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Recently, a number of minimally-invasive and non-surgical techniques for oculofacial rejuvenation have become increasingly touted as viable alternatives to more aggressive but proven procedures of lasting value. Are they?
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• Minimally-Invasive Therapies
While the list of catchy brand names used to market minimally-invasive treatments grows almost monthly, the procedures generally included in this grouping of non-surgical therapies include botulinum toxin, injectable fillers, radiofrequency energy, and non-ablative lasers. Each is discussed in some detail in the Insider's Guide to Blepharoplasty.
• Do They Work?
Neurotoxins will indeed paralyze nerve and muscle, and injected fillers will indeed add tissue volume. For some minor problems (for instance, frown lines), they offer the best means of treatment.
Radiofrequency energy, non-ablative lasers, and pulsed light treatments are a bit more "iffy." Most patients do note some modest benefit, but others claim almost no help at all.
Why undergo a procedure that offers the potential for minimal improvement at best? Seemingly painless and effortless approaches can seem almost irresistibly appealing.
• Are They Effective Alternatives to Eyelid Surgery?
That all depends upon what condition you are seeking to change, how much help your eyelids require to look better, and whether you are willing to settle for "understated" and/ or temporary results.
In many cases, minimally-invasive equates with minimally-effective (although not minimally-expensive). Improvement may be so subtle as to be almost unrecognizable or so fleeting as to seem not worth the repeated effort.
For young patients with early changes, such treatments may forestall the need to undergo definitive surgical treatment. If a certain wrinkle or subtle hollow has you feeling down, why not address it, even if the effect does disappear after a few months? Haircuts and facials don't last forever, either.
For anything more advanced, however, skirting around the problems with minimally-invasive "regimens" (that is, a shopping cart full of multiple non-surgical treatments) may turn out to be a disappointing use of time and resources. The only way to achieve surgical-quality results is with surgery.
• What Are The Advantages?
Clearly, one advantage to minimally-invasive rejuvenation is decreased down-time. If nothing much is done, there's nothing much to recover from. To soften a few frown lines or lift your brow a millimeter does not require the same recuperation as a forehead lift.
For the same reason, the risks of treatment are different. If you don't undergo real cutting surgery, the risks of cutting surgery are . . . well, simply not there.
• What Are The Disadvantages?
A few disadvantages have already been mentioned. So, what else?
While some doctors seem to think that most patients don't mind returning again and again for costly maintenance, we have not found this to be the norm. Some patients who believe they will be saving time and money by undergoing minimally-invasive procedures discover that the effort and costs add up quickly.
Staying power is also an issue. Those who been told that their results can last two or three years may be disappointed when they learn that such predictions are based on "best-case scenarios" and that a few months may turn out to be more accurate.
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Many assume that the risk of serious complications with minimally-invasive procedures is essentially zero. This is untrue. For instance, a number of cases of blindness has been reported following injection of muscle-paralyzing agents and filler materials around the eye. Permanent or semi-permanent filler materials injected into the eyelids may create lumpiness that is difficult or even impossible to treat without surgery.
The biggest disadvantage, though, is how limited the potential for improvement may be. If skin is draping, fat is bulging, and your eyelids and surrounding facial structure are stretched and sagging, don't expect too much help from anything short of real surgery and/ or ablative resurfacing procedures (like medium-depth chemical or laser peels). After all, "non-surgical eyelid lift" is a rather blatant oxymoron.
• Additional Comments
In our opinion, a better designation for many such treatments is "minimally-invasive maintenance" rather than "rejuvenation." We also believe that the practice of "warm and cuddly" naming is unfortunate and may lull a patient into seeking a treatment that almost sounds like fun. Terms like "featherlifting" tend to downplay the seriousness of what are true surgical procedures.
• Who Should You Go To?
Because the application of minimally-invasive techniques for eyelid and facial rejuvenation requires far less training and experience than with cutting surgery, practitioners in many different specialities now offer "medical spa" care that seems to blur the distinctions between physician and aesthetician as well as surgical suite and beauty parlor. In fact, some doctors have their assistants perform most hands-on treatments.
Be wary of claims from clinics or spas advertising "dramatic" results with "minimal" intervention. What seems too good to be true usually is.
A good place to seek care is in the office of a seasoned dermatologist specializing in cosmetic dermatology. Who better knows the skin? There you will find not just one or two "machines" or one "favorite filler" but the full gamut of available technology and materials supported by a wealth of experience in appropriate selection and use.
• More on Hyaluronic Acid Injections Around the Eyes
