Dr Sebagh

When I started my career as a young facial plastic surgeon 30 years ago, dealing with the ageing process of the face was essentially limited to face lifts – as in using the knife – and mainly concerned patients over the age of 50.

At that time, I coined the phrase “Ageing-Maintenance”. At that stage, it was more of a vision or wishful thinking than a reality.

Back then, women had no way of managing the ageing process. There were no cosmeceutical products with active ingredients available, no sunscreen – conversely, it was considered that the more tanned you were, the better – and no medical cosmetic procedures other than some topical injections made by the famous Dr Morin in Paris. As one of the pioneers in the use of antioxidants, he was also the creator of the famous Meso glow, using Mesotherapie injections with a vitamin cocktail.

Fortunately, the last 30 years have been amazing. Advances in biotechnology and laser tech have resulted in collagen injections; hyaluronic acid fillers; fat transfer treatments; Botox®; plasma and growth factors injections and stem cell extracts from fat.

In addition, different types of laser treatment have been launched to treat pigmentation, vascular problems, hair removal and ageing skin. Radio frequency has also been introduced to tighten and refirm the skin. Recently, too, new ultrasound therapy has been used to tighten and shorten facial muscles, further delaying any need for surgery.

So, now that we have an amazing box with different “tools”, it is essential to be a good “artisan”. But, most important of all, we must deliver the most natural result. Our task is to restore and to help people who want to age gracefully and not to transform them completely so that they become completely unrecognisable.

A recent study by Dr Ambros in California comparing the faces of 900 people over 40 years has shown that, surprisingly, the skin does not sag and its key points do not really move over this period but the skin still ages. It gets thinner and is altered by lifestyle factors, resulting in the appearance of lines, pigmentation and loss of elasticity. These facial changes really occur as a result of sagging muscles (jowls) and the fat volume slipping downwards with them, and/or ‘melting’, to give a gaunt look.

Understanding the physiopathology of the ageing process of the face helps recognise the inadequacy of the face lifts of the 70s and 80s, which pulls the skin to its maximum without lifting the muscles and without restoring volume. Since the 90s, with the focus on the SMAS (superficial muscular aponeurotic system) and the restoration of fat volume, the face lift has addressed the real needs of the ageing face with the most natural results.

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