botox, dermal fillers are common non surgical facial cosmetic surgery

1. FACIAL
COSMETIC
SURGERY

2. Contents
•Physiology of aging
Extrinsic aging
Intrinsic aging
•Parameters in evaluating the face
•Assessment of skin and the aging
process
•Non surgical procedures
Topical skin care

3. Skin resurfacing
Chemical peels
Laser skin resurfacing
Microdermabrasion
Dermabrasion
Microneedling
IPL photorejuvenation
Dermal fillers
Neurotoxins

4. Physiology of aging
• Aging process includes 2 different
categories
1.Extrinsic aging/photoaging
2.Intrinsic aging

5. Extrinsic aging
• Cumulative effects of
environmental factors under the
control of the patients
• Includes habits such as
smoking, lifestyle, geographic
location and a long exposure to
sunlight

6. Intrinsic aging
• Cumulative effect of physiologic
and chronologic aging
• Genetic and biologic action of
cellular senescence

7. • Includes
loss of collagen and elastin fibers
Production of cytokines at the cellular level such
as collagenase and elastase
Impairment of DNA signal transduction
Loss of tissue hydration and volume
Selective resorption of bone
Descent and laxity of muscles and surrounding
fascia
• This process coupled with extrinsic aging and is
responsible for the visual depiction that most
individuals associate with an aged person.

8. Other pertinent considerations include ethnicity,
hormonal differences between males and females and
anatomic variations.
Intrinsic aging is difficult is manipulate, the
focus of skin care and topical medications used
in cosmetic surgery is extrinsic aging.

9. In addition to understanding the
aging process, each patient must
also be evaluated in a systemic
manner.
There are well defined parameters
in evaluating the face.

10. What is beauty?
What is fairly standard is that the more
symmetric one’s face is, the more
attractive the person appears.
There are components of the face that
clearly augment or detract from an
overall image of beauty such as eyes,
smile, jawline, skin tone, and texture
When these features appear youthful,
combined with symmetry we tend to
recognize the individual as attractive

11. Other parameters deal with
zones and subunits of the face
and attempt to correlate a
degree of symmetry and/or
parity between each area.
The face can be divided into
equal HORIZONTAL THIRDS
and equal VERTICAL FIFTHS.

12. In addition to these parameters, there are well
known and recognized FACIAL ANGLES and
FACIAL MEASUREMENTS

13. Assessment of skin
and the aging process
can also be enhanced
by GLOGAU
CLASSIFICATION and
FITZPATRICK
CLASSIFICATION

15. Surgical vs Nonsurgical options
Surgical
Any procedure in which an actual incision is made on or
around the facial region
Non surgical
Any procedure in which incisions are not made and rather
other modalities such as
injection of a medication or a source of energy is used to
modify the facial structures.

16. All patients must be 18 years old to provide their own
consent.
Patient must be physically healthy, psychologically
prepared, and have realistic expectations
Criteria for facial cosmetic surgery

17. Non surgical
procedures

18. • Also known as MINIMALLY INVASIVE
PROCEDURES
• Main focus: top layers of the skin

19. ADVANTAGES
• Less expensive
• Less time consuming
• Require little or no
recovery time for the
patient
• Minimal downtime:a
good choice for
individuals with busy
schedules.
• Less risk of
complication: less
invasive than surgical
options
DISADVANTAGES
•Shorter-lasting results:
•Less dramatic results:
•Limited customization:

20. Topical skin care
• Products that are formulated to
be used on skin surfaces for
rejuvenation purposes
• Includes prescribed and
nonprescribed ointments, lotions,
creams and medications

21. • Examples
Vitamin A derivatives such as
tretinoic acid(retin a)
Vitamin C topical ointments
Botanicals
Antioxidants
Growth factor derivatives
Collagen creams
Moisturizers
Cleansers
Bleaching creams

22. Skin resurfacing
• Helps to restore a more youthful, beautiful
complexion by removing the most damaged
outer layers of skin to reveal the healthier looking
skin beneath and encouraging new, healthy skin
cell growth
• Help to reverse the signs of aging and stress
helping to look younger
• Key benefits
Improves skin texture
Reduces wrinkles
Reduces scars and blemishes

