101
Future of Cosmetic Surgery Robert Alan Goldberg, MD1 1 Department of Ophthalmology, University of California Los Angeles,
Los Angeles, California
Address for correspondence Robert Alan Goldberg, MD, Department of Ophthalmology, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095 (e-mail: [email protected]).
Abstract
Keywords
► fillers ► neurotoxins ► aesthetic surgery
Changes in cosmetic surgery will be driven by several key forces. The patient’s selfimage, and perceived place in society, will continue to drive patients to the cosmetic surgeon as well as to demand newer and better treatments. Technological advances, especially those based on an enhanced understanding of cellular and tissue physiology, promise enhanced tools other than the scalpel for the surgeon. Conceptual advances in our understanding of beauty and patient psychology will lead to a more integrative approach to cosmetic surgery.
Yogi Berra noted that it is difficult to make predictions, especially about the future. Perhaps, the best way to guess where we are going is to look at the driving forces affecting our discipline. If we know which way the wind is blowing, we might predict the course of the balloon. I suggest there are three main driving forces affecting the field: patients, technology, and advances in conceptual understanding. Let us examine each of these factors and consider the way that they might act on the discipline.
Patients Patients run the show. Aesthetic surgery is elective and discretionary, and obviously the future will be affected critically by the attitudes and desires of our patients. In industrialized societies around the world, esthetic surgery is increasingly accepted in the mainstream of society. Having an appointment for one’s botulinum toxin injections is as socially routine as getting one’s hair or nails worked on. Although occasional patients still want to keep their treatment private, sometimes even from their spouses, esthetic medicine generally has a high profile in the media and in everyday social conversation. Characters in movies and television have cosmetic surgery, not to mention the actors who play them. Talk show hosts interview guests about cosmetic surgery, and have cosmetic treatments themselves, sometimes even performed live on their own shows. Articles on aesthetic surgery are frequently found in print and online. Advertising for aesthetic procedures is also mainstream. In newspapers, advertisements for discounted Botox compete with each other, and in high-end magazines lush
Issue Theme 11th International Symposium of Facial Plastic Surgery; Guest Editors, Jonathan M. Sykes, MD, FACS, and Anthony P. Sclafani, MD, FACS
cosmetic surgery advertisements are found adjacent to advertisements for fine cars or jewelry. Patients also perceive themselves as being busier. Women are more likely to be working in high-powered jobs, and we see increasing numbers of male patients. Patients do not have the sense that they have the luxury of time for a long recuperation. There is also a general increase interest in minimally invasive surgery. Patients are naturally frightened of the idea of surgery. They are exposed to extensive media coverage of minimally invasive aesthetic rejuvenation, and tuned into the idea that they may be able to achieve their goals without invasive procedures.
Technology Technology will also drive the future of cosmetic surgery. Surgery, as a discipline, is fairly mature. There will be small improvements in things such as hemostatic cutting devices, sutures, and instrumentation, but we are reaching an asymptote with regard to our ability to mechanically reposition the skin and soft tissue. The main technological drivers of the future will be biological. Wound healing remains a somewhat elusive process. We are slowly starting to understand the cascades of molecular biological events that characterize the body’s response to an injury (such as a surgical injury). Being able to control this process will lead us to the next generation of treatments. For example, the contractile and fibrotic compliments of wound healing result in some of the worst complications of aesthetic surgery, such as eyelid retraction. On the contrary, these same biologic processes allow tightening of
Copyright © 2014 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.
DOI http://dx.doi.org/ 10.1055/s-0034-1371901. ISSN 0736-6825.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Facial Plast Surg 2014;30:101–102.
