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Surgeon reflects on progress, changes in cosmetic surgery

Article-Surgeon reflects on progress, changes in cosmetic surgery

Edina, Minn. — The basic goals of cosmetic surgery have remained the same — to bring to the face a freshened, natural look — and to use the principles of good surgery, says Devinder S. Mangat, M.D., F.A.C.S. But there are differences between practicing in 1979 and 2004.

The surgical tools and techniques are two of the biggest differences.

"They bring about rejuvenation more effectively in a less invasive way, so the healing time has shortened," he says.

25 years of observations Reflecting on his 25-year surgical career, Dr. Mangat, who is president of the American Board of Facial Plastic and Reconstructive Surgery, cites another development: greater awareness of the importance of volume replacement, particularly in the lips and around the eyes.

Twenty-five years ago, collagen and silicone were the only materials available.

Today, surgeons have an array of more effective materials for filling and implanting, including anatomical chin and cheek implants.

What's next on the horizon? Dr. Mangat sees procedures becoming less and less invasive.

Says the surgeon, "There are certain kinds of sutures, for example, that can lift tissue through smaller incisions. Some of that technology is available now, but it's not perfected."

He also predicts that, while laser, radio-frequency, and intense pulsed light devices will become more effective at tightening the face, many patients will continue to turn to the facelift, blepharoplasty and forehead lift. One difference: the average age for treatment may increase, as new products for preventing and reducing sun damage enter the marketplace.

Dr. Mangat notes, "I think idebenone, a powerful new antioxident, is a promising ingredient. Allergan has introduced Prevage, an anti-aging cream that contains idebenone. Other similar agents are under investigation."

The aging process Aging may be variable from individual to individual but the process is predictable, exhibiting classic signs.

"Two factors cause aging: tissues lose their elasticity, and the amount of fat under the skin diminishes," explains Dr. Mangat. "People with more sun exposure show those changes faster than others."

Overall, aging is a function of genetics, general health, smoking and sun exposure. Different parts of the face age at different rates. The eyes are the first indicators. Excess skin develops in the upper lids. Puffiness and bagginess appear under the eyes. Next, the brows begin to descend, giving the eyes a hooded look.

The sagging trend proceeds to the cheek, particularly the malar fat pat. The face may appear sallow or hollow. Smile lines deepen. Developing jowls interrupt the jawline. Finally, excess skin piles up in the neck, producing platysmal bands.

"Every part of the face is affected," says Dr. Mangat. "Even the nose. It loses some of the strength in the tip, when the cartilage and ligaments there weaken. The tip then droops, giving the appearance of lengthening."

Principles of rejuvenation Begin rejuvenation, the surgeon advises, with careful consultation, planning and counseling. It's helpful to have the patient bring photos that date back 10, 15 and 20 years so you can determine where facial features were previously positioned, he says.

Study the photographs and plan surgery carefully. Determine what procedures will help the individual look better - but natural. Remember that it's important to restore structures to the point where they were before but not beyond or above that point. Next, decide how you'll approach each procedure and in what order.

"Unlike the doctors on (the television show) "Extreme Makeover," I don't like to do too much surgery at one time," says Dr. Mangat. "My effectiveness is about four hours. If the surgery is going to be longer, I prefer to break it up."

Finally, Dr. Managat suggests that surgeons use an imaging computer to present recommendations to the patient and, thus, have a clear understanding of their goals.

Dr. Mangat reports that he has no financial interest in any Allergan or any other product or device.

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