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Minimally Invasive Procedures

Monday, December 20th, 2010


I have previously talked about how you can improve your outer appearance using new less invasive surgery or noninvasive methods. What we use depends on what has caused your particular problem. The causes are a combination of sun damage, loss of skin support including fat, gravity and/or muscle action. Use of injections to fill wrinkles, creases or depressions or stop muscle action; skin peels to reduce wrinkles or correct other problems; and the use of different machines can give added benefit to both the non-invasive rejuvenation methods and surgery or correct enough of the signs of aging that we can forestall surgery.

We can reduce early, non-permanent wrinkles especially between the eyes and around the eyes caused by muscles with a relaxer such as Botox® and, now, Dysport®. They prevent muscle contraction and, thus, wrinkle formation on average for 5-6 months. Early treatment prevents the wrinkle from becoming permanent and requiring filling or a peel. With regular use, the muscle atrophies and your need for further treatment decreases. Even used late, we can improve the effectiveness of the fillers. These products are also useful to treat abnormal sweating and some migraine headaches.

Gravity also causes creases and depressions to occur. The most common areas are under the eyes, between the lips and cheeks, below the mouth corners, in front of the jowls and in the mid cheek. Filling these can restore normal anatomy or disguise the problem. Restylane™ (hyaluronic acid, a precursor of collagen that supports the skin) was introduced seven years ago, is easy to use, safe, reliable, and lasts about five-six months. Since then multiple new fillers have become available. Another hyaluronic acid is Juvéderm®, which lasts almost twice as long as Restylane™. Radiesse® (calcium hydroxyapatite, another natural body precursor) is useful for the larger folds and depressions and lasts an average 18 months. There have been problems with permanent fillers, though a new one, Artefill®, shows promise.

I use the hyaluronic acids for lines in the top level of the skin and around the mouth and Radiesse in folds and to correct contour irregularities. There have been few problems reported for any of these, in spite of millions of injections yearly. Another filler is fat. We harvest this as live cells from an area where you have extra, and use it to fill contour irregularities. New techniques have markedly improved reliability and longevity. This makes it an excellent alternative to correct those areas where loss of fill causes you to look older and as an adjunct to surgery.

Administration of most fillers is done with regional numbing using techniques similar to blocks by dentists. Newer products can be mixed with numbing or come ready-mixed to decrease discomfort. Down time is minimal, if any. The worst problem is occasional bruising, but this is easily coverable with camouflage makeup. We can also decrease this bruising with peri-injection medications.
Filling subcutaneously under small wrinkles can eliminate them. These can also be eradicated with different peels or laser. Both remove the outer layer of the skin, including the wrinkles, much like skinning one’s knee. When new skin grows back, the skin is smoother and tighter. Newer peel methods and lasers have reduced the healing time, minimized the red that occurs after such a procedure and made them safer (less likely to scar). Adding pretreatment with a product like the Obagi® Skin Care system reduces the risk of having pigmentary abnormalities (white, dark or spotty) after the procedure. It also improves collagen deposition that augments the tightening effect. You actually look better at a year than at one month.

New IPL (Intense Pulsed Light) machines are laser-like, putting out a spectrum of light waves rather than only one, and have almost eliminated reactions, such as blistering, prolonged redness, or down time when treating red or brown spots. It also has the ability to treat actinic keratoses (premalignant sunspots) and severe acne when coupled with a chemical that makes the abnormal cell more susceptible to destruction by light energy.
Many more minimally invasive products and machines have been introduced, but have not proven significantly effective to warrant continued use. One of the most dramatic is the “string lift.” These were barbed sutures placed with a simple needle and intended to accomplish a brow, neck or facelift. However, none were effective for longer than about three months. Therefore, few are used now. Many other machines and procedures have met similar fates, as they do not produce results comparable to other less or equally invasive methods.

In summary, we now have multiple methods to modify and rejuvenate the face and body. These methods are so broad they can meet almost anyone’s needs for down time, effectiveness, permanence and cost. To find out more, visit us on the Web at www.PlasticSurgeonToday.com or call 828-526-3783 or toll free at 877-526-3784 for a complimentary consultation.