Dr. Matteo Vigo- MINIMAL INVASIVE PROCEDURE FOR FACE REJUVENATION IN COSMETIC SURGERY

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The ageing process that involves the body and face see the progressive relaxation of the skin with emptiness of the fatty bags stored in the upper part of each body area (malar fat pads, breast, buttocks, etc) resulting in a inverted proportion of the face and the body. It is well known the paradigm of the V-shape face of young ladies that converts into an inverted V with ageing. With our aging population, cosmetic neck and facial surgery for skin laxity has been a growth area in aesthetic surgery. However, the long downtime and the fear of general anesthesia, wound healing and scaring associated with excisional rejuvenation procedures and fully ablative skin resurfacing are deterring many patients from taking this approach.
The facial aesthetic issues have been treated with non-ablative modalities, using IPL, lasers and radiofrequency (RF), botox and fillers that can be performed without anesthesia or with a local one and have little or no downtime. However, the results are less dramatic than excisional procedures and often require several treatment sessions to achieve the results.
The combination of the definition of the lower jaw with the redistribution of the fat pads in the patient will lead to a full rejuvenation that most of times prevents any other surgical intervention for long time.
The lower jaw line can be redesigned by a combination of liposuction and skin thightening with Plasma with minimal invasivity. The patient has to be selected carefully to avoid unwanted outcomes or unsatisfactory results.
The technology can be applied to all ages and can treated both neck and face sagging with minimal scar and short downtime. A garment is always recommended for a certain period of time after the surgery in order to stimulate the right healing of the tissues treated.

Highlights

Nowadays, the patients are asking for:

  • Minimally invasive
  • No pain
  • Less recovery
  • Less downtime
  • Less complications
  • Faster procedures
  • No scars
  • Fast return to normal life
  • Local anesthesia/sedation
  • Day case treatments

The solution that we can use for aging cases is Renuvion. Renuvion is a combination of radiofrequency energy and/or a helium gas plasma for electrosurgical cutting, coagulation and ablation of soft tissue during open surgical procedures. The plasma is the fourth type of the matter, if we ionize the gas with radiofrequency, we can achieve the plasma. Plasma has the highest energy that we know in nature and can be used to achieve our goals:

  • Male/female 20-60 years old (BMI up to36)
  • Patients with loose skin and subcutaneous fat layers
  • Reasonable skin tone and elasticity
  • Treatment areas: neck, jawline, abdomen, hips, flanks, back, thighs, knees, upper arms, breast

On the other hand, Renuvion contraindications are:

  • Pacemaker or internal defibrillator
  • Metal or silicone implants in treatment area
  • Significant concurrent systemic illness (e.g. cardiac, metabolic and coagulation disorders)
  • Pregnancy or nursing
  • Recent surgery, particularly in the treatment area
  • Allergies, in particular to anesthesia
  • Mental disorders, such as BDD (body dysmorphic disorder)
  • Non realistic expectations

Possible adverse effects are: discomfort, hematomas, infection, skin burns and even allergic reaction, deep vein thrombosis and fat embolus. It is better to avoid withdrawing the handpiece close to the access port (stay 2-3cm away), as this region can become overheated and overtreated. The handpiece should be in motion all times when activated. The surface and surrounding areas of the treatment zone should be visible, clean and free of all excess fluid.

The below suggestions should be considered:

  • Lower power settings should be considered in areas of thinner skin
  • Lower gas flow settings should be considered in smaller treatment areas, such as neck or knees
  • Operator should consider patients assessment when determining the number of necessary passes needed for optimal results. The most common practice is 4-5 passes (this is the accumulation of strokes=1 pass)