By DAVID A. SCHLESSINGER, M.D.
The latest trends in cosmetic surgery have been geared towards less invasive rejuvenative techniques. Injectables such as Restylane®, Juvederm®, and Botox® can quickly rejuvenate a person’s appearance by filling the face and eliminating lines. Many people who needed surgery in the past can be quickly treated during these lunchtime procedures with minimal or no downtime. However, aging, sun damage, smoking, and even excessive exercising can age the skin. While injectables can fill and plump, they cannot get rid of sun damage nor do they truly tighten the skin.
Over the past years many laser and laser-type treatments have come and gone. Radio-frequency treatments and ultrasound therapy are new and have been reported to tighten the skin. However, their long-term effects are not very well documented. In addition, these treatments are focused on rejuvenating the deeper layers of the face (the dermis and muscle) and do not really improve skin tone and texture.
In order to have a complete rejuvenation of the face, there are three necessary components. First, the face needs to have the proper amount of volume. As we age, the bones and fat of the face shrink and the overlying face deflates, creating bags and lines. The elasticity of the skin diminishes over time so fine lines around the mouth and eyes form and eyelid skin becomes crepey. Lastly, the skin becomes weathered from sun and age. Brown spots form, pores become larger, and the skin simply has a dull, aged appearance.
There is not just one single treatment that can address all of these problems. Facelifts and eyelid lifts are good at removing excess skin and tightening the muscle underneath, but these procedures do not add volume to the face and don’t address aging skin. Without addressing these other factors, a facelift can actually make a person look older by giving a windswept look and a hollow face.
Traditional facial fillers and Botox® can volumize the face nicely and in many younger people can dramatically improve a person’s appearance. However, they do not rejuvenate the skin or tighten the face by creating new collagen growth. The latest fractional CO2 lasers do an amazing job of rejuvenating the skin, creating new collagen and giving an overall youthful appearance. The first lasers – which were available twenty years ago – were remarkably good at rejuvenating the face. The problem was that the lasers removed the entire epidermis and took several weeks to heal. In addition, the healing process was unpredictable and sometimes led to occurrences of scarring and pigment problems. Many other lasers were created; however, none were able to net the same great results seen with CO2 lasers.
More recently, the development of new technology in “Fractional CO2 lasers” was able to harness all of the powerful results of the old CO2 lasers only with better results, faster healing, and far fewer side effects. Specifically, the Mixto Laser, which was created in Italy and has been used with outstanding results, was recently introduced into the United States. By using a patented delivery system, the Mixto is able to maximally rejuvenate the skin with rapid healing and fewer side effects. The results were so impressive that the Mixto was voted by Cosmetic Surgeons from around the world as “Best in Show” at the Aesthetic Meeting in 2011.
However, despite the great results of laser technology, this treatment alone cannot fill the face. Therefore the “Fill and Laser” non-surgical facelift was developed. By injecting fillers such as Restylane® and Perlane® deep into the face and applying the Mixto Fractional CO2 laser treatment on the skin, a truly complete rejuvenation can be achieved. This is exciting news for patients and doctors alike. The procedure can be done in about an hour under local anesthesia, and most people can get back to a normal routine in a few short days.
By applying the Mixto fractional CO2 laser to the skin over a face that has been filled in the deeper layers, we can achieve the best results from both approaches. Brown spots and lines are significantly reduced while new collagen is produced in the deeper layers of the skin. The addition of using injectable facial fillers simultaneously can further enhance and optimize the results – all leading to a really youthful, natural-looking result.