23. •Includes
Chemical peels
Laser skin resurfacing
Microdermabrasion
Dermabrasion
Microneedling
IPL photorejuvenation

24. Chemical peels
• One of the most effective
skin therapy modalities
• Applying a chemical
solution that causes the
outer layers of skin to peel
away.
• Quite popular

25. How can a chemical peel help improve skin?
• Reduce or remove age spots, blotchiness, or
discoloration
• Smooth fine lines & wrinkles on the skin’s surface
• Minimize or remove acne scars or milder scars from
injury or surgery
• Tighten & tone the skin and brighten the complexion
• Remove keratoses or precancerous growths
• Increase the turnover of the skin cells
• Increase collagen formation
• Brighten up skin
• Decrease acne breakouts
• Improve skin texture and tone

26. There are different types of chemical peels based on
the strength or concentration of peeling agent as well
as its mode of action
Depending on the treatment, a peel will often be
classified as LIGHT, MEDIUM, OR DEEP.
This refers to how many layers of skin are removed.

27. Light chemical peels
• Typically reach partially
through the epidermis
• Milder acid solution such
as
Glycolic acid
Alpha hydroxy acid (AHA)
Salicylic acid
Fruit enzymes
A low concentration of
trichloroacetic acid (TCA)

28. Deeper peels
• Will reach further into the
epidermis or even into
the dermis
• Recommended to
address more advanced
signs of aging, such as
deeper wrinkles and
extensive sun damage,
or severe acne scars
• Phenol peels, stronger
TCA peels, and croton

29. • Often performed in the office as part of a
comprehensive skin care regimen
• Patients tolerate these procedures quite easily
• Most will experience some skin
peeling over subsequent few
days following application of
the chemical peel

30. Laser resurfacing
• Depending on the desired
outcome or goal, a specific type
of laser is used
Laser to perform skin
rejuvenation would require a
laser whose target is water
Laser to remove tattoo would
require a laser whose target is
pigments and dyes

31. • 2 most commonly used lasers in facial resurfacing:
CO2
Erbium YAG
• These layers target water within skin cells leading
to removal of all epidermis and most of the dermis
components
• In doing so, the body recognizes that an injury has
occurred and attempts to heal itself by creating new
collagen and elastin thereby rejuvenating itself

32. Ablative lasers
• Remove outer layers of skin and encourage new
skin to heal in its place
• How deep the laser penetrates depends on the
wavelength of the light
.

33. Non-Ablative Lasers
• Do not break the skin’s surface
• They work instead by heating up the skin below
the surface to encourage new collagen growth and
help restore the skin’s natural firmness and tone.
• While they work more gradually than ablative
lasers, these treatments typically require no
downtime and can have lasting results for
rejuvenating the appearance

34. What do lasers do?
Minimize fine lines or wrinkles
Treat brown spots, redness or discoloration for
more balanaced skin tone
Tighten skin and encourage collagen production
Remove acne or surgical scars
Remove unwanted facial or body hair
• Body creates new epidermis and dermis and also
eliminates unsightly scars from previous surgeries,
aging spots and photoaged skin via resurfacing
procedure.

35. • The improvements possible with laser resurfacing
are long-lasting and can be dramatic, but they will
not appear overnight.
• It takes several months for the full effects of new skin
cell and collagen growth to take shape, and residual
after-effects of treatment, such as skin that appears
pink at the treatment site, can take a few weeks to
subside.

36. Microdermabrasion & Dermabrasion
• Involve mechanical exfoliation, where an instrument is
used to slough off outer layers of skin to remove
visible skin damage and reveal smoother, healthier
and younger looking skin.
• Each of these treatments works quite differently.
.

37. Microdermabrasion
• Relatively gentle procedure that can
be used on the face, neck, hands or
body.
• Area is exfoliated by using a very fine
tipped instrument or by applying a
fine mist of abrasive particles.

