Blending dermatological treatments and surgical procedures often brings about the best aesthetic outcomes. Yet, few practices around the country possess the expertise to combine the two fields. Aesthetx is one of them. In a two-part series, Haute Beauty shares Aesthetx' approach of combining plastic surgery and dermatology. Dr. Amelia K. Hausauer and Dr. Kamakshi R. Zeidler (board-certified plastic surgeon) let us in on the topic.
When it comes to anti-aging procedures, what are the best dermatology and plastic surgery treatments that present ultimate results?
Dr Hausauer: Aging occurs on many levels: bone resorption, loss of fat and muscle, breakdown of elastic fibers and collagen, and changes in pigmentation. It is impossible to address all these changes with a single procedure, and every treatment has its strengths and weakness. For instance, I am limited in my skin tightening abilities. Surgery (i.e. a face or neck lift) is the gold standard for this. However, lifting and redraping skin does not address sun spots and fine-etched lines such as those around the mouth (aka smoker’s or lip lines) or eyes (aka crow’s feet). That is where resurfacing lasers or microneedling, depending on the situation and skin type, really shine. We have had remarkable results combining facial and breast surgeries with intra-operative laser. In our practice, Drs. Zeidler and Berkowitz do a lot of fat grafting, which we’ve seen improves skin in its own right. The combination of that plus laser isn’t just additive. It’s exponential. Our patients have been stunned at how much more luminous they look without being overdone or over pulled. Most commonly, this is done on the face with excellent results. For example, we now make fewer and fewer lower eyelid incisions because of the phenomenal results achieved by lasers. However, another often neglected area is the neck down to the decolletage, particularly when doing breast surgeries.
How does the unity of dermatology and plastic surgery affect recovery times?
Dr. Zeidler: Many of the patients at Aesthetx are high-level executives and/or busy professionals who have limited amounts of time away from work and other commitments. So, when they do take time off, it’s best to maximize and capitalize. We know that if someone is having surgery with us, they will already be laying low and resting during their recovery period So, this is a great time to do a laser procedure where you want to avoid sun exposure and may have raw or sensitive skin. Not only does the combination improve results but it also takes advantage of that time set aside to recoup and heal. Patients get creative; they may be having abdominal surgery but decide to treat their face and/or neck and chest, all with the same recovery period. Many birds with one stone, essentially.
There are many benefits to combining dermatology and plastic surgery procedures. But are there any cases when it might not be advisable to do so?
Dr. Hausauer: As physicians, we are always balancing benefits versus risks. If we are overtaxing the body or compromising results, then it is far wiser to stage these treatments rather than do everything at one time. Each patient comes with his/her own set of histories and concerns, so as doctors, we have to be respectful when designing the best treatment plan. A good example is if you have a condition that decreases blood flow and, as a result, oxygen to the tissue then we must all account for that. Another consideration is making sure patients have the emotional and physical support necessary to recuperate and care for themselves. The bottom line is to find a physician who has a firm medical background and understands all of the moving pieces that contribute to successful treatments.
What new medical frontiers are possible with the combination of dermatology and plastic surgery? How do you see it develop in the future?
Dr. Zeidler: We run a number of clinical trials in our office in an attempt to move science forward in new and exciting ways. Many of the projects that we are currently pursuing allow for collaboration and application to multiple different medical specialties, multiple body areas, and multiple conditions. Because of our diverse backgrounds and experiences, each of us sees different potential in the same opportunity and makes for exciting movements forward. Some good examples are new minimally invasive devices that translate surgical techniques but make them office-appropriate and exploring more pre-operative procedures to improve surgical wound healing and limit scars.
Given that we practice in Silicon Valley, another emerging frontier is the use of digital technology in aesthetics care. We see opportunity for tech not just in the traditional sense like imaging and treatment devices but as a way of enhancing patient communication and providing a personalized and integrative experience.
