Not all patients are ready for a surgical intervention. If you are young are have had surgery and are looking for a refresher, there are multiple non-surgical techniques that are effective.
When deciding how to proceed, it is helpful to understand how aging has affected the different layers of the face. These layers include the skin, soft tissues (fat, muscle, fascia, ligaments), and underlying bony support (bone and teeth). The youthful “triangle of youth”—high cheekbones, full midface, crisp jawline—gradually inverts with descent, deflation, and remodeling caused by genetics, gravity, photoaging, lifestyle, and medical factors.
At Thomassen Plastic Surgery, we use a layered, anatomy‑first approach to nonsurgical rejuvenation that restores volume, smooths lines, improves skin quality, and refines contours with minimal downtime.
Quick take: Most patients benefit from a combination plan—relax overactive muscles, re‑inflate strategic compartments, resurface skin, and tighten deeper layers.
How the Face Ages (What We Treat)
- Skin (epidermis/dermis): thinning, slower turnover, collagen loss, irregular elastic fibers → dryness, fine lines, dyspigmentation.
- Soft tissue: deflation, descent, and deterioration; lower‑face fat accumulation.
- Bone & teeth: infraorbital and maxillary retrusion, orbital expansion, decreased facial height—contributing to tear troughs, hollowing, and jawline changes.
- Visible signs: horizontal/vertical rhytids, temporal hollowing, midface volume loss, deep nasolabial folds, jowls.
Treatment Pillars
We match modalities to the layer(s) involved.
1) Neurotoxins (Botulinum Toxin Type A)
What they do: Temporarily relax muscles that create dynamic lines (glabella “11s,” forehead lines, crow’s feet). Off‑label uses include bunny lines, gummy smile, masseter contouring, and platysmal bands.
Onset & duration: Effect begins in 3–7 days, peaks by 2 weeks, and lasts about 3 months.
Who should avoid: Active infection, true product allergy, certain neuromuscular disorders; relative—pregnancy, breastfeeding, uncontrolled body dysmorphia.
Possible Adverse Effects: Bruising, headache, asymmetry, temporary brow/eyelid ptosis; rare diffusion effects. Lack of effect in a rare group of patients requiring a different neuromodulator use. Most are mild and self‑limited.
2) Dermal Fillers
Goal: Restore or sculpt volume, soften static folds, and enhance contours. Two main groups:
- Hyaluronic Acid (HA) Fillers: Reversible with hyaluronidase; versatile for lips, tear troughs (with care), midface, chin, jawline.
- Biostimulators: Calcium hydroxylapatite (CaHA) and poly‑L‑lactic acid (PLLA) stimulate collagen/elastin for gradual, longer‑lasting improvement; best for cheeks, temples, jawline (not tear troughs or lips). A permanent option (PMMA) exists for select indications.
Typical longevity: HA ~6–12+ months (some >12 months); CaHA/PLLA 12–24 months after series; PMMA semi‑permanent.
Injection strategy: Deep dermal/subcutaneous or pre‑periosteal planes; cannulas can reduce bruising and vascular risk in high‑risk zones.
Safety essentials:
- Understand vascular anatomy; aspirate, inject slowly with small aliquots, and avoid boluses in risk areas (e.g., glabella).
- Have hyaluronidase available for HA management.
Common AEs: Swelling, tenderness, bruising, transient nodules. Rare but serious: intravascular injection (vision changes, skin blanching)—an emergency.
3) Energy‑Based Devices (EBDs)
Lasers & Light:
- Ablative resurfacing (e.g., CO₂/Er:YAG): more dramatic texture/rhytid improvement with more downtime.
- Fractional nonablative & picosecond: improve texture, pigment, and scars with less downtime via microthermal columns.
- IPL/LED: broad‑spectrum light for dyschromia/photodamage.
Not for: active infections, uncontrolled inflammatory dermatoses; ablative lasers are generally contraindicated in Fitzpatrick V–VI (risk‑managed alternatives available).
Potential AEs: transient erythema/edema, PIH, burns, scarring (rare). Proper device choice and parameters are critical.
4) Chemical Peels
What they do: Controlled epidermal/dermal injury to resurface and brighten skin.
Depths & agents:
- Superficial: AHAs (glycolic, lactic, mandelic), salicylic; minimal downtime; great for fine lines/dyschromia.
- Medium: TCA/Jessner; more robust for photoaging and wrinkles.
