Minimally Invasive Surgery -"The Non-Cutting Edge"

   Day 1 of the 44th Annual Baker Gordon Aesthetic Surgery Symposium!
   The theme this year is "Agility in Minimally Invasive Plastic Surgery Techniques".
   That which distinguishes this particular conference from most of the other surgery conferences is that it presents live, simultaneously broadcasted surgery to an auditorium, from where we can interact with the surgeon and operating room through two way audio. Though technically marvelous forty years ago---today--- still pretty cool! Most other conference formats involve 5 to 10 minute keynote/powerpoint presentations which are great to reveal research data, or show long-term results. But nothing beats watching one of these "luminaries" in the academic plastic surgery world deal with real life variables, in real time, all the while answering our questions, and colleagues' challenges. Oh, while staying out of the camera's way... Awesome.
   The day started at 8am with Dr. James Stuzin performing an isolated Neck Lift. This procedure highlighted an issue which I have long argued- namely that the neck can and often should be treated in isolation from the rest of the face. Many younger patients present with a full, blunted neck angle which stems from a hereditary propensity to have a thick inelegant neck, or from weight fluctuations early in life. Sometimes simple liposuction is the solution. Sometimes we need to tighten the neck muscles- much like you might lace up a corset to help define the midriff. Yet other times we need to tailor the neck from multiple directions at once. Either way, we needn't do anything to the face when the neck is misbehaving all by itself. Lately, I have seen some older patients who had their face and neck addressed many years ago. Either because their face has withstood the passing years better than their neck, or because perhaps the neck hadn't been treated thoroughly enough at that time, they present with isolated neck issues- usually loose skin and draping, and unkempt neck muscles creating vertical bands spanning from their chin to the collar bone. In these patients, as well, there may be no reason at all to fift their faces again if the neck is out of proportion all by itself. Sure, sometimes its just easier to do both procedures at once.       My father once told me - "Doing what is easy is rarely the right choice". 
   Treat what needs it. Do as little as possible to make the face beautiful and the soul happy. Dr Stuzin showed excellent results, technical efficiency, and an aesthetic sensibility. Bravo.
   The middle part of the day dealt with (appropriately) the Mid-Face Lift. Presentations, surgical videos, and live surgery by three different surgeons showed us their three different approaches to the mid-face. They each had different philosophies on treating the mid-face, different sets of indications and goals, and different techniques. The bottom line here is that the Mid-face Lift has very specific benefits, significant limitations, and more downtime than average. It should not be used on just anyone- certainly it should not be a standard part of every Facelift. Amen to that.
   At the end of the day we were shown some live non-invasive procedures (needles instead of blades) with neurotoxins (BOTOX and Dysport), and Injectable Fillers (Restylane, Juvederm, Radiesse). Didn't discover anything new here. The point was made that we practitioners of aesthetic medicine more often than not use neurotoxins and fillers in "off-label"ways, considering that the FDA's approval of these agents is very specific and limited. Perhaps we should mention this more clearly to our patients. Then again the FDA is often behind the curve of actual practices.
   I thought a nice analogy for this branch of non-surgical aesthetics is to compare our techniques and choice of products, to the palette of an artist, and their use of light, and choice of brush stroke to obtain a pleasing result both to the artist and the patron.
   All in all an exciting first day.
-drB