Like most things in life, when considering a cosmetic procedure to rejuvenate the face, there are many things to take into account. For instance, some procedures are less invasive and have minimal recovery time; others are much more invasive and may require several weeks to fully recover. There is also the cost factor to think through as well. The right procedure for you will depend on many of these factors, along with the goals that you have.
For most patients, this comes down to a question of “Do I need surgery, or will non- (or minimally) invasive procedures give me the results that I’m looking for?”. There is no doubt that non-invasive or minimally-invasive procedures are inherently attractive as an option. They usually offer minimal or short-term discomfort, there are no scars to heal and fade, and patients don’t generally have significant bruising or swelling. Also, the cost of a single minimally invasive treatment is usually significantly less than that of a more aggressive, comparative surgical procedure. Examples of minimally invasive treatments include injectables like Botox© and dermal fillers, lasers and Intense Pulsed Light therapy, high grade skin care products, and skin treatments like chemical peels, facials, or micro-needling. These are some of the most common treatments performed in aesthetic centers.
So with all these great attributes and options for minimally invasive treatment, why do patients still often choose surgery? There are several reasons.
First, minimally invasive treatments are usually temporary. For example, Botox© (and similar products such as Xeomin© and Dysport©) do a great job of relaxing the muscles that create the wrinkles between the eyebrows (“the 11’s”), across the forehead, and in the corners of the eyes (“crow’s feet”). However, these muscle relaxers typically work for 3-4 months and then the effect wears off. This requires the patient to come back to the office for repeat injections. Dermal fillers typically last longer. Depending on the type of filler and the area treated, effects may last anywhere from six months to a couple of years. Some patients simply prefer something more permanent, and they want to avoid repeat treatments.
A second reason is that some aging changes cannot currently be corrected by anything but surgery. Examples include the development of jowling or of significant skin looseness in the neck area. Although some companies might hawk a magic cream or energy device to handle these kinds of issues, these don’t really work and the solution is a facelift (which includes lifting the neck). A facelift can dramatically improve these areas, and the results last for many years. Other examples of changes that require surgery as opposed to non-surgical treatments include significant droopiness of the brows or eyelids.
As plastic surgeons, we are reluctant to call the results of facial rejuvenation surgery “permanent,” although in many ways they are. Let’s say a patient undergoes a facelift and loves the improvement in skin tightness, the jowls, the neck contour, and the folds around the mouth. Once healed, these results will look good for many years. However, over the course of these years, the aging process will continue – skin will become more lax, and tissues may start to droop a bit. At some point, typically after 7-10 years or more, the patient may want to undergo additional surgery to treat these changes. But even at ten or more years after surgery, results are better than they would have been without surgery in the first place. The tendency for some recurrence over time varies by the different area of the face being treated. Brow lifts, upper eyelid tucks, and the neck portion of a facelift tend to last a long time and require repeat surgery less often, or never. Some recurrence of laxity in the lower face, however, is more common. Therefore, many patients may consider a secondary face lift 7-10 years or more after their first procedure. Of note, this secondary procedure may not need to be as extensive as the first procedure.
A third consideration is cost, and there is no doubt that surgical procedures typically cost significantly more in the short term. However over the years the cost of maintenance by means of repeated non-invasive treatments will continue to rise, often to the point that surgery can be far cheaper in the long run.
Finally, it is very helpful to think about temporary (typically minimally invasive) treatments and long lasting treatments (typically surgery) not as an “either or,” but as a “yes, and”. In other words, many patients benefit from both. For younger patients who are not yet ready for surgery, the less aggressive and temporary treatments are an ideal option. For older patients who are undergoing surgery, minimally invasive treatments can enhance and help maintain their results. It is extremely common that we “mix and match” various surgical and non-surgical procedures to offer patients the combination of treatments that will give them the best results.
If you are wondering about temporary versus long lasting treatments, and non-surgical versus surgical, the board certified physicians at the Emory Aesthetic Center can perform a comprehensive skin and anatomical assessment, and can help you think through the options and choose an approach personalized to you and your needs.
Online personal consultation request: http://www.emoryhealthcare.org/cosmetic-aesthetic/appointment.html
About Dr. Eaves
Dr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.
His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).
Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.