The New Face of Aesthetic Medicine
By MELANIE KILGORE-HILL
The trendy nature of aesthetic medicine poses a number of challenges, making it imperative for patients to perform due diligence to ensure the best care.
"One of the challenges in aesthetics is the fact that there really is no formal outcome analysis or quality assurance of the ever-growing number of procedures and services offered," said oculoplastic surgeon Brian Biesman, MD, FACS. "Some of these procedures may be safe and highly effective, while others may or may not have enough science behind them to support them."
Biesman's Nashville practice specializes in cosmetic and reconstructive eyelid and facial surgery and minimally invasive rejuvenation techniques including injectables (neuromodulators and fillers) and technology-based solutions (laser skin resurfacing, non-invasive skin tightening, body contouring, and related techniques), as well as medical grade skin care.
Biesman also serves as a clinical assistant professor at Vanderbilt University Medical Center, where he holds appointments in the divisions of Ophthalmology, Dermatology and Otolaryngology-Head and Neck Surgery.
Among the more meaningful advances in cosmetic procedures is the evolution of injectable fillers.
"Injectable fillers are an increasingly common request from patients, and we're getting more and more products on the market," Biesman said. "We've also enhanced our understanding of when, why, and how to better use them, and we have a broadened portfolio of products from which to choose."
Biesman said the growing market reflects a better understanding of goals surgeons want to accomplish for their patients. Injectables have come a long way since the early days of bovine collagen, the first injectable soft tissue filler approved for use in the United States.
"Back then, the goal was to treat wrinkles and lines, but over time we realized there are so many other factors involved," Biesman said. "Aging changes are manifest in a number of ways, including changes to the skin, soft tissue and skeletal systems, as well. If we're going to help our patients achieve the best outcomes, we have to think beyond wrinkles and lines."
That dialogue led to the popularity of revolumization, which remains a mainstay of rejuvenation. However, like treatment of wrinkles and lines, it proved insufficient in most cases to produce best outcomes.
"When you look at facial contouring - where the light reflects naturally off the forehead, nose or cheek - revolumization can only be done to a certain point before it looks unnatural," Biesman explained. "When we assess patients for rejuvenation today, we pay attention to facial contouring such as the relative prominence of the cheeks, forehead, chin and jawline, as well as general volume changes and superficial wrinkles and lines. Some of the most subtle changes are the most important when it comes to facial rejuvenation."
Devices are often used alone or in conjunction with injectables, accomplishing goals that could not previously be achieved noninvasively ... if at all.
Reduction of fat in the submental region is an example of a goal that previously required a surgical procedure and can now be accomplished non-surgically for some patients using a combination of techniques.
"We can now accomplish noninvasive reduction under the neck and can use neuromodulators to deal with muscle," Biesman said. "We also have noninvasive skin lifting procedures in conjunction with the reduction of unwanted fat. There are a lot of strategies we're using not just to accomplish a single objective but a bigger framework to help people look more youthful in a natural way."
Preventative treatments have also become standard. In fact, Biesman regularly sees patients in their 20s and 30s seeking out early treatment of modest lines and wrinkles. Regardless of the procedure, Biesman said managing patient expectations is key.
"So much of what we do depends on the management of expectations," Biesman said. "We want to know what they think this procedure is going to accomplish and ensure we can meet their needs."
Patients often visit a surgeon seeking out a treatment they saw on television or heard about from a friend. But Biesman said treatments aren't 'one size fits all,' and patients might not be a good candidate for the procedure requested.
Biesman said honesty is always the best answer. "I tell them up front if I think their expectations are unrealistic," he said. "Sometimes the best cases are those we never do, because the last thing you want to do is disappoint someone."
He also advises consumers to find an experienced physician who is both knowledgeable and skilled rather than shopping by convenience or price alone. "Bargain basement prices on aesthetic medical care can be associated with a relative lack of knowledge or expertise," Biesman said. "Achieving best outcomes depends not only on the quality of the device or materials used but on the skill and judgment of the operator."
He concluded, "It takes experience and excellent clinical judgment to determine energy level, treatment end points, and best safety practices. It's all very complicated, and the commoditization that we see is unfortunate. Aesthetic procedures, like any other surgical procedures, cannot be mastered after taking a weekend course."