Future of Cosmetic Surgery
Goldberg
the skin and rejuvenation of the soft tissue envelope with skin resurfacing technologies. Once we have the ability to modulate the biology of wound healing to our benefit, surgery will be more predictable and more versatile. Technology is also moving forward on the science of injectables. Synthetic fillers have revolutionized the treatment of facial volume. This technology will continue to evolve, with increasingly versatile, biocompatible, and longlasting materials. Materials that can restore not just the volume but also some of the biomechanical characteristics of youthful skin, are on the horizon. Neurotoxin technology will also continue to evolve with more versatile, refined, and specific agents available. In some settings, reducing soft tissue volume is appropriate to improve cosmetic appearance. Injectable and noninvasive lipolytic and volume reducing technologies will continue to improve in their safety, efficacy, and predictability. Stem cell technology is the Holy Grail of rejuvenation science. If we could actually replace or reprogram the tissues in the aging face with regenerated counterparts, fresh with the memory of their youthful biochemical status, we could truly turn back the hands of time. Unfortunately what sounds too good to be true, often is. We are a long ways off from controlling biology to that extent. However, there have been some good anecdotal reports of successful stem cell treatments, the technology is the current darling of laboratory research benefiting from lots of resources, and it is hard to resist being an optimist in the face of the dazzling promise of stem cell technology.
Conceptual Advances Conceptual advances will be significant drivers of the future of aesthetic surgery. Carefully thinking about facial
Facial Plastic Surgery
Vol. 30
No. 2/2014
aging in three dimensions has helped drive our understanding of the roles of volume versus gravitational effects. Three-dimensional imaging and computer analysis have helped construct universal models of facial beauty, and understand the spectrum of diversity of the human face. Psychological studies have helped us to understand motivations for facial rejuvenation, and psychological factors that determine patient satisfaction. All of these conceptual sciences will continue to evolve and help drive the future of cosmetic surgery.
Summary The future aesthetic surgery will be driven by patients, technology, and conceptual advances. Patients are attracted to minimally invasive technologies promising decreased recovery time and perhaps more natural results. Technological advances will offer better control of volume (both additive and subtractive), control of the biology of fibrosis and wound healing, and rational and scientific integration of stem cell technology. Antiaging technology will improve and will be an increasing component of aesthetic medicine. Conceptual advances will further refine our understanding of facial aging, facial beauty, and the psychology of marketing and patient satisfaction in aesthetic medicine. The field of aesthetic surgery will continue to reward practitioners who are imaginative, creative, and lifetime learners. The pace of change will be exhilarating, the ability to help our patients will continue on a rapidly ascending trajectory, and the opportunities to contribute to the expansion of the discipline will be historically unparalleled.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
102
Copyright of Facial Plastic Surgery is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Future of Cosmetic Surgery Robert Alan Goldberg, MD1 1 Department of Ophthalmology, University of California Los Angeles,
Los Angeles, California
Address for correspondence Robert Alan Goldberg, MD, Department of Ophthalmology, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095 (e-mail: [email protected]).
Abstract
Keywords
► fillers ► neurotoxins ► aesthetic surgery
Changes in cosmetic surgery will be driven by several key forces. The patient’s selfimage, and perceived place in society, will continue to drive patients to the cosmetic surgeon as well as to demand newer and better treatments. Technological advances, especially those based on an enhanced understanding of cellular and tissue physiology, promise enhanced tools other than the scalpel for the surgeon. Conceptual advances in our understanding of beauty and patient psychology will lead to a more integrative approach to cosmetic surgery.
Yogi Berra noted that it is difficult to make predictions, especially about the future. Perhaps, the best way to guess where we are going is to look at the driving forces affecting our discipline. If we know which way the wind is blowing, we might predict the course of the balloon. I suggest there are three main driving forces affecting the field: patients, technology, and advances in conceptual understanding. Let us examine each of these factors and consider the way that they might act on the discipline.
Patients Patients run the show. Aesthetic surgery is elective and discretionary, and obviously the future will be affected critically by the attitudes and desires of our patients. In industrialized societies around the world, esthetic surgery is increasingly accepted in the mainstream of society. Having an appointment for one’s botulinum toxin injections is as socially routine as getting one’s hair or nails worked on. Although occasional patients still want to keep their treatment private, sometimes even from their spouses, esthetic medicine generally has a high profile in the media and in everyday social conversation. Characters in movies and television have cosmetic surgery, not to mention the actors who play them. Talk show hosts interview guests about cosmetic surgery, and have cosmetic treatments themselves, sometimes even performed live on their own shows. Articles on aesthetic surgery are frequently found in print and online. Advertising for aesthetic procedures is also mainstream. In newspapers, advertisements for discounted Botox compete with each other, and in high-end magazines lush
Issue Theme 11th International Symposium of Facial Plastic Surgery; Guest Editors, Jonathan M. Sykes, MD, FACS, and Anthony P. Sclafani, MD, FACS
cosmetic surgery advertisements are found adjacent to advertisements for fine cars or jewelry. Patients also perceive themselves as being busier. Women are more likely to be working in high-powered jobs, and we see increasing numbers of male patients. Patients do not have the sense that they have the luxury of time for a long recuperation. There is also a general increase interest in minimally invasive surgery. Patients are naturally frightened of the idea of surgery. They are exposed to extensive media coverage of minimally invasive aesthetic rejuvenation, and tuned into the idea that they may be able to achieve their goals without invasive procedures.
