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by Suzanne Bruce, MD, from the Fall 2009 issue revised March 2011

The concept of global rejuvenation refers to treatments that are performed on the entire face, as opposed to treatments that focus on specific problem areas. Examples of the latter would be BOTOX® Cosmetic injections to treat frown lines between the eyebrows or dermal fillers to treat smile lines around the mouth. Global rejuvenation includes procedures that are done on the entire face to improve the signs of skin aging, such as wrinkles, sagging, brown spots, red blood vessels, rough texture and large pores. There are a myriad of procedures that can be done to address these concerns, ranging from less invasive, less downtime at one end of the spectrum, to more invasive, more downtime at the other end of the spectrum. Here I will address the more aggressive treatments. A future article will cover less aggressive options.

Four global, full-face rejuvenation procedures we recommend are Thermage®, FotoFacial/FotoFirm, Fraxel® and Ultherapy™. Thermage, with its facial treatment tip, uses radiofrequency energy to gently heat the skin to a level that triggers skin tightening and new collagen production – the holy grail of cosmetic dermatology. There is some immediate tightening of the face when the procedure is done. However, over the six months after this one-time treatment, the skin gradually becomes tighter and smoother with improved texture and reduction in wrinkles. We can also do the eyes as an add-on procedure to smooth out wrinkles on the eyelids. In most instances, this reduces hooding, giving the eyes a wider-open, more awake look. Besides the results it yields, the other wonderful thing about Thermage is that it is easy to do, no topical anesthetic is required, and there are no after effects, such as redness, swelling or bruising – hence little or no downtime.

The second of our full-face procedures is FotoFacial/FotoFirm. FotoFacial uses a technology called intense pulsed light or IPL. It reduces red blood vessels and brown spots commonly found on the face in fair-skinned Texans due to our constant, more intense exposure to the southern sun. FotoFirm is a procedure that combines IPL for the benefits described above with a laser treatment that stimulates new collagen production. New collagen improves texture and fine wrinkles. These two treatments done in a series of five are the best weapon we have for facial blood vessels, the extreme condition of which is called rosacea. Both FotoFacial and FotoFirm have a little downtime; brown spots will appear darker for a few days after treatment before they exfoliate and go away.

The third global rejuvenator we love at SBA is Fraxel. When this laser first hit the market in 2005, it was a breakthrough in facial resurfacing with its fractionated energy delivery. Rather than laser off the entire skin surface at one time like the first lasers that were used to treat wrinkles, Fraxel breaks up the laser beam into thousands of tiny columns of laser light. This fractional resurfacing of the skin is much safer with less risk of complications and less downtime than full-face resurfacing. We have two Fraxel options: the re:store, which requires a series of treatments, and the re:pair ,which is typically a one-time procedure but has more downtime than re:store. Both give excellent improvement in texture, wrinkles, brown spots and scars.

The latest device for non-surgical skin lifting and tightening is Ultherapy. It uses focused ultrasonic energy to treat the upper and deeper layers of the skin stimulating new collagen growth which results in a lifting of the brow and jowls and a redefining of the jaw line. Because the surface of the skin is not affected there is little or no downtime with Ultherapy. It can be performed on the upper face, lower face or full face. Although the results are not equivalent to a facelift, Ultherapy is an excellent non-invasive option for people who do not want the downtime, risks or expense of a surgical facelift.

After a global rejuvenating procedure, we then see if we need to put “icing on the cake”. That icing is more fully discussed in April’s and Dr. Polder’s articles on dermal filling, but we can treat deeper facial lines and sunken cheeks with our anti-aging arsenal of dermal fillers, such as Juvéderm®, Restylane®, Radiesse®, and Sculptra® Aesthetic.

The best way to get started on facial rejuvenation – global or targeted – is to come in for an individual consultation. In that appointment, we’ll discuss your issues and design a patient treatment plan that’s right for you.