Hooray for Hollywood
BY WENDY LEWIS
For four days, an impressive roster of facial plastic surgeons, plastic surgeons, dermatologists, and oculoplastic surgeons convened at California’s Beverly Wilshire Hotel to present and debate facial techniques in dynamic panels, interactive workshops, and uberpopular live surgery sessions.
The American Academy of Facial Plastic and Reconstructive Surgery’s (AAFPRS) Facial Rejuvenation Meeting in Beverly Hills included a strong focus on advanced rejuvenation techniques, pearls for surgical and nonsurgical facial rejuvenation and avoidance and management of complications.
“We had an all-star line up that featured Dr. Paul Nassif speaking on the challenges and successes of patients seen on his hit show Botched (E! TV),” says Conference Chair Rami Batniji, MD, a Newport Beach, CA facial plastic surgeon. Dr. Nassif, a Beverly Hills facial plastic surgeon, gave a candid and enlightening talk about his bromance with plastic surgeon Terry Dubrow, MD and the unique challenges of patient selection and screening for revision surgery being performed on television.
LIVE FROM BEVERLY HILLS
Course Director Theda C. Kontis, MD, a Pikesville, MD,facial plastic surgeon, worked diligently to incorporate live surgery into the conference, which was a huge draw for this event. Surgery was performed at the Beverly Hills clinic of Drs. Toby Mayer and Richard Fleming so that the audience could observe and learn from the guest surgeons.
The mix of attendees “allowed for a multidisciplinary view of surgical and non-surgical approaches, all in the name of further refining aesthetic results for their patients,” says New York Facial Plastic Surgeon Andrew Jacono, MD.
Chevy Chase, MD dermatologist Rebecca Kazin, MD agreed. She participated in the live injection demonstrations of both on-label and off-label techniques. “It was a great opportunity to learn from some of the masters, and share my own experience with fillers, toxins and other non-surgical treatments,” she says.
“The meeting provided a great mix of medical specialties dedicated to cosmetic facial rejuvenation that was well complemented by the live surgery demonstrations. I learned a lot, mainly about facelifting, which was my primary topic of interest. I was hopefully able to provide some insight into how to manage the aging Asian eyelid, and on volume restoration with facial fat grafting,” says Dallas facial plastic surgeon Samuel M. Lam, MD
LESS IS MORE
A key learning from the conference was the idea that more is not always more when it comes to facial surgery, says AAFPRS President Edwin F. Williams, MD, a facial plastic surgeon in Latham, NY. “We now have the means, ability, and technology to implement more innovative, less invasive techniques, and that can lead to overcompensation or overcorrection,” he says. “Even if it’s easier than ever before to make a lip plumper or cheek more lifted, you still want the result to be subtle.” Female leading oculoplastic surgeons, including Drs. Julie Woodward of Duke University in Durham, NC, Lisa Bunin of Allentown, PA and Elba Pacheco of Severna Park, MD presented tips and techniques for periorbital rejuvenation.
Many of the speakers noted a distinct shift away from the skeletal, tightly pulled appearance of facial plastic surgery that was popularized in the 1990s. “Today’s patients are sophisticated and understand that volume is key to a youthful face,” says Dr. Williams. San Francisco plastic surgeon Timothy Marten, MD provided his view on facelifting and fat grafting as the “dynamic duo.” He presented his unique expertise and technique refinements for restoring the periorbital area with an artistic use of fat grafts.
There were many discussions on the best uses for dermal fillers. “Sculptra® Aesthetic (Galderma) has excellent longevity and results can last up to three years after three treatment sessions,” Dr. Williams says. “It has the ability to restore volume and improve skin tone, and is an excellent choice for patients who do not have enough natural fat of their own to sculpt cheekbones and correct agerelated volume loss.”
Greenwich, CT facial plastic surgeon Neil Gordon, MD presented the one contrarian lecture of the conference: “The Illusion of Volume Loss,” which was based on a chapter he wrote for Facial Plastics Clinics. “The key point I define is there is no scientific evidence of facial fat loss but substantial evidence of specific facial soft tissue gravitational changes,” he says. Dr. Gordon also presented his research from Yale University, which was the first to quantify skeletal aging effects on a single person over time.
“Overall, an illusion of volume loss is created in aging because the ‘container’ (facial superficial soft tissue envelope) enlarges with the fat volume remaining constant,” he explains. “ A larger container holding the same volume appears as ‘half empty’. The only actual volume loss proven has been skeletal bone loss, which is in the same regions that respond best to volume injections. This occurs in the more extremes of aging and explains treatment limitations in the over 70 age group,” Dr. Gordon says.
PEELING BACK THE YEARS
Chemical peels remain a gold standard for improving skin quality, although they may not be considered as sexy as energy-based devices to many patients. Several AAFPRS members offered their experience with mild-tomoderate peels as an alternative and/or as an adjunct to resurfacing lasers to improve fine lines, tone and texture, as well as acne scars and uneven pigmentation with minimal downtime. Deeper trichloroacetic acid (TCA) peels are a perennial favorite for retexturizing and wrinkle reduction.
“Microneedling is also picking up momentum because it is easily delegated to physician extenders, it is noninvasive and delivers visible results,” says Dr. Williams. “We are using microneedling for treating acne scars, aging skin and pigmentation. It can be combined with peels, topical agents, and platelet rich plasma (PRP) to further enhance results.”
Save the dates: The AAFPRS Fall Meeting 2016 will be held from October 6-8, 2016 in Nashville, TN.