- Deep: Phenol/TCA formulas; powerful but longer recovery and higher risk; less common with modern lasers.
Contraindications: active infection/dermatitis, poor wound healing, pregnancy (medium/deep), history of keloids—use caution.
Complications: PIH/HOI, scarring, infection, HSV reactivation (consider prophylaxis), milia/acne flares.
5) Regenerative Bioaesthetics (Emerging/Adjunct)
Autologous fat grafting and stromal vascular fraction (SVF)/adipose‑derived stem cells (ADSCs) are under active study for volume and skin‑quality enhancement. Early data suggest improvements in dermal thickness and wrinkles, but no FDA‑approved regenerative products currently exist for skin rejuvenation; careful patient selection and informed consent are essential.
Choosing the Right Plan (Our “Triangle of Youth” Blueprint)
We start with a full facial analysis (resting and animated) and tailor a plan by layer:
- Relax: Neurotoxin for dynamic lines (glabella, crow’s feet, forehead, DAO/platysma as needed).
- Re‑inflate: HA for contour and fine detail; CaHA/PLLA for scaffold and bio‑stimulation (series over months). Fat grafting can provide more natural long lasting results
- Resurface: Laser/fractional RF or peels to smooth texture, tone, and pores.
- Retighten: Non-ablational laser therapy.
Downtime spectrum: Neurotoxin (minimal) → HA fillers (1–3 days of swelling/bruising) → RF microneedling/nonablative lasers (1–5 days) → Ablative lasers/medium‑deep peels (7–14+ days).
Safety, Contraindications & Candidacy
- Absolute: active infection at treatment site, true product/device allergy.
- Relative: pregnancy/breastfeeding (most modalities), autoimmune flares, uncontrolled medical issues, recent isotretinoin (device/peel‑specific), unrealistic expectations.
- Skin tones: We customize protocols for Fitzpatrick IV–VI to reduce PIH risk (device choice, fluence, peel selection, pretreatment with pigment control).
Aftercare & Longevity
- Neurotoxins: no vigorous exercise or massage for 24 hours; results ~3 months.
- HA fillers: cold compresses, head elevation, avoid makeup 12–24 hours; reassess at 2–4 weeks; maintenance 6–12+ months.
- Biostimulators: expect progressive improvement; plan boosters at 12 months.
- EBDs/Peels: strict sun protection, gentle skincare, antiviral prophylaxis when indicated; collagen remodeling continues for weeks–months.
Frequently Asked Questions
How do I choose between fillers and biostimulators?
HA is ideal for precise shaping and is reversible. CaHA/PLLA gradually improve structure and skin quality and last longer but aren’t reversible.
Can I combine treatments in one visit?
Often yes (e.g., neurotoxin + HA). We may stage lasers/peels around injectables for best healing.
What about safety of fillers?
Complications are uncommon in expert hands. We minimize risk with anatomy‑aware technique, cannulas when helpful, and have protocols for immediate management.
How long will my results last?
Most nonsurgical results are maintenance‑based. We’ll outline a schedule tailored to your goals and event timeline.
Sample Treatment Maps
Crow’s feet & brow freshness: neurotoxin → fractional laser/IPL for pigment/texture.
Midface deflation & nasolabial folds: deep HA or CaHA in the malar/zygomatic support → light HA to folds → optional RF microneedling.
Jawline & jowls (mild): HA to chin/jawline, DAO/platysma neurotoxin
Texture & pores: nonablative fractional laser + skincare; add superficial peels.
Ready to Personalize Your Plan?
Book a consultation to map your anatomy, skin type, and goals. We’ll outline a precise, staged plan—so your results look natural, refreshed, and uniquely you.
Contact us for a personalized plan • Location: Fort Lauderdale, FL
References
Pharmacologic and Other Noninvasive Treatments of the Aging Face: A Review of the Current Evidence. Bustos. Samyd S. MD; Vyas, Krishna MD, PhD, MHS; Huang, Tony C. T. MBBS, MS; Suchyta, Marissa MD, PhD; LeBrasseur, Nathan MS, PhD; Cotofana, Sebastian MD, PhD; Wyles, Saranya P. MD, PhD; Mardini, Samir MD. Plastic and Reconstructive Surgery 154(4):p 829e-842e, October 2024.
Learn more about minimally invasive treatments at the American Society of Plastic Surgeons website.