Friday, June 12, 2015

For Better Facial Rejuvenation: Combo Therapy

Combination treatment: better facelift results, less downtime

Nonsurgical procedures are the fastest growing area in aesthetics and can delay the need for invasive procedures, but they cannot treat all concerns, such as excess skin in the neck and upper eyelids and excess fat deposits, according to Palo Alto facial plastic surgeon Jill L. Hessler, M.D.
Dr. Hessler, an adjunct clinical assistant professor, otolaryngology, head and neck surgery at Stanford University School of Medicine, presented on the subject of combined treatments yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.
Among the topics she tackled: surgical and non-surgical combination treatment for facelifting.
When assessing the aging face, first surgeons need to assess volume loss from skeletal changes, bone resorption and bony remodeling, as well as facial fat loss, which leads to a gaunt and hollow appearance, Dr. Hessler says.
“Secondly, there is laxity of the skin, as some of the elasticity and collagen weakens [thereby] creating the jowls, neck redundancy and dropping eyelid skin,” Dr. Hessler says. “Thirdly, there are intrinsic changes of the skin, which cause discolorations, fine and deep lines and lack of a uniform color and smooth texture. We need to address each of these areas separately.”
Nonsurgical treatments, such as laser resurfacing can address the third area, according to Dr. Hessler.
“In that past, it was suspected that combining laser resurfacing with facelift surgery would be too traumatic to the tissues and lead to a higher risk of complications,” she says. “Multiple experiences and studies have demonstrated that this is not the case, and laser resurfacing can safely be performed at the same time as facelift surgery — particularly, with new fractionated lasers….”
Patients often are concerned with fine lines and deep lines around the face. The laser, alone, can treat superficial fine lines, but, can’t adequately address the deeper lines and folds without some form of additional skin tightening, according to Dr. Hessler.
Volume loss in the face is yet another missing piece in this picture for many patients. While facelifts reposition tissue and remove the deeper lines and folds and lasers remove fine lines and discoloration, adding volume for more youthful contours creates a synergistic enhancement with these other procedures.
“Combining these procedures allows the surgeon to obtain enhanced results, while being slightly less aggressive with each treatment, which allows faster recovery and a lower chance of side effects,” she says. “Combining surgical procedures with the less invasive procedures allows surgeons and patients to obtain the best from both worlds: optimizing treatment results with more limited recovery and downtime.”
Dr. Hessler reports no relevant disclusures. 

Lid Lift with latisse! This is a very good thing!

Bimatoprost for ‘chemical’ blepharoplasty?

Topical bimatoprost (Latisse, Allergan) is approved for the treatment of hypotrichosis, but using it off-label might help patients achieve a chemical blepharoplasty, according to a presentation given yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.
Deborah S. Sarnoff, M.D., clinical professor of dermatology at New York University School of Medicine, presented her experience and new study, published May 2015 in the Journal of Drugs and Dermatology, on the use of bimatoprost beyond eyelashes.
In the study, Dr. Sarnoff and plastic surgeon Robert H. Gotkin, M.D., report significant changes in the appearance of the periorbital area after applying topical bimatoprost ophthalmic solution, 0.03% to the upper eyelid margins. The authors write that while published reports in the literature suggest side effects and potential complications from the drug, including prostaglandin-associated periorbitopathy, or PAP, theirs is the first report in the dermatology and plastic surgery literature looking at the rejuvenating effect of topical bimatoprost on the periorbital area. 
“While periorbitopathy implies pathology or a state of disease, we report changes that can be perceived as an improvement in the overall appearance of the periorbital area. We, therefore, propose a name change from PAP to PAPS — prostaglandin — associated periorbital syndrome. This better describes the beneficial, as well as the possible negative effects of topical bimatoprost,” according to the study authors.
Dr. Sarnoff says she treated herself with bimatoprost for eyelash enhancement and used her case report for the study. She applied the topical to the base of the upper eyelid cilia daily for three months; then, reduced application to two to three times a week. By 3 months, her eyelashes were noticeably fuller. Dr. Sarnoff also notes deepening of the upper eyelid sulcus, improvement in the hooding of the upper eyelids, involution of the dermatochalasis in the upper and lower lids, decrease in lower eyelid fat bulging and lower lid skin tightening, according to the study.
"Although there is a risk for periorbital changes that could lead to disfigurement in some patients, in properly selected candidates, when used bilaterally and the dose titrated appropriately, bimatoprost can have a rejuvenating effect beyond eyelash enhancement. It can improve hooding and dermatochalasis of the upper eyelid, diminish lower eyelid fat pads and tighten periorbital skin,” Dr. Sarnoff says. “The striking improvement in the periorbital appearance of some individuals using bimatoprost (Latisse), warrants further research into its potential use to achieve a 'chemical blepharoplasty.'"
Dr. Sarnoff reports no relevant disclosures.