Best Face Forward Cosmetic procedures evolve as demand increases.


Peels, injectables, lasers, light treatments, nips and tucks.

Minimally invasive cosmetic procedures have increased nationwide by nearly 200 percent since the start of the 21st century, according to the American Society of Plastic Surgeons (ASPS). And it’s a trend that’s not likely to slow down.

“This era of the selfie has heightened everyone’s awareness of their facial appearance to a new, uber level,” says Dr. David Song, a past ASPS president. “As a result, patients are hyper aware, more so than ever before, of their facial asymmetries, wrinkles and contours.”

It seems that once women (and an increasing number of men) see how good they look airbrushed on Snapchat or wrinkle free on Facebook, without a hint of crow’s feet, they want that same look in real life. And they want it almost as fast, without a lot of down time.

Local plastic surgeons are meeting the demand. Not only are there several clinical trials underway and advances being made in fat grafting, they’re also using existing fillers in innovative ways.

Dr. Theda Kontis

“We are in the finishing phase of a clinical trial on a new injectable — a neurotoxin similar to Botox that should last about six months instead of three or four months. This will be a game changer,” says Dr. Theda Kontis, associate professor at Johns Hopkins University School of Medicine and an international expert in injectables.

“Restylane has two new fillers, Refyne and Defyne. They are very elastic; they move with your tissues and last about a year. And the best part is, they don’t lump. I use them to fill in wrinkles around the mouth.”

To address those pesky marionette lines, Kontis injects Radiesse into the jaw line with a special instrument that results in less bruising. This new procedure, nicknamed a “re-jaw-vination,” gets threaded along the jaw-line border, and the result is a quick mini-lift with virtually no down time.

“Probably the most significant change in using injectables is that we have progressed from treating only lines and wrinkles to rejuvenating the entire face,” Kontis says. “We now have multiple fillers, each with different properties that can be used to create an entire facial rejuvenation or what some refer to as a ‘liquid facelift.’ People worry that they’ll look overdone or shocking. Fillers were not made to look shocking, if you get someone who knows what they are doing. It is an artistic process. Unfortunately, you only notice the bad jobs, not the good ones.”

Dr. Craig Vander Kolk

The world of stem cells is where the future is going, says Dr. Craig Vander Kolk, professor of plastic surgery at Hopkins and director of cosmetic medicine and surgery at The Weinberg Center for Women’s Health & Medicine at Mercy. He is researching the regenerative forces in stem cells and fat grafting. Fat is a good thing, especially when it comes to facial aging, he says. Fat allows a cosmetic and reconstructive surgeon to shape tissues that have aged in the face, to graft the fat to areas that need volume restored.

“Fat-grafting procedures are the ultimate in body sculpting. You take fat from one area [via liposuction] and inject it into another area to reconstruct
deformities or improve appearance. Unfortunately, not all fat survives the grafting,” says Vander Kolk, who is researching ways to increase the number of regenerative cells in the grafted fat. “I am always looking for ways to improve the ‘take’ of the fat. This would improve the results and limit the number of procedures.”

By harvesting the regenerative forces in stem cells, he can improve the success of fat grafting and decrease the need for secondary procedures. In regenerative and rejuvenation fat grafting, Vander Kolk separates out stem cells that stimulate a new blood supply and growth factors in a way that improves the viability of the fat. These cells are then added to the fat, augmenting the number of stem cells and improving the success of the grafting and the results.

Rejuvenative fat grafting allows smaller grafts to be precisely placed in difficult areas, such as under the eyes. It also improves the volume that can be successfully grafted. Rather than injecting a smaller amount of a filler such as Juvederm or Restylane, Vander Kolk can sculpt a face with more fat, correcting the fat loss and sagging of tissues, to get a more natural, younger look, he says.

“Procedures and injectable options have increased in prevalence and diversity, and so have our customers,” says Dr. Michele Shermak, a fellow of the American College of Surgeons and a board-certified plastic surgeon. “Women and men are now having procedures younger and doing them in smaller steps. Women in their 20s are coming in for Botox or lip filler. Men like Botox and fillers because they work, they are scarless, and they have no down time.”

Dr. Michele Shermak

Surgically, she’s seeing an uptick in women seeking less invasive procedures, such as mini-facelifts performed in her office. “Women come in, pull up the side of their face, and ask, ‘Can I get that result,’” Shermak says. “The answer is, ‘Yes!’”

Using local anesthesia, a well-hidden incision is made around the ear, skin is pulled back, and the end result is a natural lift along the jaw line. “It’s a nice way to get a rejuvenated jowl line, and it doesn’t require down time. These women get back into their cars and drive home,” Shermak says. The facelifts lasts about eight years.

There has been some buzz about a topically applied Botox gel on the horizon, but this likely will not be available for a few years, Shermak says. “I’m really looking forward to seeing this rumor come to fruition.”

For now, she touts the versatility of fillers. In addition to using Botox or
Dysport to treat wrinkles or eye hooding, she uses them to treat the sides of the mouth to turn the lip up as well as for neck bands.

“Some fillers can be diluted to fill pockmarks associated with acne scars or to the temples for thinning associated withn aging,” Shermak says. As far as the often-advertised machines promising skin tightening and amazing results, she isn’t impressed. She says most of them “over promise and under deliver.”

Dr. Patrick J. Byrne, a Hopkins professor of otolaryngology and dermatology, agrees. “There are many new technologies, but the consumer should be cautious,” he says. “Some (machines) are marketed heavily without a lot of experience on the part of the provider. There is great incentive to market any new technology, something amazing and completely different. Typically, they are not.”

While there is no magic wand for reversing the aging process, with a reputable doctor and some homework on available services, a consumer can get the look she or he wants — and bring new meaning to growing old gracefully.

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