When people think of facelifts, images of aging Hollywood stars with their faces pulled as tight as their red carpet gowns might come to mind. In fact, patients considering cosmetic surgery may be concerned about the sometimes pulled, unnatural look that results from facelifts. Now, a growing trend among dermatologists is to combine minimally invasive procedures to tone, tighten and plump aging skin, creating a more natural, younger look with less risk and recovery time than a traditional surgical facelift.

Speaking today at the 65th Annual Meeting of the American Academy of Dermatology, dermatologist Michael S. Kaminer, MD, FAAD, assistant professor of dermatology at Yale University in New Haven, Conn., and Dartmouth University in Hanover, NH, discussed the benefits of some of the latest minimally invasive cosmetic procedures and how dermatologists determine what combination will work best for each individual patient.

"With new understanding about the skin's aging process -- and in particular what actually makes a person look old -- dermatologists are now able to combine several minimally invasive procedures to give a final result that approaches and in some cases surpasses that of traditional facelift surgery," said Dr. Kaminer. "From radiofrequency skin tightening to thread lifts that can lift and tighten the face without surgery, these procedures have proven to provide reliable, effective, noticeable and long-lasting improvements with little downtime."

Wrinkles Get Their Fill

Advances in soft tissue augmentation offer patients natural-looking and durable treatment options for wrinkles, which are among the most telltale signs of aging. For patients looking for a permanent correction, autologous fat transplantation uses the patients' own fat cells to fill in wrinkles without the risk of allergic reactions that can occur from manmade injectables. The two-step, same-day process, begins with a small liposuction procedure in which fat cells are taken from the patient's abdomen, buttocks, outer thighs or hips and processed for implantation. Then, the harvested fat tissue is precisely injected under the skin, using local anesthesia, with very fine instruments to contour affected areas. Results are noticeable within 24 to 48 hours following the procedure.

"Autologous fat transplantation and other facial fillers are what we like to refer to as the inside-out approach to treating aging skin, because they plump up wrinkles and folds from underneath the skin to improve the appearance on the outside," explains Dr. Kaminer. "Fillers are the perfect complement to the outside-in procedures, such as the skin resurfacing and tightening treatments, and in some cases can be performed at the same time."

Lift and Tighten Sagging Skin without Exercise

For patients with moderate signs of aging who are looking for a little "lift" without resorting to a facelift, a new FDA-approved thread lift procedure is becoming a popular non-surgical option. The thread lift procedure uses tiny suture-like hooks implanted underneath the hairline to pull the skin upward. When Dr. Kaminer slides the sagging facial areas into place, patients participate by watching this process in the mirror to ensure the amount of lift or tightening they expect is achieved. Although results are not permanent, Dr. Kaminer estimates that these new threads are expected to last seven to 10 years, considerably longer than previous versions.

"This simple, in-office procedure is very tolerable for patients, requiring only a local anesthetic and about an hour or two of their time," said Dr. Kaminer. "While a thread lift alone works extremely well to improve sagging skin, results can be greatly enhanced when paired with a resurfacing procedure or filler, which I recommend having about three to four weeks apart."

Another non-invasive procedure to tighten sagging skin is known as monopolar radiofrequency skin tightening. This novel approach tightens the skin using intense heat delivered deep into the dermis layer of the skin to produce collagen remodeling and tightening. Discomfort is minimized with the use of oral pain medications, as well as the application of protective skin cooling delivered before, during and after the application of heat. Unlike its invasive counterparts, monopolar radiofrequency skin tightening effectively tightens skin without injuring the epidermis, the top layer of the skin, resulting in virtually no downtime for the patient.

Dr. Kaminer reports that radiofrequency skin tightening can be used to successfully treat multiple facial areas, such as the cheeks, jaw line, upper neck and forehead, lifting the eyebrows and making the eyes appear more open, refreshed and less tired. While some patients will notice an immediate improvement following one treatment, results are gradual with optimal results occurring in four to six months. Some fillers can be administered during the same treatment session to enhance results. However, Dr. Kaminer recommends waiting about a week before undergoing autologous fat transplantation.

Skin Resurfacing in a Flash

Two of the newer minimally invasive skin resurfacing procedures, fractional resurfacing and superficial ablative resurfacing, are proving successful in using lasers to gently smooth out uneven pigmentation, wrinkles and irregular texture.

Fractional resurfacing employs a unique mechanism of action that repairs a fraction of skin at a time. A dermatologist uses the laser to gently resurface the epidermis and, at the same time, reaches deep into the dermis to safely promote new collagen formation. The untreated healthy skin remains intact and actually aids in the repair process, promoting rapid healing with only a day or two of downtime.

"In our practice, we use fractional resurfacing to improve skin texture, uneven pigmentation, deeper wrinkles and even acne scars on patients of all skin types," reports Dr. Kaminer. "It's an extremely versatile laser treatment that produces excellent results in as few as three to five treatments for most patients."

Superficial ablative resurfacing treats fine lines and wrinkles, as well as uneven pigmentation, with an erbium laser that removes skin as thin as a few microns at a time (which is a fraction of the width of a human hair). This new technique significantly improves the efficacy of skin resurfacing, while eliminating many of the risks inherent with older devices. Most patients notice a softening of fine facial lines and wrinkles, including those around the eyes and lips, after as few as two treatments. As is the case with fractional resurfacing, superficial ablative resurfacing requires only a few days of downtime following the procedure.

"Superficial ablative resurfacing is a great option for those who are just beginning to notice subtle changes in their skin that they would like to correct sooner rather than later," reports Dr. Kaminer. "Both superficial ablative resurfacing and fractional resurfacing can correct most of the common signs of aging, and we often use them interchangeably in follow-up treatments to enhance patient results."

Since the success of most minimally invasive procedures is highly dependent on the skill level of the physician, the American Academy of Dermatology urges patients to do their homework before undergoing any cosmetic procedure and discuss their expectations with their dermatologist.

"Treating aging skin with the newer minimally invasive procedures is a process that from start to finish can take between six to 18 months, depending on the patient," advises Dr. Kaminer. "These procedures work best when combined gradually over time, but the end result is definitely worth the wait for those who want to avoid surgery and longer recovery times."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.

American Academy of Dermatology
aad/