Who wouldn’t want the option to look younger without undergoing surgery? Even though I am a plastic surgeon, I certainly have studied and personally taken advantage of non-invasive methods to improve my facial appearance. There are so many options out there at this point, it is hard for potential patients to determine what their best options are. Week in and week out, I see patients in my office lamenting the amount of money they have invested in some options that resulted in no visible change in their appearance. The sad part is that there are good options out there that do work. In this article, I will highlight some non-surgical options for facial rejuvenation that I find to be very beneficial to my patients.

The most under-utilized tool for those of us who want to continue to look as good as we feel is a quality skin care program. It is very easy to get drawn in by the slick marketing and beautiful packaging we see in TV and print ads, as well as at the cosmetics counter in the department store. The unfortunate fact is that products sold over the counter do not have enough active ingredients in them to do much of anything. Even when they have the right ingredients, they are frequently not in appropriate concentration or in the proper chemical structure to allow absorption across the skin. To add insult to injury, many of these products are very expensive.

Thankfully, there are products that have been scientifically tested and proven to improve the appearance of facial skin. These products are obtained in offices of board certified plastic surgeons and dermatologists. I prefer the Skinceuticals line. It was developed by a dermatologist at Duke University. After reading his lab research and clinical studies, I was certain I wanted my patients on these products. We can now thicken the collagen layer of the skin, resulting in a softening of fine lines and wrinkles by using topical products alone. We can fade sun spots. Most importantly, we can turn precancerous cells into normal cells, reducing the need to remove skin cancers. Before you spend any more money on over-the-counter skin care products, meet with a board certified professional about a skin care program.

BOTOX® is another frequently used tool, but the indications for its use can be confusing to patients. BOTOX® is used to soften wrinkles in the face that deepen when we make an expression. This drug is injected to soften muscular contraction. It can be very helpful in preventing wrinkles and furrows from becoming so deep that they are visible even at rest. Like any tool, overuse is ill-advised. When too much BOTOX® is used, the face looks frozen and unnatural, in my opinion. I use modest doses to soften the wrinkles, but avoid complete inability of the muscles to move. BOTOX® generally works for four months and is then re-dosed in a brief office appointment. There is minimal-to-no downtime.

The use of injectable fillers has also become commonplace and is a wonderful adjunct to skin care and BOTOX®. There are a variety of different types of filler available. I prefer to use Juvéderm®, which is made of hyaluronic acid, a normal component of human skin. Consequently, there is no such thing as rejection or allergy. It is a gel formulation so there are very few problems with visible lumps or bumps. The product actually stimulates collagen production and repairs areas of depression, such as the lines that extend from the nose to the corners of the mouth. This product is a tremendous benefit to those of us who perform a lot of facelift surgeries. In the old days, surgeons used to use tension on the skin to smooth out the furrows around the mouth. These techniques led to some patients appearing stretched and tight. With the use of filler prior to or at the time of facelift, I am never tempted to pull tightly on the skin, as I know I can fill out the depressed areas around the mouth with filler. This product lasts one year, so the maintenance schedule is very well tolerated. It can be administered in the office with topical anesthesia.

I have discussed the tools I believe in, but there are many out there that I am not zealous about. Most of the products on the market that sound too good to be true are. Thermage is a good example. I have many patients go through this externally applied radio frequency treatment only to say it had no effect on sagging or lax skin and only minimal and temporary effects on fine lines. In fact, the unlucky ones exhibit shrinkage of the fat in the layer deep to the skin, which results in divoting in the areas treated. This modality of treatment may be perfected in the future, but my patients generally want more significant results.

Fraxel is another treatment that I don’t feel comfortable promoting. This therapy involves treating the facial skin with a non-ablative laser. The surface of the skin is not injured but the deeper layers are. Consequently, shorter downtimes occur compared to those experienced with ablative lasers, such as the CO2 laser. Once again, however, if you can reposition your facial skin with your fingers, you will be disappointed with the minimal result from this treatment.

I am fortunate to be practicing in an era of plastic surgery during which I have many highly effective tools to help patients achieve and maintain a natural and rejuvenated facial appearance. I find that when I am allowed to use all the tools I have available, I create the best results that hold up the longest. I can make a beautiful difference for patients with skin care, BOTOX®, and fillers. When gravity starts affecting the face, though, surgery should be considered for most complete results. A complete rejuvenation evaluation with a board certified plastic surgeon will start you down the path to making good choices for you, so that you enjoy your improved look for years to come.

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