UNDER YOUR SKIN By Grace Carole Beltran MD
There is a point in our lives when most of us decide to make changes that feel right and good, and mostly that is the desire to restore what weíve lost in years. Our appreciation of life is overshadowed by a poignant apprehension of mortality.
Luckily this is the golden age of anti-aging, which is why we are getting a barrage of aesthetic devices and procedures that can be confusing at times. The good news, though, is you have more options to choose from. After years of experience, Iíve selected procedures that are appropriate to the patientís requirements. The following are important in dealing with the choices we make:
1. The age of the patient. The needs of a 30-year-old definitely differ from a 60- or 70-year-old. Volume loss is the primary facial aging issue in the latter age group. A 30-year-old patient might just need an anti-aging cream and peels to improve on texture, tone and skin color, together with Botulinum toxin to address fine lines, versus someone at around 60, who will definitely need some lifting procedures using laser devices that might require more than one session depending on the severity of the sagging. Some 60- to 70-year-old patients would require more than one procedure or even surgery.
Take, for example, 64-year-old EJ. With EJ I had to do some jaw-defining procedures, together with augmentation of the angle of the jaw, because there was already some bone resorption. (As people age, the rate of resorption tends to exceed the rate of replacement, leading to conditions like osteopenia, or bone thinning.) There is also the need to do forehead, mid-face and temple rejuvenation using fillers.
HG, on the other hand, a 70-year-old lady who did not want surgery, went for Botox injections first, then laser tightening and filler injections. Fillers are structure-volumizing substances used to re-inflate lost volume, which is common in this age group.
2. Reason for consultation. Most of the time the patientís perceived problem and the solution they are considering are not compatible and realistic, so there is a need to explain and reorient them to the actual problem, solution, and changes to expect afterward. A more detailed outcome needs to be emphasized as well. The problem with some patients is that they cannot tell exactly what they want because they feel embarrassed to say it. Patient needs to verbalize what they expect after the treatment as sometimes their expectations are way too high or priorities are different from what the aesthetic dermatologist thinks.
3. Tolerance to pain plus advantages or disadvantages of each treatment method. The patient has the right to know how painful a procedure is because what is worse is withdrawing a procedure even before itís completed. We also need to determine if sedation is necessary before a procedure because clearance from an internist is required. For example, for non-surgical facelift procedures, Ultherapy is more painful compared to Profractional laser compared to HIFU and definitely Titan, in that order. Profractional laser procedures have the added effect of improving facial scars like severe acne scarring; plus, it does wonders for thin, wrinkled, crepey skin. But Ultherapy and Titan have an instant effect, just like HIFU. In heavy faces like those with thicker skin and round faces, Ultherapy is excellent but for not so rounded faces or thinner skin, Titan would be best, although some of these devices have different settings that can be adjusted according to the needs of that particular patient. HIFU is similar to Ultherapy but personally speaking, Ultherapy can reach the deeper layers for more tightening so fewer sessions are needed.
The latest among these devices, which is not painful, is the Ultraformer 3, according to my friend. All these thermal energy devices emit a certain critical temperature for treating the skin, which is specifically intended for skin soft tissue remodeling. As a conclusion, however, these devices cannot replicate the result of an accurate surgical facelift and neck lift (surgery is not just the lifting of skin; it repositions soft tissue and muscle related tissue, too).
4. What is the budget of the patient? This is very important because you cannot expect perfect results with a piecemeal or half-finished procedure due to lack of money. Patients should be given an estimated cost prior to every procedure.
5. Does the patient prefer non-surgical or surgical procedures? Does the patient want a more permanent effect that lasts longer and requires fewer follow-ups, or is the patient so afraid of surgery that they would rather go for injectables or laser devices, even though a number of sessions may be necessary for a more accurate result?
6. Is the family supportive of the intended procedure the patient wants? Conflict with the husband sometimes creates trouble, not only with the patient but also with the surgeon. The husband, children or any other close relative consists of the support system of the patient and if any of them gives a negative comment after surgery because they were opposed to it in the first place, then you are in trouble.
7. Is the transformation the patient wants subtle or major? Is that change necessary, applicable or suitable for that particular patient? How much change is needed? For example, in rhinoplasty, the patient should express how elevated the nose he or she desires, or in the case of breast augmentation, what size of breasts the patient wants.
Once these questions are adequately answered, then and only then can the surgeon decide what treatment modalities are best for that patient. Itís always best for the patient to put some questions together so that both patient and doctor can work on an effective course of treatment.
Age management is a booming industry, which is why more and more treatment options for anti-aging are coming out. To begin your journey, consult a board-certified aesthetic and pathological dermatologist who has had many years of experience and is willing to sit down to answer questions that are relevant to your problem. (www.philstar.com)
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