American Academy of Facial Plastic and Reconstructive Surgery
There is hope for domestic violence survivors

One in every four women will experience domestic abuse in her lifetime. The majority of injuries (75 percent) are to the face and head area. Facial plastic surgeons are taking a firm stand against domestic violence and helping survivors to break out of the cycle of abuse, to enhance their self-confidence, and to assist as they rebuild their lives

Over 18 years ago, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) founded FACE TO FACE: The National Domestic Violence Project in partnership with the National Coalition Against Domestic Violence (NCADV). Facial plastic surgeons provide their services to survivors of domestic abuse who cannot afford to receive treatment for facial injuries. Through surgery, counseling, and support, individuals are guided down the path to physical and emotional healing

Over 18 years ago, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) founded FACE TO FACE: The National Domestic Violence Project in partnership with the National Coalition Against Domestic Violence (NCADV). Facial plastic surgeons provide their services to survivors of domestic abuse who cannot afford to receive treatment for facial injuries. Through surgery, counseling, and support, individuals are guided down the path to physical and emotional healing

The second step is to receive counseling. The survivor is given the name of a domestic violence shelter in their local area and advised to set up an appointment with a domestic violence counselor at the program. There are two purposes for this appointment: to receive verification from an independent source that the injuries are due to domestic violence, and to ensure that all participants are attending a local domestic violence program. It is anticipated that the individuals requesting services will have been out of the violent situation for at least one year.

The final step is to receive the referral. The shelter counselor contacts the FACE TO FACE program’s domestic violence coordinator to confirm that the individual has begun the inner healing process and is out of the abusive relationship. The coordinator provides the contact information for the local facial plastic surgeon that will provide complimentary consultation and surgery. Surgery is performed to repair the damaged facial features and to hopefully alleviate the visible, painful memories of past abuse.

October is Domestic Violence Awareness month. Over five million women a year are affected by domestic violence in the United States; over one million victims require medical attention. The FACE TO FACE program is taking steps to help these women. It is an inspiring program seeking to help survivors change their lives. For more information, visit www.aafprs.org, click on Foundation, Humanitarian Programs.

Lasers can lessen the appearance of unwanted facial irregularities such as birthmarks

Lasers can be used to help you achieve a younger, more vibrant appearance. Find out what conditions they treat, what lasers are available, and how they work. This will be a good primary for you before making your consultation appointment with your facial plastic surgeon.

Laser treatment options

The following conditions can be improved via laser technology.

Acne can be treated with a laser to kill the skin bacteria that causes acne or it can be used to reduce the activity of sebaceous (oil) glands so less sebum is produced. Both methods decrease acne breakouts.

Acne scars can be improved through laser resurfacing. For more severe scarring, a stronger laser or more treatments may be recommended. After the top layers of the damaged skin are removed, a healthier new skin emerges reducing the appearance of the scar.

Crow’s feet are wrinkles in the corners of your eyes caused by repeated facial expressions, e.g., smiling or squinting, which become more permanent over time. Lasers reduce the appearance of these lines, in addition to wrinkles found elsewhere around the face.

Hair follicle stimulation uses laser energy on the scalp and appears to stimulate the follicles, reducing the progression of hair loss and in some cases increasing hair density of the finer, miniaturized hairs.

Hair removal by laser focuses light energy to heat and destroy the hair follicle. As the laser is moved over the skin, the energy passes down the hair shaft and is absorbed by hair follicles that are in the active growth phase. This disables the follicle and causes it to eventually fall out.

Pigmented lesions are clusters of pigmented cells, e.g., age spots, sunspots, café au lait spots. Lasers can be used to lighten or reduce the pigmentation.

Tattoo revision uses lasers to break up the ink. The intense light passes through the top layers of the skin and is absorbed by the tattoo pigment. This causes it to break into smaller particles; the body’s white blood cells capture the shattered ink particles and via the bloodstream are processed through the liver. The more blood supply to the tattooed area, the quicker the tattoo fades.

Vascular birthmarks—stork bites, strawberry, port wine stains—are made up of blood vessels clustered together in the skin and can be flat, raised, pink, red, or bluish in color. Lasers may be used to remove or control the growth of a birthmark.

Laser basics

Port wine stain is removed with pulsed dye laser. Photo courtesy of the American Academy of Facial Plastic and Reconstructive Surgery.

A laser is a beam of light that selectively transfers energy into the tissue to treat the skin. The light beam can be varied in intensity and pulse duration. The wavelength and power output of a particular laser determines how it is applied medically. Your facial plastic surgeon will choose the laser based on what is being treated, skin type and color, and patient expectations.

Two types of lasers, ablative and nonablative, work very differently on your skin. Ablative—which means skin removing—lasers produce an infrared light that heats water within the surface layers of the skin (epidermis) causing both the water and the tissue to vaporize. At the same time, the laser heats the underlying skin (dermis), breaking down old collagen and stimulating new collagen to form.

The depth of laser resurfacing is dependent upon the light wavelength, power utilized, and pulse direction. New skin that is tighter and smoother forms as the skin heals. A procedure using an ablative laser is a much more invasive; this means that the treatment is more severe and will require a longer recovery period. The advantage is that the laser can treat more extensive wrinkles, scars, etc., with usually one treatment.

