What is Facial Rejuvenation? From the simplest to the most elaborate, there is an option for everyone.
1. What typically happens during the ageing process?
The skin becomes thinner with loss of ground substance, collagen, elastic fibres, and occasionally, fat. This is accompanied by uneven accumulation of pigments. This results in deterioration of skin texture and color, wrinkles, skin laxity and loss of volume.
2. How do you formulate a rejuvenation regime?
Every patient requires a personalized regime. I identify the most significant problems and the ones that bother the patient most. I plan the regime based on the patient’s work schedule, tolerance for downtime, pain threshold, risk adversity and financial constraints.
3. What are the simpler rejuvenation techniques?
For improvement of skin texture, pore size, pigmentation and fine wrinkles. I recommend intense pulse light (IPL) or broadband light (BBL). This treatment is well tolerated and has no downtime. Clinical results are usually seen within two to three treatments. Some patients report results as early as one week after treatment.
Botulinum toxin injection is the standard treatment for wrinkles which are worsened by facial animation. It can improve crow’s feet, frown lines and forehead wrinkles and its effect usually lasts for three to four months. Clinical judgment is needed to alleviate wrinkles without causing an unnatural mask-like appearance.
Filler replaces volume to correct deep facial folds and volumize the cheeks for a more youthful appearance. For non-surgical augmentation of the nose, fillers be a temporary alternative. Most fillers are composed of hyaluronic acid, which lasts for about six months. Long-lasting filler materials are associated with side-effects such as infection and granuloma formation.
Botox and fillers complement each other and some patients require both.
Several non-invasive therapies are available to tighten the skin moderately. These include the use of infrared wave therapy (Scition SkinTyte), radiofrequency (Thermage), and focused ultrasound (Ultherapy). Post procedure oedema and erythema commonly resolve within a few days, but clinical results may not be as dramatic as ablative laser procedure.
Microlaser peeol (resurfacing) can further improve superficial skin texture, and the patient can put on make-up about three to five days after the procedure.
4. What are the moderately complex techniques adopted for skin rejuvenation?
Profractional laser is used to achieve further skin tightening. This ablates narrow channels into the skin, and is used to treat atrophic acne scars. The healing process is faster and patients can return to work in a few days. Thread lift provides added skin lifting to the cheeks and temporal area. Several barbed threads made of absorbable material are inserted skin-deep and stablised by suturing to the temporal area. The initial appearance may appear over-corrected but normally improves over a few weeks to months. The effects can last for one to two years.
Fat injection (grafting) has become popular for volume replacement. Fat tissue contains stem cells with rejuvenating properties which are harvested form the abdomen or thighs and processed before begin injected. Post-procedure swelling and bruising last for a few weeks, and the final result is firmer skin with increased volume and improvement in wrinkles.
5. How do you devise a surgical plan for facial rejuvenation?
Ageing affects each part of the face at different speeds and times and this must be understood in the context of the desire for facial rejuvenation. For example, when treating aged droopy eyelids. I normally assess weakness in the lifting (levator) mechanism of the eyelid, excessive eyelid skin, and brow ptosis (drooping). If all these are present, the patient will be advised to undergo levator mechanism correction, removal of redundant eyelid skin an brow or temporal lift.
Another common problem is eyebags, associated with skin and lid laxity. Surgery may involve removal of excessive fat and redundant skin, followed by fat distribution, tightening of the lower lid mechanism and fat injection to improve contour and skin texture. This may be combined with a mini-face lift to achieve a more harmonious appearance.
Some patients requests a lower face lift because of sagging chin and jowl. But since they have moderately severe eyebags, they should consider lower lift surgery with face and neck lift to achieve a synchronized result that looks more natural.
In Singapore, we do not often see the kind of dramatic before and after images that are posed on Korean websites. After a year of training in advanced plastic surgery there, I realised that we have the technology and knowhow here, but patients in Singapore are too conservative to undergo the complex multiple surgical procedures listed above to achieve the quantum leap.
6. Any advise on post rejuvenation procedures?
For optimal outcome, the patient must ensure sun avoidance and regular application of sunscreen especially after laser treatment. After surgical treatment, it is advisable to maintain the result with non-invasive rejuvenation procedures on a regular basis.