Las Vegas — Facial aesthetic surgery has gone through a series of paradigm shifts over the past 40-plus years, and, undoubtedly, there are more changes to come, said Donn R. Chatham, M.D., at Facial Cosmetic Surgery 2004.
Reflecting on the evolution in facial rejuvenation procedures since the 1960s, Dr. Chatham observes that continuing shifts in views about what defines aging have affected how it should be "fixed," and in whom. Developments in techniques and technology have dramatically altered what types of interventions are performed, as well as where and by whom. And there have been changes in how the public acquires knowledge. As a result, more and more people are seeking anti-aging interventions, but they often no longer look up to the doctor as the only authority on care.
"Just as society changes over time, so, too, has the world of cosmetic rejuvenation. It has been an interesting and ongoing evolution, and it has resulted in changes that are both good and bad," says Dr. Chatham, clinical instructor, department of otolaryngology, University of Louisville Medical School.Three periods Reviewing the past 40 years, he divides them into three periods: the "traditional" period of the '60s and '70s, the "evolutionary" period encompassing the '80s and early to mid '90s, and the "current" period that began during the latter '90s and includes the present.
In the "traditional" period, aging was viewed as inevitable, and surgery was the only answer for addressing its unwanted effects on the appearance of facial tissues. However, intervention was sought only when the signs of aging became extreme, and was sought very discreetly by only a select group of the "rich and famous" who could afford the expensive operations.
All procedures were performed in the hospital and only by plastic surgeons, and the physician was the sole source of information on treatment options. Pain was expected, and patients remained in hiding until they recovered.
During the "evolutionary" period in the '80s and '90s, aging was still considered inevitable, but a new philosophy emerged based on the idea that intervention for its signs should be undertaken earlier — before things got really bad, Dr. Chatham says.
In addition, nonsurgical treatments were added to the armamentarium and new surgical techniques were developed that offered the benefits with less pain and suffering.
With those developments, cosmetic surgery became something of interest not just to celebrities; "ordinary people" became patients more frequently. Surgery also moved into ambulatory settings, and while it was still considered a private affair, patients were somewhat less concerned about total secrecy.
Cosmetic surgery also moved outside the sole domain of plastic surgery into other specialties, and patients began to shop around for services. The doctor remained the definitive authority on treatment, but candidates began to get information about their options from other sources.
Current paradigm Under the current paradigm, aging is still considered inevitable. However, the current approach to intervention focuses on delay.
"Strategies now are based on anti-aging modalities designed to forestall aging, including aging of the face, and include sunscreen use year around, non-smoking, topical 'cosmeceutical creams,' improved dietary choices, and healthy stress management, to name some," Dr. Chatham says.
Nonsurgical treatments are considered first, and include some based on increased understanding of the aging process at the cellular level.
"There are now cosmetic interventions that address aging changes through metabolic mechanisms and awareness that dietary factors might also make a difference," Dr. Chatham explains.
When surgery is necessary, more minimally invasive procedures have been introduced that reduce or eliminate downtime and risk.
Cosmetic surgery is being marketed to everyone, and consumers have even more choices for where they will be treated. New groups of medical specialists, dentists and aestheticians in the community are offering cosmetic services, and physicians are no longer considered the only authoritative source for information.