Minimally Invasive Cosmetic Procedures Trending in 2020

Trending in 2020 will see patients demanding more natural and harmonised facial outcomes. There will be a focus on enhancing noses, foreheads, jawlines, chins, necks and temples.

Invasive facial surgery will continue to decline as women seek out innovative scarless innovations.

Patients continue to desire a more beautiful and rejuvenated appearance. It is often a very emotional experience for patients when they recaptured youthful beauty after a brief and relatively non- traumatic medical procedure.

With contemporary minimally-invasive surgical aesthetics, we can offer patients an opportunity to experience natural enhanced appearance without major risk and downtime. The objective is not to alter the appearance of a person to make them look unrecognisable, but to recapture the patient’s inherent youthful features.

2020 will be a year when patients appreciate, more than ever, that beautiful natural outcomes are achievable with minimally invasive procedures.

While some doctors "dabble" in cosmetic procedures as a sideline to their usual activities, patients have come to appreciate that a trained, dedicated cosmetic practitioner professional knows how to avoid major risks, while excelling in creating beautiful aesthetic outcomes

Dr Feiner visits the clinic of Oculoplastic Surgeon Dr. Chedly Bouzouaya in Tunisia

Australian minimally invasive cosmetic surgeon Dr Ronald Feiner recently visited the clinic of Dr Chedly Bouzouaya in Tunisia (http://www.chedlybouzouaya.com/en/) , to personally undergo blepharoplasty surgery for correction of heavy eyelids.

Dr. Feiner is the Medical Dean of the Australasian College of Cosmetic Surgery (https://www.accs.org.au/) and is passionate about innovative aesthetic surgical techniques and the training of future Australian cosmetic doctors.

One may ask why did Dr Feiner travel all the way from Australia to Tunisia for his aesthetic eyelid surgery? Dr Feiner explains that Dr Bouzouaya is not only a highly respected ophthalmologist & ophthalmic surgeon but is also internationally renowned for his plastic & cosmetic eye/eyelid (oculoplastic) surgery. 

"Frankly, I wanted my eyelid surgery performed by the person whom I identified as one of the best in field. I see many outcomes of this type of eyelid (blepharoplasty) surgery and to be candid, far too many of these surgical outcomes are rather unnatural and disappointing.”  

There are many facets to achieving excellence in aesthetic eyelid and facial surgery.

First there is the aesthetic assessment. The surgeon should possess that rather elusive and special attribute of the "aesthetic eye”. If not so, the surgical outcome may be technically adequate, but prove aesthetically underwhelming. Fundamentally to achieve excellence, the surgical result must be in harmony with the patient's general facial aesthetic. This is poorly understood and therefore neglected by many surgeons.

Second is the technical intricacy of the surgery. Often surgery is overly zealous resulting in the stigma of an "operated-on" look. 

Dr. Bouzouaya's surgery has evolved and refined over many years. He is a renowned surgical innovator and has also invented many highly effective surgical instruments which he has combined in the operating room to achieve superb outcomes.

For his patients this means not only natural and beautiful aesthetics but also relatively speedy and painless recoveries.

Dr. Feiner and Dr. Bouzouaya met in 2007 at a European aesthetic congress (http://www.drserdev.com/varna2007/) where they were both delivering clinical papers. They quickly recognised a mutual spirit, with many shared aesthetic philosophies in their professional work. Both doctors regularly co-operate on professional development, mutually advancing each other’s cosmetic facial surgery skills and sharing innovations. There is certainly a special camaraderie and energy generated between these two colleagues.

Dr. Feiner and Dr Bouzouaya have already co-authored a chapter featured in a medical reference book on minimally invasive suture lifting (https://www.intechopen.com/books/miniinvasive-face-and-body-lifts-closed-suture-lifts-or-barbed-thread-lifts/suture-lifting-and-liposculpture-integration-in-the-creation-of-facial-esthetic-harmony). 

They are currently co-authoring a chapter on Botulinum Toxin in a soon to be published medical book on this subject.  

How does Dr. Feiner feel about his own blepharoplasty surgery experience?

"Well I knew the results would be excellent and because the recovery has been rapid, Dr Bouzouaya and I have had professional time to examine and review cases in his Tunis clinic. We have continued to innovate and exercise that special energy between us.

Dr Bouzouaya introduced me blepharoplasty surgery in Tunis over 10 years ago. He is my special mentor in this surgical discipline and it is a great privilege to learn from this master in oculoplastic and facial aesthetic surgery.

Each time I visited Tunis over the last 10 years, Dr Bouzouaya shares his latest innovations with me. They are surgically tailored and unique. Afterwards I am able to return to my own clinic in Australia, incorporating these technical pearls into my own surgical cases. I feel very honoured to have this very special relationship with this esteemed colleague.”

Tunisia is very fortunate that in Dr. Bouzouaya, they have this distinguished and internationally renowned surgeon exercising his skills for the benefit of fellow Tunisians. Furthermore, a steady stream of patients from Europe and the UK travel to Tunis to have their blepharoplasty surgery performed by this master surgeon.

