Facial Rejuvenation the Resurgence

INTRODUCTION

A famous poet William Shakespeare says that “BEAUTY LIES IN THE EYES OF THE BEHOLDER”. The true meaning of facial beauty represents a longstanding puzzle. But the hunt for facial attractiveness is increasing day by day. As the age increases soft tissues over the face undergo dramatic changes. The skin loses elasticity, fat reabsorbs, muscles lose tone and volume, and the bone loses volume, which leads to descent and increasing laxity of the soft tissue that rests on it.
The cosmetologists and plastic surgeons around the globe are always fascinated to find newer strategies for facial aesthetics. In recent years anti aging and facial rejuvenation procedure has gained wide acceptance. Innumerable surgeries are taking place in different corners of abroad as well as here by cosmetic doctors annually. From face lift to botox injections, as our society gets increasingly older, more people are seeking facial cosmetic surgery and other cosmetic treatments from all sorts of medical and dental cosmetic doctors. Many surgeons has restricted their practise to cosmetics since 20th century. In the evaluation of the cosmetic surgery patient, the surgeon can generally look at the potential treatment plan as one leading to rejuvenation of the patient, to appear younger and refreshed, or one that gives the patient something that they didn’t have before, such as a smaller nose or larger chin. A small portion of any aesthetic surgery practice will also alter the acquired facial deformities, like those due to trauma, or post treatment of pathology.

HISTORY

History suggests that plastic surgery procedures are in existence for centuries. The kinds of cosmetic surgery and augmentation procedures we tend to see these days were already utilized by surgeons back within the early 1800s. In ancient India, there was such a scholar called Sushruta who was arguably one among the pioneer cosmetic surgeons within the world. In his book, it’s clearly mentioned that plastic surgeries were living in India throughout the sixth century BC. Sushruta was the primary one to perform skin grafts.¹
After few years, certain surgeons also performed nose reconstruction by 600 BC. They used a chunk of cheek skin for this reconstructive surgery. By 1000 AD, there were many surgeons around the world who performed rhinoplasty. The growing quality of such procedure was also due to the barbaric custom adopted by many kingdoms to cut off the upper lips and noses of the enemy troopers.
Gradually, surgeons and doctors incorporated parts of what was being used for reconstructive surgery to introduce cosmetic surgeries. In 19th century development in aneshesia and antisepsis make plastic surgery safer and techniques got improvised. In 1871, Tilbury Fox described the use of 20% phenol in order to lighten the skin, which became the first chemical peel, a technique that Paul G. Unna refined in 1882 when he described the properties of salicylic acid, resorcinol, phenol and trichloroacetic acid (TCA). In 1881, Robert T. Ely described the first otoplasty for protruding ears, and six years. Later, in 1887, John O. Roe took an important step forward in the development of cosmetic surgery when he performed the first subcutaneous rhinoplasty.²
The first injections for tissue augmentation were described in the last decade of the 19th century. In 1893, Franz Neuber was the first physician who pioneered the use of autologous fat as filler material.
First modern Rhinoplasty take place in the year 1923. Facial rejuvenation procedures can be roughly divided into face lift surgery and non operative, less invasive procedures, such as fat grafts, fillers, botulinum toxin injections, thread lifts, or laser abrasion. Face lift surgery or rhytidectomy is the procedure most directly associated with rejuvenation, due to its basic ability to revive the anatomical changes caused by aging. The first public face lift surgery happened within the year 1931.
Of the top 20 overall cosmetic procedures performed, facial procedures continue to be persistently popular, including rhinoplasty, eyelid surgery, and facelifts in decreasing order. The area of most growth has been nonsurgical procedures, such Botox, facial volumizing, and chemical peels that have dominated and increased 508% since 1997.

FACIAL REJUVENATION PROCEDURES

Facial rejuvenation procedures can clinically divided in to invasive procedure like face lift and non-invasive procedures like dermal fillers,fat grafts, dermabrations. The number of aesthetic facial rejuvenation procedures carried out in the India each year continues to increase.

INDICATIONS OF FACIAL REJUVENATION PROCEDURES

• Reduce lines and wrinkles
• Tighten and change tonicity of skin
• Replace mild collagen and soft tissue volume loss
• Treat crow’s feet and glabellar wrinkles

BOTULINUM TOXIN INJECTIONS

Facial youthfulness often warrants the need for recognition of facial features The most potent non surgical cosmetic facial procedures today are botulinum toxin Type A injections, which has historical ties to the field of ophthalmology. It is s derived from potent neurotoxin Clostridium botulinum bacterium.³
Injection botox was manufactured and approved in the year 2007 by Allergan for the management of strabismus, blepharospasm an hemifacial spasm since 12 years. Its prominent role is in the smoothening of facial skin and reducing severe glabellar frown lines. In addition it has got other aesthetic indications, including lifting and reshaping the eyebrows, softening perioral lines, treating platysmal bands, and correcting facial asymmetry..Its dynamic role in the anti aging process is proven to last for up to 6 months. The commonly used and described toxins are IncabotulinutoxinA and OnabotulinumtoxinA.

