In performing minimally invasive facial rejuvenation, the tools of the trade are numerous: dermal fillers, neurotoxins, collagen stimulating lifting threads; platelet-rich plasma (PRP) delivered transdermally via needle, microneedle or cannula; fat transfer and more. Simply stated, one does not need surgery or energy-based devices to achieve the best facial rejuvenation treatment outcomes.
Non-surgical face-lifts, pan-facial rejuvenation and other modern aesthetic techniques are being employed routinely around the world, and are often referred to collectively as the “liquid face-lift.” This is a euphemism for rejuvenating and volumizing the face utilizing fillers, neurotoxins and / or fat. While surgical face-lifts can involve serious downtime and complications, minimally invasive approaches often yield immediate and even long-term results with fewer complications and virtually no patient downtime.
“Although plenty of practitioners work on facial skin with energy-based devices, we’re almost at the point in the industry where we can keep up with aging and even reverse aging using just non- or minimally invasive modalities,” expressed Steven F. Weiner, M.D., a facial plastic surgeon in Santa Rosa Beach, Fla. “I have patients that have been with my practice for 10 to 14 years that look younger now than they did when they first started; even better. If people maintain a treatment regimen and apply great skincare, they can keep up with the aging process pretty well.”
According to William Philip Werschler, M.D., F.A.A.D., F.A.A.C.S., a dermatologist and clinical researcher in Spokane, Wash., “From a non-surgical perspective, we break it down into putting something on top of the skin or under the skin, with consideration on whether we apply energy or material. The core of minimally invasive rejuvenation is going to be the use of neurotoxins and dermal fillers, predominantly.”
In terms of the latest clinical approaches, the state-of-the-art in minimally invasive facial rejuvenation is combination therapies, expressed Vic A. Narurkar, M.D., F.A.A.D., a San Francisco, Calif.-based dermatologist and dermatologic surgeon, and past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.
“It’s not any single treatment that will achieve optimal results. There are so many advances in skincare and less invasive drug-delivery, such as needle-less methods of delivering active agents. We are in a non-invasive renaissance in aesthetics, in which we are globallyrejuvenating multiple anatomic areas from both the inside and outside of the body,” he stated.
As such, treatment approaches have shifted away from cosmetic surgery, noted Antonella Quaranta, M.D., P.C., an aesthetic surgeon in Florence, Italy. “We want to achieve a higher level in aesthetic medicine, which includes procedures that provide appreciable and lasting results without the use of a scalpel, in a quick, effective manner without downtime,” she said.
The patient population for non-surgical facial rejuvenation has grown, as well, noted Dr. Narurkar. “While older people can certainly benefit from minimally invasive skin rejuvenation, Millennials have really embraced these approaches,” he said.
“Many are just not quite ready for surgery, and if they start earlier in life then we potentially prevent the need for more aggressive procedures later,” he continued. “I’ve been following these patients and we have been able to maintain their youthful looks without having to undergo surgery.”
According to Nantapat Supapannachart, M.D., a dermatologist and CEO of Apex Medical Center, which operates 20 aesthetic centers in Thailand, such treatments are fast becoming the first option for facial rejuvenation in Asian clinics.
“Offering a combination of existing non-surgical techniques and technologies to optimize individual results is the recent trend in facial rejuvenation,” she maintained. “The currently available options of injectables, neurotoxins, thread lifting and cell-assisted fat transfer actually target volume loss and expression lines, which are the main reasons for an aging appearance.”
Non-surgical or minimally invasive procedures are in high demand throughout the APAC region, reiterated Kwun Cheung Hau, M.B.Ch.B., M.R.C.P., F.H.K.A.M., F.H.K.C.P., D.C.H., a dermatologist in Hong Kong.
“People want a natural, subtle effect after procedures,” he indicated. “Most Asians want to receive compliments from their friends, who are unaware of the fact that they underwent surgery.”
“This approach is very popular in this region, representing a huge market that is growing at a fast rate, around 20% annually,” stated Peter Huang, M.D., a plastic surgeon at the Rebecca Cosmetic Center in Taipei, Taiwan. “Patients are really interested in the minimally invasive aspect of these treatments,” he said.
“With minimal or no downtime, physicians can now plan custom treatment regimens by catering to a patient’s individual timeline and budget. The results are manageable and can be dramatic or subtle depending on the emotional desires of the patient,” Dr. Supapannachart indicated.
“In addition, volume replacement is one advantage not seen in conventional surgical lifts,” she pointed out. “From my point of view, reversibility of non-surgical facial rejuvenation is a major advantage over surgery.”
With Asian skin particularly, minimally invasive facial rejuvenation is an ideal approach, stated Peter Hsien-Li Peng, M.D., a dermatologist, and founder and director of the P-Skin Professional Clinic & Hair Restoration Center in Kaohsiung, Taiwan.
“Because of the facial bone structure there are differences between Caucasian and Asian patients. The Asian patient has areas of bone deficiency, such as a low nasal bone and chin recession, infraorbital maxilla recession, etc.,” he elaborated. “These aspects make Asian people seek transformative treatments at a very young age, often in their 20s.”
The number and quality of injectable products has also improved, noted Dr. Quaranta. “In the beginning, I used collagen and had to subject my patients to allergy tests. Then hyaluronic acid (HA) came along, but in formulations that were, I dare say, too broad and not specific enough. Today, we have products that are more refined and resilient, with low BDDE. These provide natural, long-lasting results,” she said.
Improved products and injection techniques enhance and better support the target tissue instead of just filling spaces, Dr. Huang pointed out.
“We call it building the wall. We are filling some areas to boost the tissue and also decrease its heaviness,” he explained. “We also call them plus and minus procedures. We try to balance the facial tissue using injectables. To be successful, it is critical for the physician to thoroughly understand the facial anatomy.”
“Dermal fillers of different G-primes help to create ‘architectural effects,’ such as bony prominences, volumization, structural support and skin hydration,” Dr. Supapannachart noted.
ART FILLER® from FILLMED Laboratoires by Filorga (Paris, France) is an example of a modern filler range that provides a balance of sculpting, volumizing and smoothing properties depending on the indication. This distinctive set of HA-based gel fillers feature proprietary Tri-Hyal® technology, which creates a flexible and moldable material for a naturally-sculpted look. ART FILLER products address superficial to severe facial wrinkles, volumization of the lips, skin moisturizing and revitalization, as well as volume creation and restoration, especially for the cheekbones and chin.
As Peter J. Damico, M.D., an aesthetic specialist in Fort Worth, Texas pointed out, the type and quality of injection tools are very important, as well. “I use a microcannula whenever I can, but sometimes I achieve a better result using a needle,” he expressed.
“The microcannula is much safer and not as traumatic, with less bruising and swelling,” he elaborated. “I don’t inject into people’s temples with needles anymore. I will use a microcannula on the lateral cheeks to obtain a good result, but in other areas like the anterior cheek there are times when you have to use a needle.”
Beyond fillers and neurotoxins lie new clinical methods that involve platelet-rich plasma (PRP) treatments, as well as the use of lifting threads, collagen stimulators, stem cell / fat grafting procedures and Micro Botox.
Article from the Modern Medicine Network