Despite the regular appearance of new products and instruments, big advances in cosmetic surgery happen only every few years. Innovations hailed as the next big thing not long ago, like the much vaunted thread lift for facial rejuvenation, often fall out of favor, either because they prove dangerous or, ultimately, not effective. Real progress is made mostly through constant refinement of the tried-and-true.
“A thread lift is borderline malpractice today,” says Dr. Christopher Saunders, a board-certified plastic surgeon in Newark and Wilmington. “You can’t believe everything you hear. You can’t believe everything you read.” Yet significant advances do occur, and that’s good news for you. Cosmetic surgery is better than ever, delivering good results for people who have realistic expectations.
To set the record straight, Saunders, author of “A Woman’s Guide to the ‘Real-Reality’ of Cosmetic Surgery” in 2006, will publish “The Tricky Fountain of Youth: Understanding Cosmetic Surgery” in March. “You need to trust your doctor to filter through everything that’s new,” he says.
Among the real advancements is a better understanding of aging, which has resulted in improved procedures. The facelift of yore, for example, was performed by tightening skin. Today, it often involves transferring fat from one part of the patient’s body to areas of the face where fat has decreased due to diminishing hormones. Fat transfer can fill hollow cheeks, reduce bags below the eyes and improve other areas.
During the procedure, fat is harvested from one part of the body through liposuction, spun in a centrifuge to remove blood and plasma, then transferred to the target area, also via a syringe.
Added in many small layers, the transfer is a sculptural technique that requires a strong aesthetic sense and deft touch by the surgeon, says Dr. Peter Coggins, a cosmetic surgeon in Wilmington.
Though fat transfer has been performed for years, it is just now hitting the peak of refinement, says Coggins, whose own refinements include inventing a special needle for contouring around the upper lip.
Fat doesn’t fix everything. Some patients may still need liposuction to remove tissue from the neck or some skin tightening in areas. Yet fat has proven to deliver a better result, one that looks more pleasing and lasts longer than traditional lifts or injections of synthetic fillers because, some surgeons believe, stem cells in the patient’s own fat eventually generate new tissue.
Though that idea has yet to be proven conclusively, fat transfer is sometimes presented as a “stem-cell lift.” The stem-cell theory may prove true in time. Still, Saunders cautions against falling for similarly fancy names or promises that seem to be too good to be true.
Two other significant advancements that aren’t hype, Saunders says: Surgeons have started inserting breast implants below the patient’s pectoral muscles to create a more natural look and feel (more below), and some are using what he calls a “pain pump” after some surgical procedures. The “pump” is taped to the body, where it drips a steady stream of the anesthetic Lidocaine through tubes to the surgery site for 72 hours to relieve pain post-op. “In my opinion, it has revolutionized tummy tucks,” Saunders says.
The only way to learn if something works is to try it, of course, so surgeons like Dr. Asher B. Carey of Dover will explore new products, like Zerona, a low-level laser instrument used to reduce fat all over the body in suitable patients. “We’ll see where it goes,” he says. Dr. Mehdi Balakhani, chief of cosmetic surgery for Christiana Care, is watching results of treatment with the Joule by Sciton, which delivers thermal treatment via laser and radio-frequency technologies in one unit that can address several skin conditions. Though it looks promising, Balakhani says, “To me, ‘cutting edge’ means nothing unless it proves itself.” Says surgeon David Zabel, “A lot of that stuff may not hurt you, but it may not last. At some point, you have to rely on the relationship you have with your doctor.”
Overall, the trend in cosmetic surgery is toward less invasive treatments that result in shorter recovery periods and cost less, says surgeon Abdollah Malek of Newark. Below, more on the most commonly performed and time-tested procedures.