What Are The Holy Grails Of Plastic Surgery?

Every year, plastic surgery gets just a little bit better. Quicker, easier, more sophisticated procedures with results that are more and more natural, for almost every part of the body. Surgery gets more and more “minimally invasive” obviating the need for more extensive procedures and long, involved recoveries. In fact, many surgical procedures have already become “antiques” and have all but been replaced by non-surgical treatments. Yet, even today there persist some challenges of the past for which plastic surgeons still don’t have the best answers – but we’re working on them! These are the “Holy Grails” of plastic surgery:

Is there a single, truly effective treatment for dark shadows under the eyes (lower eyelids)? Not really. This is partly because such shadows are most often caused by a very complex combination of factors. Bulging bags of extra fat in the lower eyelids, deficient fat fullness and/or hollowing along the rim of the eyelid, “broken” capillaries in the lower eyelid, dark pigmentation of the lower eyelid skin – any or all of these could be involved. If you are lucky, your plastic surgeon might be able to identify a dominant and treatable cause that, once properly addressed, will result in a significant difference. But as certain medications, chronic allergies, too much stress and not enough sleep also weigh in on this problem, it remains a “tough one”.

Is there an effective, non-invasive skin tightening procedure for the face, neck, arms, abdomen, thighs and other “loose skin” problem areas? We’ve actually come quite far in this department – for the face. Just within the past five years or so, laser technology has made great strides in improving the way facial skin can be tightened. But we need more. There are many patients who do not get the degree of tightening that they really wanted. Then there are those who are considered for a face lift simply because we don’t have technology that is good enough to serve as a reasonable alternative. As far as the body goes, there is no currently accepted non-invasive technology that reliably and consistently can be used to tighten the skin. Laser liposuction, ultrasonic liposuction (and possibly radio frequency liposuction) can help restore some retraction to inelastic skin but these are still invasive procedures and not effective for the advanced forms of loose skin. For skin without any appreciable remaining elasticity, there are a variety of very effective surgical “lifts” we have designed for almost every area of the body, but we are still waiting for a real non-surgical skin tightening method.

Is there an effective method for non-invasive fat melting/contouring for the face, neck and body? Have you noticed the spike in activity over the last year or two with this idea? Several of these techniques have appeared – lasers that spin and shine on the outside of the skin (as if your fat is a UPC code at the supermarket) or cold steel plates that squeeze and slowly “freeze” the fat under the skin. The claim is that these methods induce the fat to dissolve sometime later. According to the FDA, these things do work…somewhat…sort of…but only if combined with a consistent program of diet and exercise. These are certainly not equivalent alternatives to liposuction. What about those fat melting injections you may have heard about? A good idea, maybe, but still not considered perfected enough to be called safe, effective or consistent. Perhaps a wiser move would be to save your money up for HIFU (High Intensity Focused Ultrasound) which is still in development. No incisions, no surgery, just a “sound wave” applied to the outside skin surface which then passes harmlessly through the skin to the fat underneath where it disrupts the fat cells. It sounds great. We’ll see.

Is there a large volume, long-lasting synthetic injectable filler that could be used for enhancement/filling of areas like the breasts or the buttocks? The fillers that we use for the face work great but are limited to relatively small volumes with each syringe being fairly expensive. But their great advantage: a simple office procedure for which your doctor doesn’t need to do anything except take a box off the shelf to get you started. What about a large volume version of these for more substantial filling requirements and at a more reasonable cost? We hear tell of a Restylane-like product being used in this manner in Europe (why is it always Europe?) called “Macrolane”. Regardless, this is clearly still in the “Holy Grail” stage. We will have to be satisfied with your body fat being the only large volume filler currently at our disposal. That fat just doesn’t “come off the shelf” and you might not have enough for what we need to do. Sorry.

Are we any closer to having a”more definitive” form of permanent hair removal through lasers? This technology has been getting better every year so the answer really is “yes”! Techniques available today are more gentle, less risky and better at eliminating hair over the long-term than ever before. But we can do better. Today, it is considered a long-term success even if the hair is only made “finer” or less dense, and not truly eliminated. Sometimes we can make the area truly hair-free for quite an extended period of time…but not necessarily forever. One day, “Laser Hair Removal” will yield a permanent, hair-free result. We are not there yet.

Where do we stand on having a non-surgical, safe and effective means of stimulating permanent hair growth? Rogaine has been around for years (the patent on Minoxidil expired 15 years ago!). It helps, but its effects are modest and temporary. Propecia has been around since 1997 with temporary effects as well. Let’s not talk about the side effects. So, nothing new or better has appeared in over 10 years?! Sorry, but true. We do have these strange-looking “laser combs” and similar “low-level laser” treatments purporting to stimulate hair growth when used regularly. The truth – we are no closer to a better answer for this.

Will there likely ever be a form of non-injectable Botox (e.g. cream or treatment)? There were rumors last year that a cream was going to be coming out, and then we heard it might be a sort of “sticky pad” you could use overnight on selected problem areas like the “crow’s feet”. Nothing in reality yet.

Do we have an effective, preventative medication or cream, etc. that will tend to block untoward post-surgical scar tissue from ever forming and makes scars as invisible as possible? The volume of scientific information and research being done on scars is staggering. We have lots of great techniques that work in this department – they just don’t work or work well in everyone all the time. So we are still looking for the best answer to this. Most physicians feel that scar formation is such a complex process that there will never be a dominant or singular therapy that will be the “answer”. How about a similar technique which is reliably useful to treat bad scars which have already formed? Unfortunately, same answer.

Is there a reliable and effective therapy available today for stretch marks? We have lots of answers like “maybe”, “sometimes” and “we can try it and see if it works” in the worlds of creams and lasers out there but, in a word, no.

Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the body and non-surgical cosmetic enhancement techniques available today.