Facial rejuvenation and non-invasive procedures


For the last several years, the emerging trend in cosmetic surgery has been moving away from surgery and toward non-invasive procedures. A majority of patients can no longer afford the downtime associated with surgery. Another factor in this emerging trend has to do with the great leap technology has made in producing better quality products and procedures that can help patients achieve facial rejuvenation with better results, less discomfort, less downtime and even less cost.

The use of Botox and cosmetic fillers such as Radiesse, Juvéderm and Restylane have enabled the patients to achieve great rejuvenation of facial features with no downtime at all. In the last several years we have also seen an explosion of different types of lasers and light-based therapies being made available in the marketplace. The use of Botox, cosmetic fillers and lasers can achieve very good results, providing that the highest standard of care is maintained. There can be problems if these treatments or procedures are provided to patients without the supervision of board certified plastic surgeons or dermatologist. As long as the highest standards of safety are adhered to, a patient can expect a reasonably good outcome from treatment.

So now, when a patient is considering facial rejuvenation, we usually recommend a combination of Botox, cosmetic fillers and laser therapy. In fact, we only recommend plastic surgery such as a face lift as a last resort. Sometimes surgery cannot be avoided particularly if the patient has such excessive skin or sagging skin. Most of the time, however, we can achieve very good results by using a combination of non-invasive procedures. I have found that there are so many cosmetic fillers and such a wide array of lasers that it can be helpful if I describe some of the different types and how they are best used.

The Liquid Face Lift

Over the years the skin tends to lose collagen and elastin, which can contribute to sagging features. The loss of the skin’s volume and elasticity can cause wrinkles, lines and folds. Plastic surgeons and dermatologists began treating these symptoms of aging with dermal fillers and BOTOX® In many patients there were results that gave sagging features a noticeable lift. A liquid face-lift is accomplished by administering a combination of BOTOX® along with the cosmetic filler that your surgeon has determined to be the best fit for your skin's overall condition and your lifestyle.

What can a Liquid face-lift do?

* Can give a gentle lift of your overall facial features.
* Can reduce wrinkles, lines or the appearance of folds.
* Can restore the natural contours of the youthful expression of your face.
* Can give a more rested, energetic look.
* Can give you a friendlier smile.

These are the current generation of dermal fillers: Juvederm Ultra, Juvedermtm Ultra Plus, Radiesse, Restylane, Perlane and Sculptra and they are all slightly different in how they are made and how much they cost. During your medical evaluation, your plastic surgeon or dermatologist will assess the overall appearance of your skin and make a careful assessment about which filler is the best one for you. Two different types of fillers that get very good results are Radiesse® and Juvedermtm


Radiesse is made of tiny, calcium-based microspheres suspended in a natural water-based gel. It works with the body, below the skin’s surface, to stimulate the production of collagen and encourage tissue regeneration. Radiesse provides both immediate and extended results. Initially, the water-based gel helps to fill the wrinkle, line or fold. As this gel begins to dissipate, the calcium-based molecules form a scaffold that stimulates the production of collagen and promotes tissue regeneration. Ask your Doctor about Radiesse and if it is the right filler for you.


Juvederm(tm) is a crystal-clear gel produced by using stabilized, nonanimal hyaluronic acid and water. The hyaluronic acid closely resembles the hyaluronic acid that occurs naturally in the body. By replenishing nature’s supply of hyaluronic acid, Juvedermtm revitalizes and plumps up the skin, instantly diminishing the appearance of lines and giving a softer look. One of the great advantages of Juvedermtm is that the effects are long lasting but not permanent. How long Juvedermtm lasts depends on lifestyle, age, and the injection technique of the practitioner. Ask your Doctor about Juvedermtm and if it is the right filler for you.

The Laser Maze

Now I am going to devote some time to explaining Lasers. There are so many different kinds of lasers that it can create confusion. I thought it would help you if I show how lasers differ from one another. Laser treatment can be very useful for a wide variety of skin problems including rosacea, hyperpigmentation, broken blood vessels, wrinkles and sunspots…to name a few. If you are ever considering any type of skin therapy, it is essential that you are seen by a physician who is well-versed in all the variations of skin and the many types of treatments that are available.

