Cosmetic Surgery Faces Extinction

Like all surgeons, I love operating. It may be difficult for the public to understand the exhilaration that plastic surgeons feel as we manipulate scalpels, scissors and clamps, and in a matter of hours alter your appearance.

Posted on | Arthur Perry, MD, FACS | Comments ()

Like all surgeons, I love operating. It may be difficult for the public to understand the exhilaration that plastic surgeons feel as we manipulate scalpels, scissors and clamps, and in a matter of hours alter your appearance.

We can remove sags, make noses smaller and make breasts bigger. And commonly, we operate to reduce the changes of aging. But operations like facelifts and eyelid lifts, performed for the last century, may well be headed for extinction. 

There has been a quiet revolution in facial cosmetic surgery over the last few years. Injections, peels and tissue-altering energy rays are replacing skin-splitting operations. Those new increasingly effective procedures are forcing knife-wielding surgeons to learn new skills, or risk extinction. Eventually, this revolution may well cause their scalpels to be moved from the operating room to museum shelves. 

Every decade after the 1900s, procedures like facelifts became more aggressive. Starting with just a little snip of skin in front of the ear, by the 1990s, these operations lifted tissue in many layers, sometimes down to the bone. More aggressive procedures improved results, but often were accompanied by unpleasant complications. And while over 100 million people can benefit from a little nip and tuck and an Internet search will reveal nearly 2 million websites that mention facelifts, in reality, only 128,000 Americans actually had the procedure last year. And despite all the hype, over the last few years, surgery has lost popularity, only to be replaced by a booming array of so-called “noninvasive” procedures.

Hype aside, it is hard to call it noninvasive when you are on the receiving end of a few dozen pointy needles. Nevertheless, new office procedures that have you back to work the next day are soaring in popularity. The drift away from the scalpel really began in the early 1980s when a little known drug called Botox melted away wrinkles as a complication while it stopped muscle twitching. Botox gradually increased in popularity but was not approved by the FDA for cosmetic reasons until 2002. Last year, over 5 million Americans had Botox injected into their faces to decrease wrinkles caused by overactive muscles. Botox has been joined by Dysport and Xeomin in the struggle against wrinkles.

While the wrinkle filler collagen has been around since 1981, its short duration and risk of allergies prevented it from becoming a blockbuster. But when the first hylauronic acid wrinkle filler was approved in 2004, Restylane’s ability to plump annoying wrinkles around the mouth and fill deflated lips caused it to become an overnight sensation.  Juvederm and now dozens of other wrinkle fillers soon joined the wrinkle-filling landscape and forced collagen out of business earlier this year. Over a million and a half people rejuvenate their faces each year with these fillers.

Peels and lasers complement fillers by reducing splotchy facial pigmentation and wrinkles, but the big breakthrough in noninvasive skin tightening and lifting has just occurred.

A new machine called Ulthera intensifies sound, makes it shrill enough that neither humans nor dogs can hear it, and focuses it in a precise location under the skin. There, it vibrates molecules releasing energy and heat. Those of us old enough to remember Ella Fitzgerald’s Memorex commercial from the 1970s know that sound has enough energy to break glass. This energy can be harnessed to kill fat and shrink the skin and prod it to make new collagen. After a few months, the skin looks tighter and thicker with less unwanted fat. 

When we combine the effects of all of these new, noninvasive technologies, we can stall the effects of aging to the point where I begin to miss the operating room. The popularity of these new rejuvenating procedures is a mixed blessing. They improve appearance, cost less than surgery, and have far less risks. However, they are deceptively simple to perform. That has invited doctors and other health professionals to take courses as short as two hours and call themselves “cosmetic surgeons.” Disasters like blindness, strokes, scars and paralysis have occured with these new techniques. So, be sure to search out the credentials of your doctor before undergoing the knife … or the needle.

Blog written by Arthur Perry, MD, FACS
Dr. Perry has over 2 decades of experience as a clinical surgeon and has been named to the “Best Doctors in the NY Area” book...