The Right Age for Plastic Surgery
Article by Rian A. Maercks, MD
Miami Plastic Surgeon
A question often posed is “when is the right time for plastic surgery?” In this instance it is of course aesthetic surgery that is being referred to. The short answer is simply there is not one universal “right time.” Aesthetic surgery is an extremely personal decision although becoming more ubiquitous at a younger age day by day.
Environmental and cultural factors have led to a higher prevalence of young people interested in treating the first signs of facial aging. If someone is thinking about an intervention, the question is almost already answered. the pertinent question becomes “what is the right intervention?” Unfortunately monetary motivations have really polluted the meaning of terms like noninvasive, nonsurgical, and nonsurgical. Furthermore new products with heavy marketing dollars behind them appear everyday adding to the public misinformation and confusion.
Early interventions for facial aging can be appropriate as early as the 20s in the right patient, however, correct selection and execution of the intervention are critical! How can you avoid making a bad decision? The answer is to find a practitioner that is capable, that you are comfortable with and importantly that has a large skill set to choose from. The old saying “if all you have is a hammer, the whole world is a nail.” This explains the ever expanding patient population seeking secondary plastic surgical corrections from the misapplication of injectable products.
‘Off the shelf products’ are very attractive for patient and physician because of quick application, quick revenue generation and short recovery but are not perfect and absolutely are not a replacement for other interventions. While absorbable hyaluronic injectable products are safe and reliable, they are temporary and require continued expenditures every 6-12 months. For the patient with minimal facial aging changes and acceptance of this continued cost and inconvenience, they are very well tolerated.
Problems, however, appear when shortcuts are attempted by placing semipermanent or permanent off the shelf fillers. There is a complication rate associated with this classification of fillers that is largely hidden from the public. Why is it hidden? It is largely not intentional deception, simply a result of the natural history of these products. The most devastating complications are not early and patients rarely return to the original physician for correction. Thus practitioners with complication rates are frequently unaware of these results.
Why are artificial fillers less than ideal? Anything placed inside the body, no matter how innert, illicits a response from the body and its local tissues. The viscoelastic properties of any injectable or implantable product are very different from the body’s native tissues. This means that even under ideal conditions these products cause atrophy, resorbtion and atrophy of the bodies tissues, fat and skin! What does this mean? It means these products actually advance the signs of facial aging!!! when these changes occur, even well placed product will migrate to unnatural positions creating bigger reconstructive and aesthetic problems.
Unfortunately this is only the beginning! An foreign body has a chance of causing a granuloma, a noninfectious nidus of chronic inflammation that can cause pain, redness and tissue destruction. Even hyaluronic acid injection can cause granulomas, luckily hyaluronic acid is usually not present long enough to cause severe problems even if a granuloma were to occur. Infection is an even worse complication and can happen at any time, with the possibility of devastating consequences. On a daily basis plastic surgeons correct and reconstruct problems caused by the trendy injectable products that were used 1-3 decades ago.
What about products that simply ‘create new collagen’ and are permanent?
This is a really attractive appearing pitch, but is a bit unethical in presentation. To begin with there are no naturally occurring foci of colagen in the deep layers of the face where these fillers must be injected. Secondly the new collagen refered to is SCAR TISSUE! Who would pay for a procedure designed to create a whole bunch of scar deep in their face? Well, these are some of the most popular interventions! A concentration of firm scar has slightly less predilection for causing granuloma but it just as well could be an implant because the relatively nonelastic qualities in an abnormal position also accerlerate facial aging!
So what can we do ?
For lasting volume correction, I inject a combination of fat, growth factors and stemcells that are derived from the patients own body. The result is beautiful correction, relatively unlimited volume correction at no additional cost( as in with off the shelf products). the advantages include permanent correction, actual improvement of the quality of the overlying skin(instead of deterioration), relative absence of long term complications, and significant cost savings for the patient. The average patient spends more money on injectable products in 2-3 years than the cost of this procedure! With injectable products the patient is either left with nothing, or with an ongoing risk of complications. With autologous injections the patient has a permanent rejuvenation that will change naturally with their body.