Trends in Face Surgery

According to Sydney cosmetic plastic surgeon Dr Darryl Hodgkinson, the history of facial cosmetic surgery is fascinating. “If you look at the history of cosmetic surgery of the face, it was almost always a multiple staged procedure,” he says. “Patients in the ’60s would have perhaps their eyelids done and then they would be told they should wait until their 60s for a facelift. All the skin rejuvenation procedures we use now weren’t available then. The only rejuvenating treatment we had in the ’50s and ’60s was a skin dermabrasion, which was usually selected for patients who had acne scarring. Back in the ’70s, complications were so feared patients would have surgery on one side of the face and then, a week later, surgery on the other side of the face.”

"The trend for patients to have procedures done earlier is connected to the pressures of the commercial world"

Over recent years, Dr Hodgkinson says, there have been two major trends in cosmetic surgery. The first is towards earlier all-over facial rejuvenation with multiple treatments, and the second is for surgery to be performed in a surgeon’s own day-surgery facility.

“The trend for patients to have procedures done earlier is connected to the pressures of the commercial world,” he says. “There is a lot of discussion at the moment about how the older age groups have to keep working. There is also a lot of pressure on women in the 40s age group. Personal image is very important and professional women can feel pressure from the savvy, highly skilled younger women on the way up. Some may start to lose their confidence – and work is all about confidence. So having cosmetic surgery earlier may be seen as a means of securing their social and professional status, helping to make them less vulnerable in the work place.

“In addition, the TV program Extreme Makeover has exposed the fact that more and more patients are having multiple procedures,” says Dr Hodgkinson. “What has further enhanced this new environment for face surgery are the numerous injectables available.”

Collagen was introduced in 1977 on a trial basis and then established on the market in the early ’80s. This was followed by the hyaluronic acids, such as Restylane. More recently, Botox has revolutionised the management of more niggly problems like crow’s feet and frown lines.

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Before/after facelift by Dr Hodgkinson

Actual patient after an "extreme makeover" by Dr Hodgkinson

“We also appreciate that much of ageing is due to textural change in the patient’s skin complexion,” adds Dr Hodgkinson, “and this is where skin resurfacing comes in. The introduction of microdermabrasion, chemical peeling and Intense Pulsed Light (IPL) significantly reduces the reliance upon surgery alone to give an overall facial rejuvenation.”

As with all surgery, reduction of scars has been a major aim. And so, too, in facelift surgery, minimal incision surgery using an endoscope has been available for only 10 years. This has dramatically reduced any scarring and the recovery time is much shorter, again making multiple procedures more accessible.

Dr Hodgkinson is a proponent of performing multiple procedures on patients to give an optimal result – not a budget result. “My philosophy is to give an exact fee for everything we do so that patients can save up for the most suitable treatments,” he says. “With facial rejuvenation, a patient’s face may look a new age but other aspects of their appearance may not match it; so as part of our holistic approach, we send our patients to the experts,” he says. “We have for a long time utilised the skills of psychologists,make-up artists, hair stylists and image consultants. What we offer is the whole package.”

The second major trend has been in performing the procedures outside of a hospital environment. Many plastic surgeons have now developed their own day-surgery facilities. “There are a number of reasons for this,” Dr Hodgkinson explains. “Procedures have became safer as advances in medical technology have occurred and as doctors have learned how to minimalise complications such as haematoma. Plus, patients are often more comfortable in a day surgery facility than in a hospital environment because they don’t have to deal with, say, crowded, noisy recovery rooms. Fear of antibiotic-resistant infections is also a major factor in discouraging patients from hospital admission.

” An additional and more recent change in relation to cosmetic surgery has been the shift in the media from the previously negative journalistic emphasis on the patient being a ‘victim’ of cosmetic surgery and the ‘complications’ involved, to a more positive media perception. “Extreme Makeover is a prime example,” concludes Dr Hodgkinson. “That is a big change and reflects the view that cosmetic surgery is now more acceptable and within everyone’s reach.” acsm