38. • The exfoliated skin is then immediately vacumed
away.
• Safe for all skin types
• Carries very little risk for side effects
• Requires no downtime.

39. What can microdermabrasion do to
improve skin?
•Minimize fine lines & wrinkles, such as crow’s feet
•Help skincare products work more effectively
•Brighten skin & improve tone
•Reduce age spots or mild acne scars

40. While immediate improvements are usually
noticeable, microdermabrasion treatments are
often performed in a series to achieve optimal
improvements.
 It is also essential to protect the treated area from
the sun, as skin will be more sensitive to sun
damage after microdermabrasion

41. •A rapidly rotating instrument or
blade is used to precisely
remove skin from the treated
area layer by layer until the
desired depth.
Dermabrasion
•More powerful mechanical resurfacing technique than
microdermabrasion.

42. •Because it reaches more deeply into the skin’s
surface, dermabrasion can affect skin pigmentation
•Thus is not recommended for every skin type.
• Typically, patients will receive a topical anesthetic or
local anesthesia to ensure comfort during and after
the procedure.

43. What can dermabrasion do to improve skin?
•Minimize vertical lip lines,
smile lines, or other facial
wrinkles
•Remove acne scars and other
blemishes
•Smooth the skin and balance
complexion

44. •The purpose of dermabrasion is to remove enough
layers of skin to remove the visible concerns and
encourage new cell growth.
•Therefore, the area will be
tender and “raw” after treatment.
It is essential to keep the area
well protected from the sun

45. Microneedling
• Uses the skin’s natural healing process to reduce skin
imperfections, treat sun damage, and restore a
smoother, clearer complexion.

46. • Instead of removing layers of
skin with heat or chemicals,
microneedling creates
microscopic “injuries” in the skin
using an instrument containing
dozens of very fine, short
needles.
The “injuries” are not visible to the naked eye, but they
do trigger the natural healing response, prompting the
skin to produce new collagen and elastin and
regenerate new, healthy skin cells.

47. What skin concerns can microneedling treat?
•Fine lines & wrinkles
•Acne or surgical scars
•Large pore size
•Sun damage, age spots and hyperpigmentation
•Stretch marks
•Rough patches & texture problems

48. •Generally safe for all skin types
•Requires no downtime for most patients, and does
not require a post-treatment “peeling” period.
However, results may not be as dramatic as what is
possible with more aggressive treatments, and
multiple microneedling treatments are usually
needed to treat specific skin concerns in an area.

49. IPL (Intense Pulsed
Light)
• Similar to laser resurfacing in
that it uses light to treat skin
problems, particularly
pigmentation problems, and
rejuvenate the complexion.
•However, instead of a highly focused, single
wavelength, IPL uses a broad spectrum of light
wavelengths, delivered in brief pulses.

50. • This light helps the skin in two ways.
First, the wavelengths in IPL absorb excessive
pigment in the skin (reds and browns) to restore a
more even complexion.
To a lesser degree, IPL stimulates collagen production
to improve overall skin tone.
• Non-ablative treatment and typically requires little to
no downtime.

51. What skin concerns can IPL treat?
•Sun damage
•Hyperpigmentation
•Age spots & freckles
•Spider veins
•Redness & rosacea
•Vascular lesions
•Texture problems
•Fine lines

52. IPL is marketed under many different names,
including BBL (broad band light), photofacial, and
photorejuvenation.

53. Dermal fillers
• Gel like substances that are injected beneath the skin
to restore lost volume of face, smooth out wrinkles
and soften creases or enhance facial contours by
filling a void or a wrinkles
• Casually known as
wrinkle fillers

54. • Early versions derived from bovine collagen and
required skin testing to rule out allergic reactions.
• Newer versions include
Hyaluronic acid(HA) fillers
Injectable silicone
Polymethyl methacrylate(PMMA)
Calcium hydroxylapatite(CaHA)
Poly-L-lactic acid
Autogenous fat injections/Facial fat grafting

