There are three aesthetic layers of the face. These layers include the skin, the subcutaneous tissue, i.e. the fatty layer, and the deep fascia including the muscle. Most aesthetic surgery is focused on these three main layers.
Let’s start off with the first and most visible layer, the skin. Dermatologists often see patients with troublesome red spots, dark spots, pores and fine lines. Most skin-directed therapies are best tackled with lasers. As a general rule the more energy that is applied to the skin the better the efficacy. The downside is as we apply more energy, the higher the injury to the skin surface, and therefore longer duration for skin renewal and recovery thus requiring longer downtime. A good example of this is the high energy ablative fractionated CO2 resurfacing laser which produces superb results but also has a significant downtime of about one to two weeks. On the other end of the spectrum is the low-energy device such as Clear+ Brilliant ® which produces subtle skin surface changes, however, has little downtime. Most resurfacing devices have varying degrees of efficacy for fine lines, pores and pigmentation. Treatment of red spots is different as one needs to target the blood vessels. Similarly, a higher energy setting works the best but can cause significant bruising requiring more downtime to settle. Therefore, most red spots are treated multiple times with a low-energy nonbruising settings.
Beside lasers, neuromodulators such as botulinum toxin can be used to eliminate some of the fine lines of the skin.
Botox® is the most common noninvasive cosmetic procedure done in the United States due to its safety and efficacy in the hands of a trained physician. Botox ® is Federal Drug Authority (FDA) approved for frown lines between the eyes. However, it has multiple safe off-label uses in aesthetic surgery including the treatment of “gummy smiles,” “bunny lines” on the nose, “crow’s feet” around the eyes and reducing dimples in the chin.
Overactive muscles create forehead wrinkles and frown lines. Localized injections of this medication relax these muscles and therefore reduce “worry lines” between the eyebrows and wrinkles in the forehead and around the eyes.
Injectable Fillers (Juvederm ®, Voluma ®, Restylane®, Perlane,® Radiesse,® Sculptra®) are used to rejuvenate the aging face. As one ages, there is a significant loss of collagen and fat in the face. As a result of this, the youthful appearance of the face starts to disappear. Fillers are used to recreate the missing volume and achieve a noninvasive natural “mini face-lift” appearance. Some of the newer fillers such as Belotero® can also be injected more superficially for fine lines. Another more permanent solution is the injection of fat in order to replace the missing fat. The advantage of fat transfer is that one uses their own fat and no foreign material is used therefore minimizing the risk of side effects. Fat transfers are usually more time-consuming procedures to perform for practitioners and therefore a bit more costly to do. However, given the fact that fat lasts longer than the average hyaluronic acid filler and the fact that fat contains stem cells that improves the overall texture of the skin including higher volume replacement, fat transfers prove to be more cost effective over the long term.
Deep fascia tissue:
The deeper fascial layer can be either tightened with focused ultrasound, radio frequency or traditional surgery. Most often the best approach is a combination of the above.
We are now able to combine the most technologically advanced tightening devices such as Thermage® and Ulthera® with traditional surgery in order to attain a more natural face-lift. This has allowed us to move away from traditional face-lifts to the less invasive minimal incision face-lift. We often do this procedure with only sedation and tumescent anesthesia; therefore, the patient avoids a long, five-hour procedure under general anesthesia. It is important to note that not everyone is a candidate for the minimal incision face-lift, and some patients do require a traditional face-lift for optimal aesthetic results.
For further information on surgical aesthetic procedures please contact Dr. Khorasani at DrKhorasani.com.
Hooman Khorasani, MD, Chief
Division of Mohs, Reconstructive and Cosmetic Surgery
The Kimberly and Eric J. Waldman Department of Dermatology
at The Icahn School of Medicine at Mount Sinai
5 East 98th Street, 5th floor
New York, NY 10029-6189
Tel.: (212) 241-9728