FILLER "RHEOLOGY"---A GOOD REASON TO AVOID POORLY INFORMED COSMETIC INJECTORS

"Rheology—the study of flow-related properties—has been recognized for almost a century as being relevant to a number of fields, including materials science, geophysics and pharmaceutics.

Rheologic theory and measurements are considered critical for the manufacture of topical medications, paints and inks, concrete and even chocolate"

 

Hema Sundaram, MD, FAAD Medical

Director of Sundaram Dermatology, Cosmetic &

Laser Surgery in Rockville, MD and Fairfax, VA.

 

Contemporary cosmetic injectors require a fundamental appreciation of the RHEOLOGY of the fillers they inject. Selection of an injectable filler with tissue appropriate rheological properties optimises the possibility of achieving a pleasing and durable aesthetic outcome.

 

Todays Hyaluronic (HA) fillers are manufactured with a variety of sophisticated rheological characteristics (eg-plasticity, viscosity, elasticity, cohesivity)  that only well informed and technically advanced injectors can safely utilise to avoid untoward outcomes.

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Just as the driver a sophisticated vehicle requires a good working knowledge of the engineering, today's cosmetic injector should display both excellent technique and an excellent working knowledge of filler choice for aesthetic task at hand. Few of us would be comfortable as passengers in a high tech vehicle being driven by a naïve driver.

Equally, discerning cosmetic patients can be reassured by choosing a cosmetic practitioner with an advanced appreciation of the product to be injected.

My next blog will focus on injectable cosmetic filler complications. Another compelling reason to choose your cosmetic practitioner very carefully.

 

 

 

 

Corporate Creeps

Corporate cosmetic clinics and franchise arrangements may soon dominate the marketplace for aesthetic treatments. Aggressive marketing while diminishing the real risks of treatment hallmarks the voracious drive to get the punters in the door. Once your are in the door upselling is name of the game. Unhappy with outcome? Well too bad-you didn't you read the fine print when you signed on? 

It should be appreciated that these clinics operate to a "set play",  delivered by anonymous
practitioners trained to a formula. The delivery is fast track with the predictable simplicity of
a "one size fits all" formula.


The clinics are almost exclusively motivated by profit and characterised by an "off the shelf" approach. It may be worth asking who owns the clinic. The answer is more than likely to be a non-medical entrepreneur.


Like McDonald's they may well succeed but you can't wear a burger on your face and get away with it.

The stomach is far more forgiving than the face.  Discerning patients are not seduced by the lure of cheap end corporates with highly indigestible outcomes.

"COSMETICA"--KEY AESTHETIC FACIAL SIGNIFICATION

Facial aesthetic key features are signified by beautiful eyes, cheeks and mouth along with a heart shaped face. Skin quality is fundamental but creating a beautiful face is a challenge that goes far beyond diminishing wrinkles.

Contemporary cosmetic practitioners focus on these signifiers of facial

beauty, improving them by "winding back the time" to recreate a more youthful aesthetics

while maintaining the essence of the patient. 

At COSMETICA Castle Hill our reputation is founded on this approach and it is why  

patients from all over Sydney and beyond are attracted to our clinic,

seeking out beautiful but natural treatment outcomes.

Penelope Cruz is of course not one of our patients but her face features the triad of beautiful eyes, cheeks and mouth, along with a youthful jawline, harmonious proportions and lovely curves.

Within the limitations of what can be achieved with each patient these are the facial signifiers we try to create that hallmark aesthetic female beauty.

Filler Injection Techniques- A Significant Evolution

Filler techniques have evolved over the last 15 years. Gone are the days where fillers simply involved injections to corrected lines and folds. Contemporary application of fillers requires a far more advanced knowledge of anatomy and physiology to aesthetically enhance the face.
While each patient presentation has to assessed and treated in a bespoke approach, much more emphasis is directed towards youthful contouring of cheeks, lips, jawlines, temples, nose and forehead. Tear troughs and eye hollows can be gently corrected although great care must be taken to avoid lumpiness and vascular complications.
We now have much better appreciation of skin attachments to deep fixed tissues. These are called the facial ligaments http://asj.oxfordjournals.org/content/33/6/769 that contain and constrain regions of injectable target tissues. A knowledge of where these ligaments are situated affords an advanced practitioner the possibility to fine tune and optimise aesthetic outcomes. From an engineering perspective these ligaments slacken with facial ageing and associated soft tissue volume loss. They are re- tensioned and  re-suspended by appropriate filler placement.
We now also have an increasingly sophisticated array of filler choices. Fillers are marketed with various levels of hyalurinic concentration, bonding, particle size and elastic recoil. This allows a practitioner further tailoring choices for ideal filler placement in different areas of the face.
Some practitioners favour sharp needle depot injection techniques like the "8 point injection" method while others prefer the use of broader cannula delivery.
From the patients perspective it does not matter too much which technique is used as long as pleasing outcomes are achieved and the effect is reasonably long lasting.
More on this subject soon!