55. What does fillers do?
Fillers are ideal in non surgical facial rejuvenation by
augmenting nasolabial folds, lips, lower lid areas , acne
scars, cheeks and any other region that is devoid of
adequate volume
• Smooth out lines around nose and mouth(marionette
lines/smile lines/parenthesis)
• Enhance and restore volume to sunken cheeks or
temples
• Diminish vertical lip lines
• Plump and enhance the lips
• Smooth out a chin crease

56. • Easily performed in the office setting
• Fillers are placed within the dermal layer of the skin
after administration of a local anesthetic block or
topical anesthetic through a series of
transcutaneous injections causing an immediate
augmentation

57. Hyaluronic acid
• Naturally occurring substance that is already found in
skin
• Helps keep skin plump and hydrated
• Most hyaluronic acid products are injected by mixing
powdered hyaluronic acid in a particular ratio with
water to produce a solution.
• Two main sources of hyaluronic acid used in facial
injections: animal-derived(chickens) and non-animal-
derived(bacterial origin) sources.

58. Advantages
Quick and relatively inexpensive with almost no
recovery time for patients
HA molecules are synthetically formulated so the
injected particles slowly dissolve within 6 to 9 months
depending on the viscosity of the material and hence
the effect lasts for 6 to 9 months or longer
Most HA fillers are infused with lidocaine to help
minimize discomfort during after treatment
Availability of antidote(Hyaluronidase) to address any
complications(untoward reactions like formation of skin
granulomas, allergic reactions)
HA are the only injectable dermal fillers with reversal
agents

59. Calcium hydroxylapatite(CaHA)
• Naturally occurring substance found primarily in bones
• Consistency thicker than HA filler and typically last longer
for about 12 months
• Also helps stimulate natural collagen production
• Typically used for deeper lines and wrinkles.

60. Polymethyl
methacrylate(PMMA)
• Synthetic biocompatible
substance
• Takes the form of a
microsphere or tiny ball that
remains beneath the skin
indefinitely to provide
continuos support
• Also contain collagen that
provides structure and

61. Poly-L-lactic acid
• Biocompatible and
biodegradable synthetic
substance
• Collagen stimulators as their
main mechanism to smooth fine
lines is by helping skin rebuild
natural collagen
• Typically used to treat deeper
facial wrinkles
• Result lasts for more than 2
years

62. Neurotoxins
• Most popular
• Stops the muscle from contracting and thereby
improve or eliminate the appearance of wrinkles
• Derived from bacteria Clostridium botulinum
• Purified exotoxins
• Trade name: Botox
Xeomin
Disport
Daxxify

63. • Neurotoxins block the
release of ACH at the
postsynaptic cleft thereby
preventing muscle
contraction
• After a few months, the
body creates new ACH
molecules and receptors-
worn off
• Most commonly used
areas- forehead

64. The 6 Top Facial Areas for BOTOX Injections
1. The Forehead. At the forehead, BOTOX can
reduce the appearance of horizontal brow
lines caused by repeatedly raising the
eyebrows
2. The Sides of the Nose
3. The Eyebrows
4. The Outer Corners of the
Eyes
1. The Perimeter of the Lips
2. The Jaw

65. •Appropriate injection of
selective muscles in
forehead can relax forehead
wrinkles, produce a smooth
appearance and even levate
eyebrows
• Easily administered in office
without any local
anesthetics
• Results are evident for upto
3 months

66. Conclusion
Minimally invasive facial surgery mainly uses drug
injections, fillers, thread lift, and radiofrequency to
improve facial function and appearance.
Compared with traditional cosmetic surgery, such as
facelifting, non-surgical modalities is increasingly
favored by cosmetic surgeons and patients because of
its advantages, such as small wound surface, short
recovery period, and more natural effects.

67. References
• CONTEMPORARY ORAL AND
MAXILLOFACIAL SURGERY 7TH EDITION
• https://www.lewisburgplastic.com/blog
• https://cosmeticsurgery-partners.co.uk
• https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C8894069/
• https://www.americanboardcosmeticsurgery.o
rg/procedure-learning-center/non-surgical-
procedures/