Surgical facial rejuvenation in younger patients

Gordon H. Sasaki, MDNicanor G. Isse, MDThomas A. B. Bell, MDGregory L. Ruff, MDDr. Sasaki: I am pleased to moderate this panel about surgical facial rejuvenation in younger patients. We will focus solely on surgical procedures, ignoring treatments such as radiofrequency, laser, chemical peels, soft tissue fillers, and Botox.Aesthetic plastic surgeons are seeing an increased number of younger patients for surgical facial rejuvenation. This trend is related to greater personal and societal acceptance of aesthetic surgical procedures and to more acceptable and available surgical options for the younger patient. Another factor has been the increase in discretionary income to meet such goals.Younger patients present unique demands, including the request for procedures that produce less visible scars and have a quicker recovery time. They may also expect the less invasive procedures to yield the same long-lasting effects that are observed after more extended procedures. These patients are also concerned about the impact of surgeries performed when they are young on their aging and on future surgical procedures.The first patient is a 31-year-old woman who has concerns about her angry appearance, lower lid puffiness, midface irregularities, and weak chin (Figure 1). She has had no prior surgical procedures, Botox, or soft tissue fillers. Dr. Isse, how would you evaluate and treat this patient?Figure 1 This 31-year-old woman has had no previous surgeries. She is concerned with her angry appearance, lower lid puffiness and hollow deepening of the nasolabial line, flattened cheeks, and lack of chin definition.Dr. Isse: In general, the patient has symmetrical facial structures. The “angry” appearance results from a low-medial brow position in relation to the central and lateral brow.This condition is due to overactive glabella muscles (medial portion of orbicularis oculi muscle, depressor supercilli, and procerus). My treatment of choice would …