Facial Plastic and Reconstructive Surgery: New Patients, New Reasons, New Techniques

For others patients and surgeons, there are lasers. The CO2 laser and the erbium laser have been around for some time and are very effective, although the CO2 laser, because it has a greater depth of penetration, is more effective for deep resurfacing. Sometimes it is combined with dermabrasion, Dr. Kridel explained.

Now a new laser, called the Fraxel laser, yields resurfacing results nearly as good as those of the CO2 laser but entailing much less recovery time. Five treatments are given, with two to three days of recovery time after each, as opposed to one treatment with the CO2 laser. The Fraxel, although used over the entire face, actively treats only about 20% of the tissue at one time because the area around each changing “microthermal treatment zone” is said to remain untouched.

The device stimulates collagen deep in the facial tissue, stimulating the creation of new collagen which elevates depressed areas of skin, Dr. Kridel explained. “A lot of people who have wanted better looking skin but couldn’t afford the downtime are doing this. It’s not quite as good on wrinkles, but does improve the texture and coloration of the skin,” he said.

Still other light sources and lasers, generally termed “minimally invasive” or “nonablative,” are now available that only stimulate the skin. Long-term results on these new devices are not yet available.

Yet another modality, called the Thermage Therma-Cool system, sends radiofrequency waves, and thus heat, to deeper tissues. “Reportedly,” said Dr. Kridel, “through tightening of existing collagen and stimulation of new collagen development, it can tighten facial skin, although results are neither very predictable nor remarkable.”

He added: “But others have found—and I too, have seen—some cases of active acne in which Thermage has improved the condition. Presumably the heat penetrates into the deep pilosebaceous units, causing them to become less active.”

Reconstructive Surgery

Advances in reconstructive surgery of the face have been aided by improved imaging of fractures and other defects, better biomaterials to hold parts of the face and head together while healing takes place, and the use of endoscopy in repairing facial fractures. Titanium plates remain the standard for helping to fix and reconstruct the face but in addition, according to Dr. Papel, there are now available absorbable facial reconstruction plates that facilitate healing of bones. One such material is Biosorb, a self-reinforced polyglycolide-co-polylactide 80/20 material used to make plates and screws to help fix osteotomies and fractures. Another is LactoSorb, a copolymer of 82 L-lactic acid and 18 glycolic acid.