83 - Facial rejuvenation

Summary

Approaches to facial rejuvenation include non-surgical and surgical techniques. Non-surgical techniques such as dermabrasion, chemical peels, or laser skin resurfacing are often adjunctive to surgical procedures. Chemodenervation with botulinum A exotoxin (BOTOX) is another treatment modality for certain facial wrinkles or as an adjunct to operation. Injections are directed to areas of skin wrinkling caused by active muscle contraction such as frown lines and crow's feet. The paralytic effect of the injection has peak effect at 5–7 days and duration of 4–6 months with standard dosing.

Skin care regimens that focus on protection from sunlight, collagen stimulation with retinoid products, exfoliation and hydration are used preoperatively and postoperatively to enhance and prolong surgical rejuvenation procedures. Additional precautions include smoking cessation and strict avoidance of aspirin and non-steroidal anti-inflammatory agents for two weeks prior to the operation.

Surgical procedures for facial rejuvenation are typically performed on an outpatient basis. Postoperative monitoring can be done in a recovery suite, occasionally with an overnight stay in a hospital setting. General anesthesia provides reliable intraoperative patient comfort and allows quick postanesthetic recovery. For selected operations of short duration, local anesthesia with sedation is adequate; however, if multiple operations are planned during the same episode, general anesthesia is preferred.

The duration of the operation tends to vary with the number of procedures being performed: browlift surgery may take 30 minutes to 1 hour, surgery of the upper eyelid can be completed in approximately 30 minutes, and lower eyelid and cheek surgery as well as the standard facelift may each take 1–2 hours.