The South African Arm of The International Society of Aesthetic Plastic Surgery (ISAPS) was hosted in the BMW Pavilion Conference Centre, during March 2008, in Cape Town. Currently, based on merit, ISAPS is the best and most informative aesthetic congress in South Africa. Because it is representative of specialists, academics, private specialists and trade. The national secretary of ISAPS (South Africa) is Dr Russell Walton, FRCS, plastic surgeon from Johannesburg (email: firstname.lastname@example.org or telephone (+2711) 6401573. For more details look at www.isaps.org .
Important topics that were discussed included, facial rejuvenation, breast surgery, volumetric face lifting, face lifts, labioplasty, rhinoplasty, abdominoplasty, medical ethics, cell therapy, audit, thread lifts, platelet-rich plasma and application of PLATELTEX-ACT. Presentations were made by Proff Daniel Baker, Frank Trepsat, Jose del Herra and Don du Toit, to mention a few. Dr Baker is a leading authority on aesthetic facial surgery and frequently presents at plastic surgery, dermatology and cosmetic surgeon congresses world-wide.
Other important cosmetic and aesthetic congresses:
Figure 1: Waterfront Cape Town. Home of ISAPS. Congress proceedings are in the BMW pavilion.
FACE LIFT VERSUS RF AND FRACTIONAL PHOTOTHERMOLYSIS FOR FACIAL REJUVENATION: FACE LIFT OR LASER LIGHT? WHICH IS THE BEST?
There is no magic elixir that can ensure everlasting youthfulness. Rape of the face by natural aging or solar damage is the usual outcome. The problem with fractional laser resurfacing is the danger of post inflammatory hyperpigmentation and variable results or no response. So, clients just throw away money because all these non-invasive treatments are based on a dream, with poor outcomes, and often don’t work. Often the devices disappear as fast as they appear. Many are gimmicks. Dr Daniel Baker of the United States confirms that a good facelift is still the gold standard and renders durable results far superior than IPL, fractional lasers. Laser facial resurfacing does not always work. This includes devices such as Titan, Eclipse, Thermage, Pearl, Fraxel, Aesthera PPX, Omnilux.
Follow up studies after face lift at 1, 10 and 15 years cannot be matched by non-invasive devices, but the results are surgeon dependant. One of the main advantages of a face lift is that sagging tissue is repositioned which lasers and IPL cannot due. Face lift addresses deep sagging which IPL and lasers cannot treat. Face lift can be complimented with rhinoplasty and blepharoplasty for bags below the eyes. Lasers and IPL cannot affect the excellent comesis for baggy eyes, provided by blepharoplasty. These results are durable and good results are seen after 10 years. So in many ways face lift renders excellent results for periorbital skin rejuvenation. In many cases, lasers do not improve deposition of collagen in the dermis but rather produce scarification. Facelift is one off and lasers and IPL need many treatments often exceeding 6 weeks. Many patients after IPL and lasers become despondent and fed up, because of no result or a variable result, and seek correction by a plastic surgeon. At best results are modest and patients cannot see the results in the mirror, after many treatment sessions. Laser and IPL are therefore not a quick fix for wrinkles neither and often create terrible and unsightly depigmentation or hyperpigmentation of the face that is permanent. Again, not all lasers and IPL can confidently be used on persons of colour. Loss of 3D profile of the face as a result of a facelift is a misconception. The areas where facelift is far superior to skin tightening devices include:
Sagging midface ptosis
Bags under the eye
FACIAL MICROFAT GRAFTING FOR REJUVENATION: A natural filler
In the hands of experts, this autologous filler can obliterate facial wrinkles very effectively and is far superior to hyaluronic acid injections that are very short lived, costly with rapid recurrence of the wrinkles within 6 months. Another drawback is the development of very bad skin granulomas that clients dislike.
Dr Frank Trepsat, a very experienced plastic surgeon from Geneva, Switzerland has shown that bags under the eyes are related to facial fat atrophy. In many cases blepharoplasty is not necessary and puffiness responds well to fat injections. According to him the best place to harvest the fat is from the inner part of the knee. His follow-up of patients at the 5 year mark is very good. The back of the hands can be injected with fat and greatly improve the skin tone and texture. Sun blemishes and lentigines are nor reversible with fat injections. Only one session is needed for the injection. He uses living adipocytes and periorbitally he places the injection deep to the Orbicularis oculi muscle. He reshapes the face by this micro-fat grafting. Drawbacks include fat necrosis, small fat lumps, calcification and cysts, but are very rare in his experience. He injects superior and inferior to the Chantal line. This treatment is physiologically more sensible than applying a laser, RF or IPL that does not address the main problem of aging fat atrophy, and often does not work despite the claims of skin tightening. This is a very good form of facial rejuvenation and addresses periorbital skin and dermal aging. In some cases he recommends facelift plus microfat grafting, that can recreate a lost shape. Also useful for breast augmentation, avoids a breast prosthesis, but a preop mammogram is needed. So in his hands liposculpture of the hands and face are possible by microfat grafting. The one area that microfat grafting does not treat well is the nasolabial folds, an area that is resistant to most forms of treatment. Fat transfer is far superior to Thermage and Fraxel for the treatment of jowls. At best the latter modalities only provide an 80% subtle result. A full range of Thermage treatment is in the range of R25,000 and is therefore unaffordable for most on a small cosmetic budget.
FIGURE 2: Living adipocytes and fibroblasts
PLATELET-RICH PLASMA (PRP) FOR FACIAL REJUVENATION
This modality has shown to be reasonably effective for the treatment of facial wrinkles, but the effect is lost at 6-8 months. It is popular with patients but the result depends on how the PRP is prepared. Many doctors in South Africa offer this treatment now. The distributors of PRP blood collection kits in South Africa is Omnimed , in Johannesburg. Other devices such as RF, IPL, lasers may be needed as add-on.
Sixteen ml of blood is taken by venous puncture from the arm. The blood is processed in the doctor’s rooms after centrifugation. The PRP is extracted and the patient’s own plasma is then used to rejuvenate the facial skin by tiny injections, like mesotherapy. The process takes about 1 hour. Slight swelling of the face can be expected in some clients but this subsides in a few hours. The process is safe and works fairly well. The tone and texture of the skin improves with time and a response can be seen within 3-4 weeks. The lines of the upper lip respond poorly.
Figure 3: Male client undergoing PRP facial mesotherapy in Cape Town. Sometimes the treatment is referred to PRP or ACR ( autologous cellular regeneration).