American facial plastic and reconstructive surgeon and author Dr Corey Maas will be a keynote speaker at the ACCS/CPSA Cosmetex Conference in 2012. Here he gives us a sneak peek into his perspective on anti-ageing at home and abroad.
What are the new trends in cosmetic procedures that are impacting your personal practice?
What we are seeing are trends toward younger patients investing in appearance maintenance, patients in their late 30s and 40s seeking incremental steps and ongoing maintenance for older patients that have had comprehensive rejuvenate procedures such as face and browlifting.
What is the tipping point between candidates you feel could be treated successfully with minimally invasive procedures, to recommending surgery?
I think the hard line between nonsurgical and surgical options has been overstated, even by physicians. The public is increasingly aware that many surgical options can be as cost effective and as ‰Û÷easy’ as non-surgical options. Simply described, I feel the surgical and non-surgical options we can offer patients are complimentary and our job is to effectively describe the options and their benefits, as well as risks, and let the patient decide what works best for them given their personal circumstances.
Timing is imperative when considering a procedure. When is the best time to have facial surgery?
I like to present patient with what I refer to as an appearance care life plan (ACLP). The plan is different for everyone based on genetic factors – like gender and heritage – and extrinsic factors such as sun exposure or smoking.
The two basic reasons for facial surgery are balancing facial features and age rejuvenation. In general, starting early with prevention and skin care as young adults and moving to smaller procedures like injectables can be helpful early on.
Balancing features can be important even in children. For example those with protruding ears, who can have self esteem issues during their early years, or teenagers with grossly disproportionate or twisted noses. Managing ageing is best done with a life plan that provides reliable steps to appearance, starting as young adults.
Do you believe facelifts are still considered the gold standard for addressing the ageing face?
In my experience, the term facelift is poorly understood by patients. While the surgical definition of a facelift is a repositioning of the lower face and neck tissues, many of my patients present describing their perception of a “full facelift” as a series of procedures as we as surgeons would think of them – namely browlift, blepharoplasty, and facelift with or without midface lifting.
Who is a good candidate for face lifting?
Most patients in their 50’s and above are good candidates for a facelift, which I describe for them as a lower facelift or cheek, jawline and necklift. A midface lift is a valuable ancillary procedure in over half of my patients – those that have retained midface volume that has become ptotic or droopy.
In the remaining patients the midface is, to varying degrees, hollow with volume loss. These patients benefit from lower facelift and midface volume enhancement, which can be addressed with fat transfer or injectable products like Radiesse or Sculptra.
Mini-facelifts (which are not standardised) can be offered to younger patients for subtle jowling and skin laxity around the cheeks. I typically recommend necklifts to patients with previous facelifts and accelerated loss of neck contour afterward or, in some cases younger patients with isolated (usually genetic) poor neck contour – the so-called ‰Û÷turkey waddle’.
What is your personal approach to facelifting?
My approach to the midface is a percutaneous technique using a proprietary suspension device. This technique involves a device that engages the ptotic malar fat pad and repositions the pad in a superiolateral (toward the temple) vector. In contrast to some of the published medical literature, I believe the vector of descent of these tissues is not inferior (straight down) but inferiomedial (toward the lip and nose). Thus the best way to correct the problem is to reverse the direction or vector of descent. I am not in favour of the subperiosteal, vertical or extensive dissection techniques.
Any expert tips for Australians wishing to keep the signs of ageing at bay?
Sun protection! Exercise. Healthy diet. Patients should have a good dermatologist, plastic or facial plastic surgeon or cosmetic doctor that can provide a plan for skin health and appearance management, long term.
