1. Are there any non-surgical alternatives to facial rejuvenation surgery?
You will see from the popular media today that apart from surgery there is an increasing armamentarium for the cosmetic surgeon available to help enhance the face and one’s complexion. The techniques that I think work best include Botox, dermal fillers, chemical peels, medical dermabrasion and skin lasers. Some of these techniques are simply used in the outpatient clinic whilst others may require a local or even a general anaesthetic; occasionally one of these modalities of treatment will be used in conjunction with a surgical procedure. Ideally, your cosmetic surgeon should be experienced not just in surgery, but also in a comprehensive range of techniques and modalities of treatment, as pure surgery on its own may not be the best solution for you.
2. What are the uses of Botox?
Botox is not a replacement for surgery, but in some people it can delay the need for surgery or enhance the outcome of surgery. It works essentially by disconnecting the nerves from those structures they supply – this includes muscles but also sweat glands so it can be used effectively for excessive sweating. There are now different makes of botulinum toxin that need to be used slightly differently.
As it works by paralysing the muscle it is important that the person using Botox is familiar with the anatomy of the muscles under the skin – as I operate on those muscles the anatomy for me is straightforward.
The use of Botox in the face relies on paralysing some muscles whilst leaving others untouched and the cosmetic surgeon has to be careful not to lose facial expression at the same time as eradicating wrinkles. The best use in the face I think is for the wrinkles between the eyebrows as no one wants that particular expression; the next best use is for the laughter lines at the corners of the eyes, although not to remove them as that would remove character, but to soften them. Other areas include forehead and brow including improving the angle of the eyebrows and it can also be used at the corners of the mouth to improve one’s natural expression.
3. Where and how can dermal fillers be used in the face?
Dermal or facial fillers can be permanent or temporary. Generally, I don’t like to use permanent fillers as permanent materials, if they cause a problem, will cause a permanent problem. The advantage of a temporary filler is that if there is a problem it will be temporary.
The disadvantage of a temporary filler is that if you like the results, they will only be temporary and the treatment will need repeating at some point.
Dermal fillers now come in different forms and some are more long lasting than others; also they last differing amounts of time depending on where you place them so you will need to discuss this with your surgeon.
The areas that dermal fillers are most used for at the lips, the nasolabial folds or creases which run from nose and mouth, the rather unkindly named marionette lines which go down from the corners of the mouth, the cheeks and jowls and between the eyebrows. More recently, fat grafting techniques allow you to use your own body tissues to achieve a better, longer-lasting effect but this needs special expertise.
4. When and how are chemical peels used in the face?
Chemical peels, dermabrasion and resurfacing skin lasers all work in a similar fashion by removing the outer layer of the skin to produce the end result. Chemical peels can be very gentle, medium or deep. How and when chemical peels are used depends to a significant degree on the experience of the surgeon and also on the skin type of the individual. Advice will be different for those individuals with fair skin from those with darker complexion.
Peels are available in the high street clinics and these often use glycolic acid or are called fruit acid peels; these are gentle but then make only modest and often temporary improvement. I use trichloroacetic acid which is a more powerful agent and so needs experience to be used effectively. Different strengths of peel will be used for different areas of the face and for achieving differing aims.
For some people the skin will need to be prepared or primed for the peel to be optimally effective and to avoid problems with the sometimes seen side effects such as changes to the pigmentation of the skin. Peels can be used for improving acne scars, for wrinkles, for improving the complexion, potentially to remove pigmented or age spots in the skin and they can be used outside the face in the décolletage area of the front of the chest and on the backs of the hands. Recently, I have also used peels for deeper acne scars with a special technique called TCA CROSS and have found early results to be promising.
5. What is medical dermabrasion and how is it used?
Dermabrasion works in a similar way to chemical peels and resurfacing skin lasers in removing the outer layer of the skin. There is a technique known as ‘microdermabrasion’ used in high street clinics that can improve the complexion of the skin by a sandblasting effect but usually this is temporary. This should not be confused with medical or manual dermabrasion, sometimes referred to as dermasanding which needs an anaesthetic, usually a local anaesthetic. You can use special equipment in theatre, but in fact I learned my version of this technique from one of the top cosmetic surgeons in Paris. I used special sterilised silicon carbide paper and use this to sand down the skin; as I am doing this by hand I have good control over how much I do and how far I can safely go to achieve the best outcome. It is particularly good for wrinkles around the mouth and for some scars.