What is the difference between Lasers and Light-based therapies (IPL)?

What we call (IPL) Intense Pulse Light or Photo Rejuvenation or Photo Facial—they are all light based therapy. They are not laser therapies per se. The difference between the Laser and the IPL is the spectrum of the light. Lasers are usually one wave length and they are more precise. Lasers have more narrow “indications” than any type of (IPL) Intense Pulse Light or Photo Rejuvenation or Photo Facial light therapy. (IPL) Intense Pulse Light or Photo Rejuvenation or Photo Facial has a broad spectrum of light that can successfully treat Rosacea, spider veins, sun spots or hyperpigmentation and fine wrinkles at the same time while it tightens the skin.

Lasers such as the Vascular Laser and lasers that can do skin resurfacing are very specialized and can only perform the function for which they were intended. Some lasers are strictly vascular and only treat spider veins. This can be a much more effective treatment than light based therapies. Lasers that do skin resurfacing (CO2 Lasers and Erbium: YAG Lasers) were created to do skin resurfacing—to remove the upper layer of the skin epidermis and part of the dermis, which, in this process, also removes sunspots and small to moderate wrinkles. Laser resurfacing will stimulate the creation of new skin or new epidermis.

What about Titan and Thermage?

IPL and Lasers are different from Titan and Thermage. Titan and Thermage are not lasers and work on a different kind of technology. They go underneath the skin and reach the level of the deep dermis to stimulate the collagen and to tighten the skin. They do not do anything to remove redness, Rosacea, spider veins, sun spots or hyperpigmentation. They are limited in scope.

How are Titan and Thermage different from the Profractional Laser?

Titan and Thermage are not lasers. Profractional is a laser. Now as technology evolves and gets better, the Profractional Laser can basically do two things. First, it can remove the sunspots, hyper pigmentation, and do a micro peel. Second, at the same time it can tighten the skin by stimulating the collagen the same way (Titan and Thermage stimulate collagen.)

Two of the latest, non-invasive cosmetic procedures can be done with the Sciton Contour TRL Laser. Known as the “Weekend” Skin Peel, The MicroLaserPeel procedure can give you healthier, smoother, more vibrant skin. The MicroLaserPeel is the perfect step between microdermabrasion and full skin resurfacing. Skin conditions such as wrinkles, scars, acne scars, keratoses, or pigmentary problems have been very successfully treated with a MicroLaserPeel. The ProFractional Laser procedure is quick and improves the appearance of your skin with little or no downtime. ProFractional can improve a wide variety of skin conditions such as Wrinkles and fine lines, Post-traumatic scars, Acne Scars, Age spots, Sun spots, Freckles, and Aging and Sun-damaged skin.

The MicroLaserPeel or the Profractional Procedure: Which is the best one for you?

The ProFractional Laser procedure can be combined with a MicroLaserPeel or other aesthetic procedures such as Botox and cosmetic fillers to further enhance your treatment results. We have had a wave of patients who have undergone these two new laser treatments with the Sciton Contour TRL Laser and have been very pleased with the results they are getting with little or no downtime.

In summary, a physician must carefully assess the overall condition of your skin and the level of improvement you desire. A medical doctor must look at the skin of the patient and find out what the patient wants to achieve. The doctor must analyze the patient’s skin and decide the best treatment possible. Most of the time, the patient needs a combination of treatments: IPL Intense Pulse Light Therapy, and superficial skin resurfacing through a Micro Peel, followed by the tightening of the skin with the use of a Profractional laser.

The patient might also be best served by administering Botox and a cosmetic filler. The key is to find a physician who is well-versed in skin and who knows all of the best treatment options that are available. I can’t stress to you how important it is that before you opt to get any type of non-surgical facial rejuvenation treatment that you thoroughly understand the training and experience of your plastic surgeon or dermatologist. My first concern is, as always, for the safety of the patient.

Article by
Massena Facial Plastic Surgeon