Clinical approach to facial rejuvenation requires a perception of integrity and customised analysis for each individual patient. Patient selection is one of the key factors to a successful cosmetic procedure – most patients want to look refreshed, and a thorough consultation will determine the appropriate treatment plan. Another vital factor is to understand the limitations of non-surgical options and have a good understanding of what surgical procedures have to offer. Whilst many procedures are performed non-surgically, there are certain goals or outcomes that can only be realised by surgery.
This critical balance is meticulously assessed by Dr. Karaaltın, and Dr. Karaaltın Clinic provides the best medical consultation to achieve an optimal result.
The face, nose, lips and neck areas are amongst the most complex regions of the human body, due to the complicated interplay between different structures (bones, ligaments, muscles, fat, and skin).
Ageing occurs in all facial structures, but the onset and the speed of age-related changes differ between each specific structure, between everyone, between different ethnic groups as well as genetic background. Therefore, knowledge of age-related anatomy is crucial when trying to restore a youthful face.
Skin is a complex organ covering the entire surface of the body. Aged skin is characterised by the appearance of wrinkles, hyper melanosis(hyperpigmentation), increased laxity, and loss of volume. These changes occur under the influence of intrinsic and extrinsic factors (sun exposure, daily habits. Etc).
Under the skin, lies the muscles, ligaments, and fat compartments (the facial cushions). The superficial muscular-aponeurotic system (SMAS) is a layer of organised fibrous network composed of muscle fibres, fascia, fat as well as a fibromuscular layer. With such unique composition and connection to facial muscles and the skin, it helps to coordinate muscular contractions of the face and provides a functional role of movement for facial expression. The facial retaining ligaments act as anchor points to tether the skin and underlying layers to the facial skeleton. With time, deep facial structures tend to sag and hood over these fixing points, creating folds and ptosis which exacerbates the appearance of an aged face. There are multiple fat compartments in the face and neck, which typically lose volume and migrate with age. Facial muscles also develop tone over time, which can lead to shortening, weakening, and straightening.
As the foundation, the facial skeleton is an intricate three-dimensional structure that reciprocates the facial silhouette through supporting the overlaying structures. However, the facial skeleton undergoes morphological changes with increasing age, especially around the orbit (eye socket tends to become wider and larger with age). The composition, robustness as well as volume also start to decline with time, hence affecting the face in a negative way.
The decision-making process when it comes to facial aesthetics is not a straightforward one and is often influenced by physician factors (e.g., knowledge, skills, range of services) and patient factors (e.g., lifestyle, budget, downtime, expectations). However, the treatment plan proposed to the patient should be guided by scientific foundations built on professional experience, physical examination, patient status as well as an honest and thorough consultation prior to the procedure.
Several studies have shown the chronological changes to the fat compartments of the face and neck and their clinical implications for facial rejuvenation. Some fat compartments undergo hypertrophy whilst others lose volume over time – this varies between individuals and ethnic backgrounds. This volume ‘drift’ leads to a ‘sheared’ effect – the face and neck lose definition and smoothness over time, contributing to a saggy appearance. The concept of fat compartment shifting, and enhancement involves volume enhancement and reduction in the appropriate areas, as well as soft-tissue repositioning. The use of adipose-derived stromal vascular fraction cells (Stem Cells) and PRP further enhances the effect of this powerful treatment concept.
Inspired by the popular motion picture, the Benjamin Button effect is used to describe the goal of achieving a clearly younger, more attractive, yet natural-looking appearance utilising minimally invasive therapies after performing a surgical approach. The concept can be applied when it comes to combining surgical and non-surgical modalities; non-surgical treatments can be utilised after an invasive face lift procedure to enhance the outcome and longevity of results.
Typically, patients who underwent cosmetic surgery would be encouraged to use topical liposomal epidermal growth factor with self-microneedling (1 mm) for 10 minutes for 1 month. This at-home regime is repeated annually, whilst maintaining regular clinic visits for non-surgical treatments such as neurotoxin injections and skin resurfacing treatments, as well as the continuous use of medical-grade skincare products.