Dr. Martin Jugenburg, plastic reconstructive surgeon, interview: "Is the Face Lift Dead?" by Deirdre Kelly, The Globe and Mail.

TORONTO, CANADA, November 13, 2010

A three procedure approach, a combination of fillers, Botox, and skin bleachers (to erase brown spots (age spots and even skin tone and pigmentation) is now able to create astonishing results without the downtime of a major surgical procedure such as a Facelift.

According to the American Society for Aesthetic Plastic Surgery, cosmetic surgeries were down 17 per cent last year to 1.5 million from 1.8 million in 2008, based on data from an annual survey polling 928 board-certified physicians. The two biggest declines were facelifts (down 28.9 per cent over the previous year) and forehead lifts (down 30.7 per cent).

By contrast, less expensive non-surgical cosmetic treatments fared better, with 8.5 million of them performed last year, up less than one per cent from 2008. That category includes Botox injections (up five per cent over the previous year) and hyaluronic dermal fillers such as Restylane, Perlane and Juvederm (up six per cent).

A tremendous amount of research has gone into understanding what changes a face undergoes as it ages, and we now understand that from a cosmetic point of view the main issues of an aging face are: shrink, sink, and shrivel (loss of volume, sagging, drooping, and wrinkling and age spots).

Facelift will always have a place in patients with significant signs of aging and excessive skin laxity. However as more and more patients are starting rejuvenation treatments earlier and earlier, they are preventing signs of aging and may very well never get to the point where a facelift is their only option.

However, as the non-surgical treatments keep improving, so do surgical options available today. For example, some surgeons are starting to be able to perform surgical facelifts under local anaesthesia. It's almost like going to a dentist. A single needle poke on each side to numb the face is all it takes to allow surgeons to perform a full surgical facelift. A facelift, known as MACS facelift is minimally invasive and well suited to be used in addition to local anaesthesia. The benefit of this new advancement in facelift surgery is that now patients do not need to be under general anaesthesia, there are no side-effects such as nausea, no need for 24hr monitoring after surgery. Patients simply get up and leave as if they just went to the dentist. Fillers or fat injections are also used in combination with a surgical face lift. Facelifts today reposition and lift fat pads back in cheeks but sometimes it's not enough so you also add filler or fat to replace pockets of missing fat to even out and sculpt the face back to a more youthful appearance.

Shrink, sink, and shrivel of an aging face can be corrected with a Three D (deterioration, decent and deflation) Treatment: A combination of Volumizers and Hyaluronic Acid (HA FILLERS) like Restylane, Juvederm and Teosyal), and Botox, and lasers or acid peels (to erase brown/age spots).

All of these problems can be corrected with a combination of fillers such as Hyaluronic Acid, Botox and topical bleaching products or lasers like IPL for correction of uneven pigmentation and age spots.

With the use of fillers such as Hyaluronic Acid (HA) based products (Restylane, Teosyal and Juvederm,), and fat graphting which are able to provide volume and support, are able to create effects that previously were only possible with surgery. Many Hollywood stars or TV personalities are open about their use of these fillers and or Botox like Jenny McCarthy, Janice Dickinson and Lisa Rinna while others don't admit to it but certainly look like they've had some help like Sharon Stone.

In addition to the armament of fillers which add volume, contour and correct hallow cheeks and chin there is, neurotoxins such as Botox are used to paralyze very specific facial muscles to prevent the formation of future wrinkles, or the worsening of existing wrinkles which form when patients smile, talk, and frown.

In addition to synthetic materials such as Hyaluronic acid fillers, a growing number of physicians are using patients' own fat for facial rejuvenations. There are many great benefits to fat. Fat is 100% natural. Fat grafting to the face introduces a permanent, all natural facial rejuvenation. Once it heals in place it stays there forever, unlike most filler, which get absorbed over time. In addition to adding volume and support to the face, fat is now known to be a great source of stem cells, cells which have a great regenerative potential and can help repair the damages associated with aging and sun exposure. Tissues exposed to stem cells seem to regain a more youthful look and feel to them. They are thicker, softer, and smoother. Using your own body material (fat injections) is also being successfully used to add volume to the hands, breasts and butt.

To round out the revolumized and refreshed face there are skin surface treatments like various bleaching products to get rid of brown aging spots and uneven pigmentation and lasers like the Intense Pulsed Light (IPL) that are quite effective at improving the texture quality of the skin by treating sun-damage, enlarged pores, brown spots, broken capillaries, acne and skin redness.

Being overdone is never the goal for most. The predominant majority of patients come in asking to look natural; they just want to look a little more youthful, relaxed and refreshed. They do not always want the more dramatic change that a facelift may produce. However there will always be a small subset of patients who think extra large lips, overly prominent cheeks are beautiful and request that look but they represent a minority of the patients out there.

Many Hollywood stars have had fillers and Botox and the results are not always ideal. Overly done lips, frozen faces, the landscape is littered with examples of what not to do. And patients often do come in pointing out particular Hollywood stars as an example of what they do not want. Names like Nicole Kidman, Megg Ryan, Lisa Rinna and Katie Price often come up.

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