We live in a world of instant gratification where everything is available at our fingertips from internet access to telephone banking, 24 hour tailoring, you name it. The same applies to the pursuit of the beautiful face and the perfect body. We expect to go out, buy a set of creams and become instantly gorgeous, smooth and fair. Patients coming for plastic surgery also demand a quick return to work and are less accepting of the long downtimes that have plagued traditional cutting techniques. Whilst some of this is still largely unavoidable, surgeons around the world are constantly researching new, less invasive techniques that allow us to achieve these goals for our patients.
Ageing affects all tissue layers of the face including the skin, fat, muscles and skeletal support. The face shrinks and begins to deflate and sag allowing gravity to exert a downward pull on these tissues much like a balloon that sags after the air is let out.
Conventional facelifts give excellent results in the neck and periphery of the face, pulling these areas taut but they often do not correct the central face where the signs of aging are most evident. These are characterized by frown lines in the glabellar, forehead and outer eye regions, the development of deep grooves and hollows around and under the eyes as well as cheek flattening which if left uncorrected result in a disharmonious or incongruous look. In addition, lower facelifts often exacerbate the flattening of the cheek prominence which is a key feature of the youthful face whilst browlifts often elevate the eyebrow excessively giving a peculiar, surprised appearance.
A youthful face is characterized by smooth, full contours and a firm midface. My stepwise approach to facial rejuvenation is called the 4R PRINCIPLE. Here I identify the crucial 4 PILLARS of Non Surgical Facial Rejuvenation: RELAX, RESTORE, REDRAPE and RESURFACE and address these first before moving on to more invasive surgery.
RELAX – BOTOX, the amazing wrinkle buster that is the most popular cosmetic procedure in the world today is used to create a Browlift effect as well as smoothening wrinkles and lines around the eyes and mouth. This gives the eyes a fresher, brighter appearance. It is also used for chin rejuvenation and Jaw reshaping and some of its newer uses include facial slimming, facial lifting and tightening and pore reduction using the MICROBOTOX technique (pioneered by myself), as well as decreasing sweating and body odour.
RESTORE – Synthetic Filler materials fill out grooves and hollows and restore projection and 3-dimensionality to the central oval especially under the eyes, the deep smile lines at the side of the nose and to the cheek and chin mounds. This restores volume and projection and highlights to the central oval which confers a more youthful look.
REDRAPE – WOFFLES LIFT and APTOS facial threads are used to elevate and redrape selected regions of the face which have become saggy, thus complementing the volume correction achieved thru fillers. These unique self retaining threads are non surgically injected into the sagging facial tissues which are then suspended to the dense and firm tissue of the scalp by these threads. Multiple threads are inserted to achieve the desired lift. No skin is excised and patients return to social activity the next day. The WOFFLES LIFT has in recent months been featured in the New York Times, Elle(USA), the Houston Times and CNBC.
RESURFACE – the skin envelope is resurfaced or rejuvenated non surgically by using IPL, Cooltouch, Microdermabrasion, mid depth peels, and Radiofrequency treatments such as INDIBA and Thermage. INDIBA is a monopolar Radio frequency device that heats up the tissues in the body between the grounding pad, (usually on the back) and the probe (which may be on the face, body, thighs etc). The broad concept is similar to Thermage in that they are both Monopolar RF devices but Thermage uses a patented technology that delivers the heat to a specific point in the skin to induce immediate collagen contraction and gradual remodelling over several months. It is a little painful and the treatment heads are expensive but is excellent for long term tightening of skin, lifting of brows or for abdominal laxity and stretch marks.
INDIBA gives an immediate tightening and lifting effect to the soft tissues but this effect wears down after three weeks or so if not restimulated. Therefore INDIBA has to be used in the form of a consistent series of treatments. Patients can come once a week(IDEAL) or space the treatments further apart but they must repeat it. Guidelines are that they come weekly for six sessions and then monthly thereafter.
The beauty of INDIBA is that it is more versatile and can be used for facial tightening and the treatment of cellulite, abdominal laxity, as well as reducing fatty deposits of the thighs, tummy and arms. It is cheaper and can cover a much wider area.
The ideal treatment is to combine both Thermage and INDIBA. Thermage kickstarts the whole process and INDIBA maintains or even improves it.
Rejuvenation of the central oval with this stepwise approach gives a harmonious appearance and can either complement or delay the need for full facelift surgery in many patients.