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While Plastic Surgery is truly a much more comprehensive field including reconstructive surgery following burns, cancer surgery, and birth defects, the image most often projected in the media is that of image or beauty enhancement and non-surgical and surgical facial rejuvenation of otherwise normal people by surgery.

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Revolutionary technological advancements in the past decade have significantly impacted the field of Plastic Surgery creating a shift from traditional surgical procedures to new non-surgical methods for correcting aging changes and improving appearance.

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Today Botox® injections can remove crow’s feet, frown lines, worry lines, and help lift the sagging brow. Prior to Botox® major facial surgery such as a brow lift and blepharoplasty (eyelid lift) were performed to correct these aging changes.

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New fillers such as Restylane® and Radiesse® are injected into the nasal-labial fold, lips, and marionette lines, those deep lines running from the lips down around the mouth and chin. Previously, a face lift was performed to correct these lines.

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Skin tightening technology such as aluma, ActiveFX, LuxIR, Titan® and Thermage® are becoming better and can improve facial sagging in 30% patients if used early before the sagging is severe. Many patients choose to have one of these techniques rather than a face-lift. Many other new exciting techniques for laser restoration of skin collagen (Laser Genesis®) and improvement in skin wrinkling, removal of pigment, and removal of red spots and blood vessels on the face are already in use today.

These dramatic advances coupled with increasing public awareness of the importance of sun protection, a healthy anti-inflammatory diet, exercise, stress reduction, and a healthy lifestyle undoubtedly will impact the Plastic Surgery practice of the future. The Plastic Surgeon of the future will still have to be a highly skilled, knowledgeable surgeon, but I predict he/she will need to be an expert in the newer laser, light, pharmacological, and lifestyle therapies as well.

Plastic Surgery is becoming more non-surgical with every new technological advancement. The 6-step facial rejuvenation program encompases all the new non-surgical facial rejuvenation techniques. For questions read Save Your Face, or contact me.

Dr Seckel

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Wrinkles on the face are surface irregularities and must be smoothed out by deep skin exfoliation to remove dead skin and wrinkle debris from the surface of the face. Non-ablative technologies such as IPL, Photo Facial, Thermage, Titan, Aluma, LuxIR and other photo-facial therapies work by stimulating new collagen to grow in the deeper layers of the skin but do not provide skin exfoliation which is required to remove the surface irregularities. Restylane, Radiesse, Sculptra, Collagen, Hylaform, Cosmoplast, and Cosmoderm are non-surgical facial rejuvenation fillers which are injected into the deep layers of the skin to plump lines, but again they do not provide skin exfoliation and do not address the surface wrinkles.

Skin Exfoliation removes dead skin and surface irregularities similar to the way imperfections on wood are removed by sanding, but in a much gentler and safe way. Deep skin exfoliation also stimulates the deeper layers of the skin to grow new collagen. After exfoliation, once the dead skin cells are removed, topical creams such as Retin A, Tazarotine, Vitamin C, and Prevage will penetrated the skin more easily and be more effective.

Effective skin exfoliation can be accomplished by microdermabrasion, micropeel, and ablative laser skin exfoliation therapies like microlaserpeel, ActiveFX Laserlyte Peel, or by various chemical peels. I start my patients on gentle no down time methods like Obagi Skin Care and skin exfoliation with microdermabrasion first. When the patient decides they want more skin exfoliation and wrinkle removal I advance to the new effective deep skin exfoliation provided by the ActiveFX Laser Peel, an exciting effective laser skin peel which provides deep skin exfoliation and skin tightening as well with minimal down time.

There are many new exciting facial rejuvenation methods available today, but they must be applied in the proper order. Skin Exfoliation is the first basic step in the 6-step facial rejuvenation program. To spend money and time on therapies that work on the deeper layers of your skin to promote new collagen formation without first using skin exfoliation to remove dead skin and the wrinkle surface irregularities is in my opinion-wasted effort.

First things first, start with the first step, deep skin exfoliation for effective wrinkle removal. Contact me for further information or questions or read Save Your Face.

Dr Seckel

Boston, Massachusetts

I use this exciting new technology to treat fine lines, sun damage, brown spots, blotchy pigment, uneven skin tone, and acne scarring with excellent results.

Unlike so many widely advertised non-ablative, photofacial laser and IPL treatments that require 5-7 months to see a result, the results of the MicroLaserPeel are evident immediately. Better, the beneficial effects of the MicroLaserPeel, new collagen formation, and softer more uniform younger looking healthy skin continue for months after the treatment.

MicroLaserPeel removes the outer dead skin cells from the face and stimulates the deeper skin layers to from new healthy young skin cells and new collagen in the deeper skin layers. The result is fresher looking, glowing new skin with fewer fine wrinkles and fewer brown spots and pigment irregularities.

The first step in any skin rejuvenation program is exfoliation, the removal of the dead skin cells covering the outer surface of the facial skin. None of the many non-ablative laser and IPL therapies offered today provides this important first step. Only the MicroLasaerPeel using the Erbium laser provides this important basic first step facial rejuvenation process, in a uniform manner, with minimal down time.

The MicroLaserPeel is the perfect minimal down time alternative to the “gold standard” laser resurfacing for facial rejuvenation.