The carbon dioxide laser (CO2) was one of the earliest, ablative gas lasers to be developed and is still used widely today. Ablative fractional lasers separate the laser light into separate beams that treat a portion of the skin’s surface. It can target specific zones deep in the skin. The Erbium YAG laser has a crystal that the light passes through in order to focus the energy for the desired effect.

Nonablative lasers are lower energy devices than ablative. The energy of the laser beam passes through the epidermis with little damage and stimulates collagen production underneath in the dermal layer. The collagen growth may improve skin tone, texture, and fine wrinkles. These lasers usually require multiple treatments— with little or no recovery time—to bring about the desired results. Common nonablative lasers include pulsed dye lasers and nonablative fractional lasers. Treatments with these lasers may be referred to as photo rejuvenation.

Light-based devices, e.g., Intense Pulsed Light (IPL), use flashes of light and are technically not a laser. They are noninvasive and stimulate the dermal tissue to tighten underlying skin and improve skin tone and appearance. Repeated treatments are usually necessary in order to achieve the desired results.

Conclusion

Technological and technique advancements will lead to new applications and new generations of lasers. Your treatment should be customized based on your goals and tolerance for downtime and risks. Discuss your options with your facial plastic surgeon.

Tune-up or overhaul—what is your preference?

A s a prospective patient, you have many options when it comes to improving your appearance, from non-invasive treatments to cosmetic or reconstructive surgery. Consider the advantages of each and then make an appointment with your facial plastic surgeon to discuss what works best for you.

Tune-up

"I was a bit frightened to undergo surgery and wanted a less invasive procedure. I chose an injectable filler as a great way to ease myself into facial enhancement," says Heather B., age 37.

Minimally invasive procedures—such as microdermabrasion, light chemical peels, injectable fillers, Botox, photorejuventation— delay the aging process. Microdermabrasion and light chemical peels (glycolic, lactic, and fruit acid) can revitalize and reduce the appearance of wrinkles. The top layers of damaged skin are removed and a fresh, smooth layer emerges. Injectable fillers can reduce the appearance of wrinkles or plump up areas, e.g. lips. Botox reduces the furrows between the eyebrows and crow’s feet. To improve blemishes, sun damage, birthmarks, broken capillaries, and more, you might try photorejuventation, a noninvasive intense pulsed light laser treatment. There is no downtime, but several treatments may be necessary for desired results.

Overhaul

There are varying degrees of overhaul. Depending on your unique needs, you may benefit from one procedure or a combination of procedures.

"I always told myself that when the muscles of my face started going south, I would have something done—right away. I didn’t want to wait so long that the surgery would cause a remarkable difference. So, two months ago, I had a facelift, and I haven’t regretted it for a moment. It didn’t give me a new face—it gave me back my old face, the way it was 10 years ago," says Agnes W., age 58.

The facelift procedure is popular; it elevates and tightens the muscle and tissue underneath the skin and removes any excess sagging skin. Implants in the lips, cheeks, and chin can restore a youthful appearance and improve your profile. Rhinoplasty, surgery of the nose, can reduce a bump, shorten a drooping tip, or straighten a crooked nose. Blepharoplasty, eyelid surgery, removes excess sagging skin from above or below the eye; it can also reduce the appearance of wrinkles around the eyes. Necklifts and browlifts are similar to facelifts in that they reduce the skin that has lost its elasticity and reduce the appearance of wrinkles. Otoplasty, ear surgery, is performed to reshape the ears, often minimizing the apparent prominence of the ears.

Minimally invasive procedures have the advantage of less downtime and less cost; however, the results are not permanent. The more invasive procedures have long-lasting results; although, they usually require a bigger budget and longer recovery time. Whether you are looking for subtle improvement or a major change, research, plan, and consult with your facial plastic surgeon to move forward with the treatment that you feel the most comfortable with and know will improve the quality of your life significantly.


ASK THE SURGEON

How can I improve the look of my eyebrows? It seems that the bushy look is back and I’m very self-conscious of my overplucked pencil lines.

Eyebrows frame the eyes and provide symmetry to the face. In addition to over plucking, sparse eyebrow hair can be due to genetics, thyroid or other medical conditions, or even trauma (e.g., burns, surgery, accidents). Eyebrow transplant may be a good option. The goal of eyebrow restoration is to re-approximate the natural direction, angle of growth, and distribution of hairs. Scalp hair often makes the best donor hair because regrowth is reliable. Your facial plastic surgeon will obtain the donor hair and prepare individual hair grafts to be inserted; the number can range between 75 to 350 per brow depending on gender and the amount needed. More than one session may be necessary to achieve the desired results.

HEALTH TIP

Timing is everything—even when planning a cosmetic or
reconstructive procedure. Consider the following influencing factors:

  • Time of year. Your recuperation may require you to avoid the sun rays as much as possible. For this reason, it may be easier to schedule your treatment during the winter months.
  • Preparation time. The healthier your body is before surgery, the easier your recovery may be. Eat nutritious food, quit smoking, and exercise.
  • Clearance time. Plan for appropriate testing and clearance from other physicians if you have a medical condition that may affect your procedure or treatment.
  • Vacation time. Select a time when you can take at least a week or two off from work, depending on the extent of your surgery.
  • Family’s time. Coordinate with your family and friends so that you have adequate support at home during your recovery.
  • Time of event. Share the date of your special event with your surgeon as soon as possible so you can plan enough time for healing. For example, if you want to have a facelift before your high school reunion, you should probably schedule the surgery three to six months prior to the celebration.
  • WHAT’S NEW?

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