|A recent Wall Street Journal weekend article looked at the present status of aesthetic improvements in the population. The featured “cosmetic provider” stated that he had fewer requests for surgery and more for non-invasive procedures, such as lasers or minimally invasive injections of fillers or neuromodulators (i.e., Botox). He states people want to look younger and generally improve their looks but without the long recovery required after surgery.
This works well for patients who need a small amount of correction. Less invasive procedures were designed to add and keep clients who were not good candidates for surgery or weren’t ready for surgery. The patients wouldn’t be turned away, and the non-invasive procedures added a revenue source to the practice. These procedures would keep the patient looking youthful until they needed surgery.
However, the article leaves out the fact that these procedures are costly for the patient and the results are modest, at best (i.e., 30% improvement in aging features). The provider in the article appropriately recommends procedures every 4-6 weeks for up to 6-8 sessions to achieve the results. At $1000 a session, it adds up to a hefty source of revenue for the provider and a moderate improvement for the patient. Then it needs to be repeated next year.
A prominent Beverly Hills dermatologist warns against an overabundance of non-invasive aesthetic procedures. He sees this regularly in “Hollywood types.” Skin that is over-worked by lasers or peeling has the effect of reducing the skin’s pigment, giving it the appearance of smooth white ceramic. The loss of lines by the over-use of neuromodulators and fillers eliminates highlights and shadows, giving an overly polished look and a waxy texture. The over injection of neuromodulators can decrease sweating, giving the skin an unnatural “buffed” appearance. Injecting too much filler decreases and sometimes eliminates facial contours. Light reflections occur when the contours of our face change from area to area. Contours give the face character and are unique to each person. A face without contours looks great under stage lights but appears strange in person, and some people even look un-life-like and character-less.
Minimally-invasive procedures or surgery should not stand alone. It is not one or the other. Less invasive procedures seldom eliminate the need for surgery, but there are some aging features that surgery alone cannot reverse. The skin should not be pulled so tight to correct all loose skin. Gentle pulling on the skin and filling residual loose skin with volume injections will create a more natural look. A combination of skin treatments (skin care, peels, and lasers) along with surgery will give you the best result. This will leave you with skin that is plump, healthy, and glowing on top of repositioned youthful facial structures.
Thomas Francel, M.D.