Cosmetic Surgery : Facial Rejuvenation & Body Contouring

Dr. Francis Beninger is one of the most renowned plastic surgeons in North America. He has trained with many prominent plastic surgeons and has practiced in both the United States and Canada where he performed the latest cosmetic surgery techniques and procedures focusing on facial rejuvenation and body contouring. On a recent Botox visit with Dr. Beninger, I asked if he would provide MODWOMEN readers a clearer perspective on the myriad of available treatment and surgery options. Here's what Dr. Beninger had to say:

1. The term Portrait facelift is a misnomer. The portrait device is a skin resurfacing technology. It lays down hundreds of tiny laser pixels on the skin, which results in a very superficial removal of skin. These tiny zones of injury are spread apart from each other so that there is unharmed skin in between the dots. Because the injury is superficial, the areas heal very quickly and results in some new collagen formation. There is softening of fine lines, and some skin tightening. This is not nearly as dramatic as the results that have been obtained with Erbium lasers or CO2 lasers. The problem with the older lasers is that there is considerable down time for healing, and a risk of skin pigment changes. These risks are dramatically reduced with Portrait. As well, the degree of skin tightening is not as great. Some physicians who are not surgeons do repeated treatments with the technology in an attempt to rejuvenate the facial appearance and thus call it a face lift. It does not even begin to compare with the results obtained with a surgical lift. It can improve the appearance of the skin as well as texture and even out the color of the skin.

2. I think that women overall are more educated and socially accepting of cosmetic procedures. There has been a great push to have natural results without the over-operated look that was common previously. With some of the reality shows that are on TV, the public may be misinformed about what surgery can really do for them. TV wants the "wow" factor but I think they are going overboard. The public is not being informed about how much of the wow is due to lighting, makeup, camera angles, or editing. They may think that there is nothing to the procedures and may be under-informed about the risks involved or the psychological changes. Having multiple procedures performed in a short course of time is not the norm. Television is still pressuring the public that they must look a certain way and that any sign of aging is a negative thing. People don't generally ask to look like a certain celebrity, but do comment about certain celebrities features that they consider attractive, or sometimes unattractive. Most women do not want to lose their identity. They want to look like themselves. They don't want to look operated on. They are really looking for procedures that make them look revitalized, not necessarily younger.

3. Hottest new procedures are really anything with shorter down time. Today's society is extremely active and on the go, both physically and socially. They don't want to hide out for a couple of weeks while they recover. Less aggressive surgery usually results in less bruising and swelling which allows them to get back into circulation quicker. There is a great push towards less invasive treatments. Technology is being investigated to cause skin tightening without cutting the skin. The concepts make sense, but it takes time to perfect the equipment. We are really in the first or second generation of this equipment and there is a great distance to go before we can offer a non-surgical facelift.

There is certainly wide-spread use of Botox. Gone are the days of individuals wanting a paralyzed face. Rather, Botox is being used to artfully sculpt the facial features by softening muscles. This can only be done by expert injectors. Treatments are now being offered in dental offices, spas, people's basements. This is where results are going to suffer.

We have always known that aging faces lose volume. It is comparable to a grape slowly aging and turning into a raisin. We want to re-inflate the raisin so that it looks like a grape again. Unfortunately, we didn't have many means to do so. This has changed with the introduction of the longer term filler like Sculptra or BioAlcamid. These can be used to restore facial volume and "re-inflate" the skin envelope which results in a more youthful, rejuvenated appearance.

4. Skin care has always been important. This is a multi-billion dollar industry. The most important components are sunscreens and moisturization. Lately, more has been understood about anti-oxidants. These can reduce and in some cases reverse damage done by cellular metabolism, sun damage, smoking damage, and pollution. Anti-oxidants can be taken orally (several vitamins) or topically (eg Vitamin C creams). Vitamin A acid creams and retinols can plump the skin and give it a more even texture. There is a lot of work being done to create a cream that is really a drug delivery system and allow "medications" to pass through the skin.

Skin care does not have to be expensive or time consuming with multiple products. Unfortunately, there is no one product that is best for every one. You may have to try different products until you find which one is best for you. This can also change as you age, or even during different seasons of the year due to changes in temperature, humidity, or sun exposure. I am always surprised that some people are willing to pay thousands of dollars on skin care, but continue to smoke a pack of cigarettes a day. Skin care should begin by reducing toxin intake and sun exposure. Skin creams are only a component of skin care.

5. There aren't any new procedures for body surgery. The surgical techniques are being modified to try and reduce the size and length of scars as much as possible. There is a greater increase in excess skin removal procedures as society is becoming more weight conscious. Many people have been overweight and are now trimming down. There is a continued interest in breast augmentation or breast lifts to restore a woman's breasts to what they were like previous to having children.

6. Botox parties are unprofessional. They are not being performed by expert injectors. The environment is not a proper clean medical environment, and the attendees are not being properly informed about the risks and benefits. Individuals may be coerced by their friends to do something they may not really want to do. Medicine and medical care is serious. If a physician is willing to participate in this kind of environment, their reputation should be questioned.

There is no specific age that one should consider starting procedures. I see people in their 20's who have significant aging and have also seen people in their 60's who really don't look aged at all. People have differing ideas of what aging looks like. I think that the right time to start to do something is when the individual sees something that bothers them enough to consider doing something about it. They must understand and accept the risks involved, the cost, the recovery, and the duration of effect. Certainly starting some less invasive treatment such as Botox injections at a younger age, may reduce the development of permanent lines and wrinkles which may require a more aggressive treatment at a later date.

7. All individuals should consider:

• - A healthy diet, quitting smoking, multivitamins and supplements which are anti-oxidants, sunscreen, skin care, and drinking lots of water.
• - At age 35, women could consider Botox or Hyaluronic Acid Fillers (eg Restylane or Juviderm) and skin peels with an Esthetician.
• - At age 40, the above. Some women may start to consider upper eyelid surgery, tummy tuck (following childbirth), and breast augmentation to restore volume lost from having children.
• - At age 50, the above. Some women might consider volume augmentation of the face using Sculptra, brow lift (often endoscopic), mid or full face lift. Breast lift.
• - Age 60, the above. Sometimes redoing a previous procedure for maintainance.

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