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Aesthetic Medicine

Aesthetic Medicine has developed rapidly in recent years, as patients demand for corrections easy to perform that allows an early return to their activity.

The plastic surgeon is the best qualified to practice this procedures of aesthetic medicine because he knows perfectly the anatomy of the face and the action of the products on different facial muscles.

In our practice, aesthetic medicine uses three main products which are safe and give good results:

  • Hyaluronic acid
  • Botulin toxin
  • Radiesse or Calcium hydroxy-apatite
  • Prevention of facial aging

The prevention and management of facial aging is currently grouped under the term "Anti-Aging Medicine”, generic term which groups together the different modalities. Among these means, preventative measures of facial aging are fundamental ++, and should in no way be neglected. Good habits must be adopted at an early age, because facial aging begins to appear at the age of 20 ; it is important to adopt good habits early, in order to keep as long as possible, a young and natural appearance of the face.

The skin must be nourished by regular application of moisturizing ointment. Avoid cleaning the face too often as it will attack the skin unnecessarily. The best is to apply a moisturizer adapted to your skin texture and to perform gentle manual massages.

It is also important to have a healthy and balanced diet, poor in red meat and favouring white meats, fish, and especially fruits and vegetables. It is important to maintain a constant weight, that is, to avoid gaining weight, because weight loss will lead to significant and premature aging of the facial skin. As well, alcohol consumption should be avoided as it may be involved in skin damage. It will ensure good body hydration by drinking at least 1.5 litres of water per day throughout the day. The benefits of a general hydration of the body are singularly felt on the skin (in addition to other positive effects such as the prevention of urinary tract infections).

The practice of a regular sporting activity is also important. It maintains good form, and a good health overall. On the other hand, we do not recommend intensive sports and too prolonged, type marathon, half marathon, or other significant effort, which masculinize the silhouette and damage the features of the face. We must focus on water sports, such as swimming, and maintenance sports, which give a nice silhouette and maintain a good state of health.

At last, it is important to sleep well +++ to have a well rested face. A good sleep means to respect its rhythm, and to give yourself enough amount of sleep according to your individual needs. Everyone could notice, in his entourage, that the lack of sleep reinforced the aging, and favoured the skin aging.

  • Management of facial aging

From 20 to 30 years of age:
At this age, the only preventive measures are to be obtained with a balanced and healthy diet, a regular sports practice, and a good sleeping habit. Closer to late 20’s, as muscle hyper-contractions appear, especially at the level of the glabellar or frontal region, we can practice injections of botulinum toxin in small doses, which can prevent a wrinkle (fold of the skin) from settling. Before the age of 30, the surgery has rare indications. Sometimes we can perform lipostructure when the patient has a remarkable family history, and specially if another surgical procedure is provided for another reason.

Between 30 and 40 years of age:
It is usually at this time of life that aesthetic medicine treatments can be considered, and in rare cases light surgical procedures (blepharoplasty or lipostructure). Most of the time, Anti-Aging treatment consists of botulinum toxin injections twice a year. These injections must be performed in a delicate and light manner in order to simply treat the appearance of the first wrinkles of the frontal region and the glabellar region, but keeping a natural look to the face. These injections have a powerful preventive action by slowing the installation of wrinkles, and reduce skin aging by decreasing the contractions of the muscles, responsible for the formation of wrinkles. Rare cases of patients that present genetic predisposition to aging of the orbital region, we are prone to perform a blepharoplasty of the upper eyelid to correct the excess of skin or a blepharoplasty of the lower eyelid in the appearance of palpebral pockets.

Between 40 and 60 years of age:
The signs of aging can appear and analyzing them precisely requires the patient in front of the mirror. It is generally around this age that facial rejuvenation surgery is performed. It has to be done with delicacy and subtlety to preserve the natural look of the face and not to alter the expressions. In this period of our life, the facial lifting has to be adapted to the intensity of aging, without waiting to the point where a complete aging process took place. We will adapt the surgical gesture, based on the aging signs, addressing every area of the face with a simpler intervention instead of a “complex facelift”, and individualized to every patient. The message to be passed on is that it’s rather worth to preserve the signs of youth instead of waiting for significant signs of aging, requiring heavier surgical procedure that are harder for the patient. This concept leads to a faster recovery, smaller scars, and a more natural result tag is in harmony with the natural evolution of the face. A supplement with injections of hyaluronic acid is often useful to perfect the result or treat small wrinkles not treated by surgery (labial wrinkles for example). Botulinum toxin remains very useful to maintain the results for the fronto-orbital region, and the neck.

After the age of 60:
For the patients that never had any facial rejuvenation surgery, a facelift will be proposed specially for the lower face, usually the patients’ main requirement in order to correct cheeks, jowls and neck area. It is good to know that it’s not ideal to wait too long before considering a lift; once the tissues are too loose, two face-lifts one year apart may be required in order to obtain the same result because the significant tissue excess can trigger a tissue loosening in the first year post-op. Even if most of the patients are focusing on the lower face, an examination of the entire face should be done, and a blepharoplasty should be suggested at the same time so that the whole face would be more harmonious. In fact, it is the homogeneity that gives the face its harmony and avoids the situations of a bad rendering or the look. As in case of younger faces, a supplement with injections of hyaluronic acid and botulinum toxin is often useful to perfect the result or treat small wrinkles not treated by surgery. This must be done with great subtlety to maintain harmony and consistency of the face.

Who to trust to perform injections?
These last years, the Aesthetic Medicine has taken an important place in the management and prevention of facial aging, and many practitioners have been tempted to practice these injections, attracted by the novelty, efficiency, and relative ease of this approach. Some have thought it best to denigrate facial rejuvenation surgery, to try to further develop their activity of aesthetic medicine, sometimes leading to "puffies" that can be seen in some evenings, or some congresses of aesthetic medicine, and that do a lot of damage to the image of our specialty. It is important to reposition Aesthetic Medicine and Aesthetic Surgery, each in their right place, like the trays of a scale that would tend to balance. The Plastic surgeon is the best placed and most able to find the right balance between Aesthetic Surgery and Aesthetic Medicine. Furthermore, mastering the anatomy of the face allows him to perform the injections as accurately and efficiently as possible. If you can easily get injections from a plastic surgeon, this is probably the best choice.

The Renewal of cervico-facial facelifts directed by Delay E. Paris: Elsevier, 2017:253.