Renaissance Plastic Surgery

A recent New York Times article highlighted these proven treatments for wrinkles: retinol, carbon dioxide laser and hylauronic acid injection.  Even though their description is very accurate of the effects of these treatments on the skin and the science behind how they work, their article is a little long and exhausting to read.  Here are the highlights.

All three of these treatments are well-known to plastic surgeons.  The Vitamin A derivatives (retinol, Retin-A) cause a change at the deeper structural layer of the skin, the dermis.  The product leads to rapid turnover of the skin and by a mechanism not completely understood, the collagen which makes up the dermis, is remodeled and demonstrates a more organized appearance, which in time will translate to a decrease in fine lines.

The laser also generates a more organized collagen layer, however, through tissue injury.  Shallow injury created by either a carbon dioxide laser, erbium laser, dermabrasion or a deep microdermabrasion or some other modality will stimulate this change.  Once the reparative process is set in motion eventual new collagen will be made, often resulting in a more flattering appearance.  Keep in mind, however, too much tissue injury can result in scarring and potential disfigurement.  For this reason, true skin rejuvenation requires a highly trained physician.

Regarding the facial filler, hylauronic acid, the plastic surgeon again relies on the reparative response of the body.  Hylauronic acid is a building block of collagen and when injected leads to an immediate plumping of the skin and a decrease in the appearance of wrinkles.  Additionally, the body will recognize the filler as foreign and over time will remove the substance from the body.  This process, which is rather complex, also forms additional collagen which may further reduce the appearance of a wrinkle.  This process also occurs with many of the other facial fillers that are currently on the market.  Of interest, fillers are thought to be a temporary fix.  When in fact, there is a long term permanent improvement to the area injected that may or may not be noticeable over extended periods of time.

Today's media has a fascination with celebrities and even more so with celebrities who have had plastic surgery.  While occasional unattractive outcomes do occur, more often than not celebrities are photographed in the healing phases following surgery and are thought to have a bad result.  Like all of us, celebrities cannot stay cooped up inside for 3 to 4 weeks to fully recover following surgery.  Swelling and bruising are not uncommon following facial surgery and will often distort not only the person's original appearance, but also what the final outcome will be.  In the end, however, this period of down time is almost always worth it.

Because the recovery period may be psychologically stressful, it is critical that the plastic surgeon fully review the recovery phase with the patient.  Knowing how long the recovery period will last will help patients time their procedure.  I personally have found it helpful to tell my patients not to hide their surgical experience, but share it with those around them.  By simply explaining to your friends and family before surgery that you are doing something to improve yourself, will significantly reduce the anxiety associated with the surgical experience.  What you will find is that family members will be interested and engaged in the recovery period and will not be shocked by your early post-surgical appearance.  Furthermore, they will support you and even cheer the "new you" on.

My advice to patients undergoing cosmetic surgery ......... share it with those around you ......... you will be surprised how many of them will have surgery too!

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