PALM DESERT, CALIF.The new, overriding concept in cosmetic procedures is that what the aging face often needs is new volume.
It is the view that the aging face is a "deflated" face, Dr. Gary D. Monheit said at the annual meeting of the American Society for Dermatologic Surgery.
"It is the volume loss as much as the ptosis," said Dr. Monheit, immediate past president of the ASDS. "It is the volume loss in the face that has become the new concept, the volume loss of bone, fat structure, and muscles, and we now have some new handles in order to rejuvenate." Such "handles" include using fillers like hyaluronic acid to enhance hollow cheeks, and barbed sutures used to lift the malar area to smooth out nasolabial folds and create an impression of high cheekbones.
Dr. Monheit, who practices in Birmingham, Ala., said this approach follows the precepts articulated by Dr. Richard Glogau of the University of California, San Francisco. Dr. Glogau said there are four features of the aging face that can be addressed by the cosmetic dermatologist. He calls them the four Rs: rebuild, relax, resurface, and redrape.
For rebuilding, there are fillers. For relaxing, there is botulinum toxin. For resurfacing, there are lasers and cosmeceuticals. And, for redraping, there are the barbed threads. But, all of these options also are making cosmetic dermatology much more complex than it has ever been.
The new challenge for cosmetic dermatology is the number of products now available for rejuvenation, with many more probably coming soon, an almost bewildering array, Dr. Monheit said.
The field will have to be careful in evaluating and embracing these products as they come onto the market, he warned.