumes and number of syringes and most can be done in the office setting with minimal downtime. Surgical rejuvenation is optimal for neck and brow rejuvenation as well as eyelid and cheek elevation. These techniques are generally done in the operating room and require some down time with an increased cost though a longer lasting result. Skin resurfacing in the form of chemical peeling and laser resurfacing can be applied in conjunction with surgical rejuvenation and usually delayed in the non-surgical volumetric filler patient. Skin resurfacing can be applied to the entire face or tailored to individual anatomic sites. The decision between non-surgical and surgical rejuvenation techniques should be an informed decision and can combine both techniques to improve the global facial appearance. A consultation with a board certified plastic surgeon experienced in all aspects of facial rejuvenation should help direct your decision on facial rejuvenation.