Contact my office via e-mail, or call 978-369-4499 for more information on any of the above procedures, or read Save Your Face.

Dr Seckel

Boston, Massachusetts

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A startling 12.4 million cosmetic plastic surgey operations were performed in this country last year and estimates are that nearly half of them were to correct facial aging and this does not include the millions of non-surgical facial rejuvenation procedures.

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As the baby boomers reach their 50’s everyone wants to look younger but no one wants to have surgery. Most people do not want to have surgery especially if it is not for serious medical reasons.

However, revolutionary advances in technology have made it possible for many people to reverse facial aging changes using new non-surgical facial rejuvenation techniques without having to undergo plastic surgery.

This past Wednesday, September 28, 2005, I spoke on a panel entitled Non-surgical Facial Rejuvenation at the meeting of the American Society of Plastic Surgeons in Chicago, Illinois. My topic was Botox, the soft tissue fillers including Restylane and Radiesse and the many skin peels used for exfoliation to remove wrinkles and signs of facial aging. I came away from that meeting very excited and enthused about all the wonderful new non-surgical facial rejuvenation therapies that are safe and effective for patients today.

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There are so many new wrinkle removing and skin tightening non-surgical facial rejuvention options available that the patient must understand exactly what facial aging change it is that they want to correct. Usually the patient just feels that their face looks older but cannot pinpoint exactly which facial aging change is causing concern. It is important to seek consultation with an experienced board certified Plastic Surgeon or Dermatologist who understands all the options so that the correct option is chosen for your very unique face. I advise you to avoid doctors who only do one or two facial rejuvenation procedures and tend to push patients to have the procedure that he/she performs rather than customizing the procedure to the patient’s needs.

The 6 Step Facial Rejuvenation Program™ consists of:

Step 1-Exfoliation-topical cremes, microdermabrasion, superficial skin peels with various fruit and salicylic acids to produce exfoliation to freshen the skin and give it a youthful glow and remove wrinkles. These treatments also stimulate the skin to form new collagen to replace the old damaged aged collagen, and help rejuvenate and tighten the facial skin.

Step 2- Stimulation of new collagen production- Controlled inflammation of the deep skin layer called the dermis causes the dermal skin cells called fibroblasts to manufacture new collagen to replace the collagen lost by sun damage and aging. Topical RetinA and the deep exfoliative process in step 1 start this process. Newer technological interventions like the Lux1540, Fraxel, Lux294o, Sciton Profractional, and Lumenis bridge therapy are powerful stimulators of new collagen production.

Step 3-Remove pigment and red spots-In addition to exfoliation new light and laser therapies such as IPL, Photo facial, Lux1540 and Fraxel® can be used to remove brown spots, pignent, broken blood vessels called telangiectasias, and rosacea from the facial skin. Pigment and blood vessels are a classic sign of facial aging and the non-surgical removal of these skin discolorations provides noticeable facial rejuvenation. These high tech yherapies can also remove wrinkles.

Step 4-Remove lines of facial expression wrinkles- Botox can be used to relax the muscles of facial expression and remove crow’s feet, worry lines, frown lines, and bunny lines and dynamic wrinkles, all of which are very early signs of facial aging. Botox® effectively removes these lines in most people for 6 to 9 months after a simple nearly painless injection.

Step 5-Fill deep facial lines called the nasolabial fold lines and marionette lines make the face look tired and old and coupled with the frown lines often make people look angry. Deep facial lines are deeper than wrinkles, and I do not use fillers for wrinkle removal. New soft tissue fillers can soften the nasal labial fold lines and marionette lines when they are injected into the skin beneath the aging lines. Commonly used soft tissue fillers are Restylane, Radiesse, Zyderm, Zyplast, Juvaderm, Sculptra®, Fascian®, Cymetra®, and Isolagen®. Each of these fillers has different characteristics and are better for some facial aging changes than others. For a thorough discusion of fillers consult Chapter 7 “No Down Time Facial Anti-aging Procedures” in Save Your Face, available on line at www.saveyourface.com.

Step 6-Skin Tightening. The final facial aging change to treat is loose sagging skin. While the plastic surgical operation called a facelift is still the “gold standard” for facial rejuvenation, several new technologies are evolving which can tighten aged facial skin. LuxIR and Titan®, devices using infrared waves, and Aluma and Thermage® which use radiofrequency waves, are all being used to heat the collagen in the deep layers of the skin called the dermis causing the collagen to shorten and tighten the skin. While these technologies are new and only about 30% effective and require multiple treatments, they will most certainly be improved in the future and effective skin tightening of aging facial skin will be possible. Some wrinkle removal is seen following successful skin tightening.

Non-surgical facial rejuvenation is here and is getting more effective as new products come out every month. One of my common expressions whenever I speak about the new non-surgical options for facial rejuvination is “plastic surgery is becoming non-surgical” and try to encourage my fellow plastic surgeons to embrace the new technology. I still believe that an experienced board certified plastic surgeon is the best doctor to provide the non-surgical facial rejuvenation procedures to patients because these doctors are the facial aging experts and they have the ability to do what is necessary for the patient whether it is Botox or a facelift. Each face is unique and a “one size fits all” approach just does not work in facial rejuvenation.

Contact me for more information on any of the above procedures, or read Save Your Face.

Dr Seckel

Boston, Massachusetts