By Dr. David Kirn


So much attention has been focused the use of injections to treat facial wrinkles in the recent past that surgery has almost become an overlooked option. While attending the annual meeting of the American Society for Aesthetic Plastic Surgeons a few months ago, a speaker commented that we (the surgeons) should not be reluctant to promote those skills since surgery provides the ultimate rejuvenation. The reality is there are some age related changes which can only be successfully addressed surgically.

None of this is to say that a skillful injector cannot accomplish a lot. In fact, some problems are best addressed non-surgically. For example, crow’s feet wrinkles are best treated by injection rather than surgery. Neurotoxins such as Botox and Dysport, significantly diminish or resolve crow’s feet wrinkles. There really isn’t an effective surgical option for this area. Although modern injectable drugs are very safe and effective, they are only as good as the person using them. Thus, it is very important to know that the injector has been well trained, has significant experience, and has a good sense of the balance line between a youthful, natural appearance and an overdone appearance.

Having all of these options available allows us to direct patients into whichever treatment(s) will be the most effective and longest lasting.

Our practice has the advantage of offering the full spectrum of options for facial rejuvenation. In addition to me, we have two very experienced nurses who have performed thousands of injections. We have a full service skin care center under the same roof. Laser treatments remain a mainstay of a comprehensive rejuvenation and “anti-aging” program. Yet, the core of our practice remains surgical. Having all of these options available allows us to direct patients into whichever treatment(s) will be the most effective and longest lasting.

Modern surgical techniques allow us to address all of the layers in which the aging process manifests. Of course, the most obvious is the skin. Although numerous attempts have been made to non-surgically tighten skin, surgery remains the only method to remove excess skin. The importance of restoring volume to zones of the face where it been lost is a key element of modern facelifting technique. Volume restoration is one of the ways the modern operation creates a youthful look. By contrast, the historical methods just pulled the skin as tight as possible creating an unnatural or surgical look. Lastly, themuscle and supportive layers of the face are tightened which yields staying power.

How long does a facelift last? I generally tell patients to anticipate 8-10 years duration. This timeline is a stark contrast to the few months duration of injectable treatments. But, it also indicates that the aging process marches on and human tissues are bound to change with time. What happens in 8-10 years? The interval represents the time frame during which patients typically seek a second surgery. That second surgery may be more simplistic than the first. Frequently, no new scars are necessary since the old incisions may be utilized. It is common for patients to experience less bruising and swelling on the second operation since the previously utilized planes of dissection may provide a guide path for the second procedure. As with a first facelift, restoration of volume with fat grafting or fillers is usually combined to achieve full rejuvenation.

So, don’t forget about surgery as an option for facial rejuvenation. Modern techniques provide a natural appearance and substantially reduced recovery time as compared to just a few years ago. The lasting effect of surgery simply cannot be paralleled with non-surgical methods.

If you are unsure about which options are best for you, seek consultation with a surgeon certified by the American Board of Plastic Surgery.

Dr. David Kirn is a Board Certified Plastic Surgeon who is devoted to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body. In private practice since 1998, he is located in a state of the art facility which includes a full service skin care center. The practice is focused on personalized patient care and attention to detail. Where possible, Dr. Kirn utilizes minimally invasive procedures. The goal is to deliver quality clinical results while minimizing patient recovery time. Examples of this include a no-drain tummy tuck, armpit incision breast augmentation with gel or saline implants, fat grafting, and a short scar facelift. In addition, Dr. Kirn and nurse-injectors Carey Sanders, RN and Shirley Ramsey DNP, APRN, offer a full spectrum of non-surgical treatments such as Botox®, Dysport®, Dermal Fillers, Kybella®, & Laser.