FRED SUESS, M.D.
PLASTIC  AND  RECONSTRUCTIVE SURGERY
COSMETIC  SURGERY
DIPLOMATE AMERICAN BOARD OF PLASTIC SURGERY

NOTES ON FACIAL REJUVENATION

Patients often ask, what can be done to postpone the need for facial rejuvenation surgery. Hopefully the following strategies and treatments may be of help.

The aging of the face is due to many factors, including the passage of time; sleep patterns, smoking and genetics. Ethnic heritage determines how soon you may develop wrinkles and also how susceptible you are to sun damage. Previous sun damage is not only an important determinant for skin cancer, it also causes wrinkles at an earlier age. An estimated 80 percent of sun-damaged adult skin is due to sun exposure before the age of 18.

Sunscreen should be at the least sun protection factor (SPF) 30. There are minimal benefits to higher SPF's. Proper sunscreen application involves applying sunscreen to all affected areas, allowing it to be absorbed on the skin and to completely dry before outdoor activities. Waterproof sunscreen will only last for 80 minutes when applied properly. Compliance and repeated applications of sunscreen throughout a sunny day is key to getting appropriate protection form the suns rays.

A good skin -care regimen is very important to your skin's health. Any product that increases gentle exfoliation allows your skin to look it's best. Gentle chemical exfoliants, such as glycolic skin cleansers, are important to achieve daily exfoliation. Generally higher strengths exfoliants are not available at the pharmacy or spa, but only at a physician's office.

Prescription drugs are useful in achieving optimal skin tone. Hydroquinone is a skin-bleaching agent that is useful for skin abnormalities due to aging, sun exposure and acne. Retin -A has been used for several decades and is helpful in removing fine wrinkles and increasing collagen production in the dermis. It also encourages the formation of collagen layers, resulting in improved texture and a more youthful appearing skin.

Routine skin care is important, and skin peels can be used as well to achieve longer lasting results. Various chemicals and concentrations may be used, but it is important to realize that certain chemicals and higher concentrations have potential permanent complications and should be applied only under the direction of an experienced physician. Common chemical peels include glycolic peels, acid peels, Trichloroacetic acid (TCA), and phenol. All of these chemical peels work by exfoliating the outer surface of the skin, which encourages regeneration of the outer layers of skin. This newly generated skin is more youthful, has fewer wrinkles and fewer areas of discoloration. It can take four to six months to see the final result.

Microdermabrasion is a technique that applies fine crystals under air pressure to the face via a tube. The crystals are immediately suctioned away after contact with the face. The result is an overall finer appearance of the skin, with smoother skin and fewer wrinkles. Microdermabrasion treatments generally need several applications over several weeks for optimal results.

Exfoliation on a larger and deeper scale can be achieved by facial resurfacing. Laser Resurfacing not only exfoliates the skin, but also induces the collagen in the dermis to become more organized. The skin that does grow back is smoother, has fewer wrinkles, has more organized and thicker collagen and has more consistent skin tone and more even coloring.

Dr. Suess uses an Encore Active Fx Laser Resurfacing that ablates and tightens single layers of skin. The Laser emits light intense enough to vaporize the outermost layer of skin. The skin heals in about 7 days but the skin is pink for 3-6 weeks. Possible side effects from skin rejuvenation procedures include redness, bruising, and hyperpigmentation and hypopigmentation. More serious side effects can result in permanent scarring. It is important that you feel informed and comfortable with your procedure prior to commencement of treatment. 
                                                           
Botox, or botulinum toxin A, is a temporary muscle paralytic. Recently, it has received increased media exposure, and the Food and Drug Administration (FDA) has approved it for cosmetic use in the forehead area between the eyebrows to eliminate wrinkle lines. It is being used on an "off label" basis for forehead wrinkles and in the "crows feet" or periorbital area. Botox is injected into the muscles that cause wrinkling or worry lines and lasts three to five months.

Filler agents also can be used for old scars, acne scars or the facial, brow, or forehead Lines. The most popular filler agent in the United States is hyalaurnic acid. They are injected into the area desired to be filled and lasts anywhere from six months to a year. Radiesse is another popular filler. The patients own fat can also be used and transferred to fill in facial creases. Additional filler agents are awaiting FDA approval. It is very helpful to work with physicians as well as estheticians to achieve quick recovery after procedures. Estheticians can also work with patients to apply camouflage makeup after procedures.

It should be understood that the procedures discussed do not replace eyelid, brow or facial-neck surgery, but may postpone surgery and in some cases enhance the results if performed at the time of surgery.

Fred Suess, M.D.
San Francisco, California