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Pivotal Changes in Facial Rejuvenation


There are plenty of tools available to keep patients looking rested, youthful, even beautiful, but it’s the way they’re used that creates either natural- or unnatural-looking results.

The dermatology, plastic surgery, facial plastic surgery, and oculoplastic surgery cosmetic multi-specialties have developed techniques and tools that can be used to keep the aging process at bay.

“Everybody that's in this room understands how the face ages,” says Suneel Chilukuri, MD, Refresh Dermatology, Houston, Tex. “And we also understand [that] when filler and other tools are used incorrectly, people get a very unnatural result.”

Dr. Chilukuri was invited to present, “Through the Years—What do Patients Look Like After 2 to 15 Years of Aesthetic Treatments?,” at the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) virtual meeting 2020.

From the dermatologist’s standpoint, “We really understand the histology, and we look at the skin, not just from the outside, but what we see on the inside that continues to enhance and improve our results for years to come,” says Dr. Chilukuri.

Respect the Fat Pads

How dermal fillers are used has evolved, from literally filling in lines to augmenting facial structure. This is an area in which dermatology and plastic surgery intersect. Dr. Chilukuri attributes this pivotal change to Rohrich and Pessa’s published research on facial fat compartments and the implications for cosmetic surgery.1

“When we individually fill those compartments, we can recreate that three-dimensional structure,” he says. “Bring that patient back to a natural result.”

In 2013, another pivotal change came with longer-lasting HA fillers. Once only lasting six to twelve months, now they last up to two years.

“I recommend that you as a surgeon who understands the anatomy place these fillers and place these products yourself. You're going to have better understanding than anybody else.”

Dr. Chilukuri describes taking a staged approach to tailored restructuring of the face, first with neuromodulators + HA fillers + skincare.

“I'm using neuromodulators for three to four weeks before I use any type of resurfacing because I want to enhance the results of that resurfacing,” says Dr. Chilukuri. “I don't want the skin to fold on itself and recreate those rhytids that are at rest.”

NEXT: The Evolving Face of Rejuvenation

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