Optimizing the Results of Aesthetic Facial Surgery

By Mark E Van Wormer, MD

Published on August 01, 2006

Aesthetic facial surgery can be as simple as the so-called cold laser rejuvenation of the skin (technically called regional non-ablative rejuvenation), or as complex as combining a full face-lift with full face laser resurfacing. But no matter what type of aesthetic facial surgery procedure you may be considering, preparing your body, skin, and mind before the procedure is critical. (Your postoperative care, both immediate [the first two weeks] and long-term, is also an extremely important factor to bear in mind.) There are several variables you need to consider prior to aesthetic facial surgery.

Incisions and Thermal Damage

Externally, the skin will obviously be affected by the incisions made and/or by thermal damage. Incisions can be made with scalpels, radiofrequency knives, or laser beams. While scalpels are not particularly hemostatic (blood stopping), radio frequency knives and laser beams are, the laser being the most hemostatic instrument. Either way, efforts should be made by the surgeon to prevent potential hemorrhage during the procedure. Your can help your coagulation system prevent significant bleeding and bruising by taking oral Arnica and topical Arnica for several days prior to and after surgery. Arnica also has an anti-inflammatory effect and helps prevent postoperative wound infection.

You can also improve the results of laser skin resurfacing by minimizing thermal damage to the skin. While thermal damage to the skin ultimately results in the removal of wrinkles, excessive thermal damage can result in a disastrous outcome. For the last few years I have gradually decreased my dosage of laser energy with excellent results. By carefully planning the preoperative period to include vigorous exfoliation, the surgeon performing the laser resurfacing can use much less thermal energy and achieve the same results. How? With the top layer of skin (surface epithelium) completely exfoliated, the thermal energy applied to the skin is much more effective. Furthermore, since the layer of dead epithelial cells (stratum corneum) is not there to absorb heat and transfer it to the skin, excess heating of the tissue is minimized. In practical terms, this means that the surgeon can use two or three moderate energy 'laser passes' -- rather than three or four maximal energy passes -- with similar cosmetic results. In fact, the reason Erbium-YAG lasers became popular was that less thermal energy was applied to the tissues with less postoperative redness.

Preventing Postoperative Complications

'Down Time'

The surgeon can minimize 'down time,' as well as the embarrassing appearance of postoperative redness, scaling, and crusting by carefully planning pre- and postoperative care, and by paying close attention to laser settings (thermal energy) and the number of 'skin passes' used during the procedure. I find that most patients only have a mild, 'sun burn' appearance that actually looks healthy by about 14 days after the procedure. The patients even appreciate the glow. A few years ago, the postoperative redness encountered during laser resurfacing was often prolonged and cosmetically disfiguring. Fortunately, today's patients do not have to suffer through this; the optimization of skin health achieved through gentle preoperative exfoliation and use of Arnica preparations has eliminated much of the postoperative down time patients used to suffer through.

Pain, Swelling, and Redness

In most case, continuous facial cooling for the first 48 hours prevents postoperative pain, swelling, and redness. Rarely do my patients require any postoperative painkiller other than Tylenol.

Hyperpigmentation and scarring

Again, so long as the surgeon properly prepares the skin, and uses moderate laser settings and fewer laser passes, the risk of postoperative complications is greatly minimized. For patients who have olive to dark skin, the surgeon should provide a bleaching program using either hydroquinone or Kojic Acid daily.

Wound healing

Oral antioxidants such as vitamin C, Coenzyme Q-10, Vitamin E, pycnogenol, and grape seed extract with proanthocyanidins can be very helpful. L-ascorbic acid applied topically has been shown to minimize chemical and laser induced injury and diminish postoperative redness, as well as promote wound repair. Also, topical epidermal growth factor promotes cellular growth for wound repair. Human growth hormone used one month prior to the procedure and two months postoperatively results in significant reduction in healing time.

All the comments above apply to surgical face lifting, blepharoplasty, and cutaneous laser surgery.

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