DERMAL FILLERS

Another radical change in the cosmetic world is dermal fillers which gives a vibrant and youthful look. The type of filler materials used for each areas of face based on their pertinent anatomy. There are fillers which is either human derived collagen products or bovine derived, these materials retains in tissues for up to 12 months. One which is synthetic in origin is HA (Hyalouranic acid) is considered as work horse for liquid lift treatments.⁴ The main advantage of this volumetric rejuvenation is longevity. This is area of aesthetic procedure is still improving with the use of ultra sound guided approaches and detection of specific areas of fat depletion by high-resolution ultrasonic skin probe. Dual plane, dilution of filler material, and balance between peripheral and central restoration are interesting new concepts to read about in this symposium on facial volumetric rejuvenation. The commercially available ones are Juvéderm, Cosmoplast, Perlane (HA).

DERMA ABRASION

Another complement to aesthetic surgery is derma abrasion. It is considered safe and efficacious procedure can be even practised by dentists. It is the controlled abrasion of superficial dermis and epidermis using cylindrical fraises that rotates at 12000to 25000rpm via a hand held motor. After a series of abrasion increased dermal thickness with fibroblast production of new collagen and elastin occurs , and also enhances increased skin hydration with improved epidermal barrier function. Although it’s very simple and cost effecitive technique, dermabrasion should be in the primary list of any facial cosmetic surgeon as an adjuvant procedure.

PLATELET RICH PLASMA (PRP) SKIN REJUVENATION

Platelet rich plasma is a protein growth factor which has a key role in all phases of healing. Its an autologous concentration of human platelets in a small volume of plasma. Microneedling could be a kind of controlled, painless physical injury that is performed on the skin in order to trigger a healing and repair cascade. After numbing your skin with topical cream, heres use a small roller with small needles to do the microneedling that creates hundreds of mini channels in the skin for introducing PRP. PRP will boost stimulate the collagen production and tightens the areas of administration.

FACE LIFT or RHYTIDECTOMY

Are your eyelids droopy ? Do you have a doube chin? Face lift or rhytidectomy is considered the baby boomer in this field. The key factor in choosing a facelift is, when you begin to have lower facial jowling and lax or sagging neck skin – then it is time to stop fillers and Botox and consider a surgical facelift. Before any procedure it is important to open your expectation to your cosmetic surgeon. This procedure is done to contour the facial features and bring back the natural jaw line. Although facelift surgeries date back to twentieth century procedures are still evolving. It can be done as an outpatient basis on local anaesthetics and sedatives or general anesthesia.⁵
SMAS is a composite layer of face consisting of collagen, elastin and facial mimetic muscles. SMAS layer also ages. Relaxation of the SMAS layer occurs, and the tonicity of the SMAS and facial expression muscles decreases. SMAS plication is procedure which involves manipulation of the deep soft tissue underneath facial skin, a suture plication technique for the SMAS layer .it may be combined with surgery to enhance the forehead, cheeks, brows, and eyelids. The advantages of SMAS plication are that it is easy to perform, there is little risk of facial nerve injuries because no dissection is performed under the SMAS layer, and it involves a relatively short downtime. In addition, since the deeper tissue and retaining ligaments remain untouched in this technique, the long-lasting result of the lift may be limited.

TYPES OF FACE LIFT

• SMAS PLICATION
• MACS {MINIMAL ACCESS CRANIAL SUSPENSION LIFT}
• LATERAL SMASECTOMY
• EXTENDED SMAS
• MODFIED DOUBLE PLANE
• COMPOSITE
• SUBCUTANEUS
• SUBPERIOSTEAL

CONCLUSION

There is a paradigm shift in the dental practise nowadays towards aesthetic dentistry. In today’s world of sophisticated patients, it’s time to take a serious look at the topic of facial rejuvenation. The between facial crucial relation soft-tissue contours, anterior dental aesthetics and function, must be addressed and its importance should be detailed to our patient.

REFERENCE

1. Bennett JP. Aspects of the history of plastic surgery since the 16th century. Journal of the Royal Society of Medicine. 1983 Feb;76(2):152-6.
2. Rogers BO. The development of aesthetic plastic surgery: a history. Aesthetic Plast Surg. 1976;1:3–24
3. Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Journal of pediatric ophthalmology and strabismus. 1980 Jan 1;17(1):21-5.
4. Klein, Elson. The history of substances for soft tissue augmentation. Dermatol Surg 2000;26:1096-105
5. Sozou PD, Seymour RM. To age or not to age. Proc Biol Sci. 2004;271:457–463