Technology Technology will also drive the future of cosmetic surgery. Surgery, as a discipline, is fairly mature. There will be small improvements in things such as hemostatic cutting devices, sutures, and instrumentation, but we are reaching an asymptote with regard to our ability to mechanically reposition the skin and soft tissue. The main technological drivers of the future will be biological. Wound healing remains a somewhat elusive process. We are slowly starting to understand the cascades of molecular biological events that characterize the body’s response to an injury (such as a surgical injury). Being able to control this process will lead us to the next generation of treatments. For example, the contractile and fibrotic compliments of wound healing result in some of the worst complications of aesthetic surgery, such as eyelid retraction. On the contrary, these same biologic processes allow tightening of
Copyright © 2014 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.
DOI http://dx.doi.org/ 10.1055/s-0034-1371901. ISSN 0736-6825.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Facial Plast Surg 2014;30:101–102.
Future of Cosmetic Surgery
Goldberg
the skin and rejuvenation of the soft tissue envelope with skin resurfacing technologies. Once we have the ability to modulate the biology of wound healing to our benefit, surgery will be more predictable and more versatile. Technology is also moving forward on the science of injectables. Synthetic fillers have revolutionized the treatment of facial volume. This technology will continue to evolve, with increasingly versatile, biocompatible, and longlasting materials. Materials that can restore not just the volume but also some of the biomechanical characteristics of youthful skin, are on the horizon. Neurotoxin technology will also continue to evolve with more versatile, refined, and specific agents available. In some settings, reducing soft tissue volume is appropriate to improve cosmetic appearance. Injectable and noninvasive lipolytic and volume reducing technologies will continue to improve in their safety, efficacy, and predictability. Stem cell technology is the Holy Grail of rejuvenation science. If we could actually replace or reprogram the tissues in the aging face with regenerated counterparts, fresh with the memory of their youthful biochemical status, we could truly turn back the hands of time. Unfortunately what sounds too good to be true, often is. We are a long ways off from controlling biology to that extent. However, there have been some good anecdotal reports of successful stem cell treatments, the technology is the current darling of laboratory research benefiting from lots of resources, and it is hard to resist being an optimist in the face of the dazzling promise of stem cell technology.
Conceptual Advances Conceptual advances will be significant drivers of the future of aesthetic surgery. Carefully thinking about facial
Facial Plastic Surgery
Vol. 30
No. 2/2014
aging in three dimensions has helped drive our understanding of the roles of volume versus gravitational effects. Three-dimensional imaging and computer analysis have helped construct universal models of facial beauty, and understand the spectrum of diversity of the human face. Psychological studies have helped us to understand motivations for facial rejuvenation, and psychological factors that determine patient satisfaction. All of these conceptual sciences will continue to evolve and help drive the future of cosmetic surgery.
Summary The future aesthetic surgery will be driven by patients, technology, and conceptual advances. Patients are attracted to minimally invasive technologies promising decreased recovery time and perhaps more natural results. Technological advances will offer better control of volume (both additive and subtractive), control of the biology of fibrosis and wound healing, and rational and scientific integration of stem cell technology. Antiaging technology will improve and will be an increasing component of aesthetic medicine. Conceptual advances will further refine our understanding of facial aging, facial beauty, and the psychology of marketing and patient satisfaction in aesthetic medicine. The field of aesthetic surgery will continue to reward practitioners who are imaginative, creative, and lifetime learners. The pace of change will be exhilarating, the ability to help our patients will continue on a rapidly ascending trajectory, and the opportunities to contribute to the expansion of the discipline will be historically unparalleled.
This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
102
Copyright of Facial Plastic Surgery is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
