Historically, plastic surgeons have approached treating facial aging with a decisively surgical bias, devising surgical procedures that lift and pull the neck, brow, or the mid face in either one or two directions without necessarily addressing the real cause or causes of facial aging.  In the last 10 years or so it has become clearly evident that we need an entirely new approach towards facial aging that is less surgical and much more regenerative or restorative and natural in appearance, addressing primarily three factors:

1) Skin aging  due to chronological age, skin genetics, the loss of collagen and elasticity,  and environmental factors such as sun damage and less than healthy lifestyle effects such as smoking and alcohol.

2) Volume loss and deflation in all tissue layers from the skin, the fat compartment layers and even bone which thins and resorbs.

3) Skin laxity and skin excess in the neck, mid face, and lateral brow, which is typically very minimal after the first two factors are addressed.

Multiple nonsurgical and minimally invasive procedures have been recently developed due to a much deeper understanding at the cellular and molecular level about how our face ages. Numerous technological advances and energy devices specifically have been designed to induce a more regenerative response in the patient's own tissues that does not occur with a surgical procedure alone.   These technological advances are designed to primarily induce and enhance the quantity and quality of collagen in the skin and deeper connective tissue, as well as take advantage of a greater understanding and knowledge of fat as a very metabolically active and regenerative tissue.

Skin rejuvenation.   Newer lasers with fractional laser technology have allowed us to treat simultaneously both the superficial and deep layers, penetrating much deeper into the skin with heat and energy that has a much greater collagen inducing response in the deeper dermis as well as some resurfacing qualities.  This effectively induces a thicker, more elastic and more hydrated skin with smoother and more even pigmentation and surface texture.  Microneedling with or without RF technology is seeing a very renewed interest especially with the advantage of being able to directly infuse serums containing metabolically active peptides, growth factors, and stem cells, all of which induce a greatly enhanced collagen production.

Lost volume restoration   Possibly the most unrecognized aspect of facial aging for decades has been the very significant loss of soft tissue volume, primarily fat, that begins in the fourth decade of life.  Facial fat is layered in the face in structural packets of different sizes, shapes and thickness.   In the young adult face the compartments are full and hold the skin in a firm and youthful appearance.  As we age the fat beings to atrophy and as the compartments deflate gravity allows the skin to sag and slide causing hooding of the eyebrows, sagging of the cheeks, nasolabial folding, and jowling along the jaw line.  These compartments can be ideally refilled with a patients own fat, harvested and re-injected under local anesthesia as an in office procedure.  This creates a much more natural 3 dimensional lift, unlike the more “pulled’ and unnatural look of a surgical facelift.   The ultimate benefit from fat grafting may be from the large number of active adult stem cells that naturally reside in fat.  These cells have been studied extensively and have been shown to generate new fat cells, vascular cells, and the cells that manufacture and build collagen.

Nonsurgical skin tightening.   This has been the last frontier of facial rejuvenation.   Firming and actually shrinking or tightening skin intrinsically has been pursued for many years and is finally a reality.   Both superficial and deep heating of skin, connective tissue and deep muscle can be produced by ultrasound and radio frequency technology.   These tissue tightening treatments can be done as an in office procedure under local anesthesia, saving the patient the high cost of general anesthesia and operating room costs, not to mention the downtime of a surgical procedure and a permanent facial scar.