Facial plastic surgery is in the midst of a revolution. It is now well accepted that the aging face results from loss of volume. There is loss and remodeling of bone and fat as we age. Thanks to the dedicated research and clinical studies by Val Lambros MD, Sidney Coleman MD, Danny Vllegar MD, Rebecca Fitzgerald MD, Joel Pessa MD, Rod Rohrich MD, and Sam Lamm MD to name just a few, plastic surgeons, facial plastic surgeons, and cosmetic dermatologists are in the midst of changing how we have addressed the aging face for the past 50 years.

Today, a large percentage of patients are able to be rejuvenated without surgery. Instead of cutting and pulling, we are filling and buffing. By replacing lost volume, natural youthful facial contours are restored. The choice of material to replace volume varies and includes Juvederm, Restylane, and Radiesse; newly FDA approved "for cosmetic use" Sculptra, or a patient's own fat. The tone, texture, color, and additional tightening of facial and neck skin can be further enhanced with fractionated CO2 laser treatments such as Fraxel repair.

By combining volume replacement with fractionated CO2 laser skin resurfacing, patients achieve their goal of looking healthy, youthful, and natural without the need for general anesthesia, operating rooms, or scalpels. As evidenced by the emphasis of volume replacement and fractionated CO2 laser skin rejuvenation lectures and instruction courses at our national and international dermatology, facial plastic, and plastic surgery meetings, there is truly an unprecedented revolution occurring in the treatment of the aging face. In patients with excessive skin redundancy, there will still be the need for surgery. For the most part though, the future facial cosmetic surgeon will likely be asking, "Syringe please" instead of "Scalpel".

Just returned from San Diego American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) Fall 2009 meeting. Here is what is new: Sculptra (Sanofi-Aventis) will be the volume facial filler of the future as Danny Vlleggar, MD (Geneva), Todd Matthews, MD (Houston), and Rebecca Fitzgerald, MD (Los Angeles) wowed the audience of core cosmetic surgeons with their amazing rejuvenating results using the recently FDA approved for cosmetic use product. Many surgeons will be performing a little less surgery and a lot more filling.

Daniel Alam, MD (Cleveland) shared his experience as the facial plastic surgeon who performed the first American face transplant on the woman shot gun victim. At the completion of his lecture, Dr. Alam deservedly received two long standing ovations from about 1000 of his peers in the packed lecture hall.

Keynote speaker Bob Woodruff, ABC News correspondent, shared his incredible story about his serious injury sustained in Iraq and his even more amazing story of recovery.

Tori McClure inspired surgeons with her adventures as the first woman to row solo across the Atlantic Ocean, and to ski overland to the South Pole. Both keynote speakers have shared their experiences in book form as well.

Dean Toriumi, MD (Chicago) shared his meticulous and excellent work on rhinoplasty, as did Robert Simons (Miami), Norman Pastorek (NYC), and Leslie Bernstein (Sacramento). Gary Burgett (Chicago) and others shared their total nasal reconstruction methods and pearls.

Jay Burnett, MD (NYC) gave a most impressive presentation on the use of micro-droplet Silicon-1000 use for the treatment of scars and facial rejuvenation.

Acculift (Lutronic), a new laser assisted liposuction technique was presented by David Holcomb, MD (Sarasota). The hour procedure removes unwanted fat from the jowls and face.

The uses of various laser modalities were also emphasized.

Out going President of AAFPRS, Donn Chatham, MD (Louisville) initiated "FACES OF HONOR", a voluntary program where members can treat Iraq veterans with facial plastic and reconstructive surgery problems at no cost. I am very proud to be a member of the AAFPRS family. Next year in Boston!

Allergan has filed a federal lawsuit seeking a court ruling that would allow it to share relevant information with the medical community on the safe use of botulinum toxin A for certain off-label therapeutic uses, the company announced in a press release.

In the suit, "Allergan contends that the government's legal position that it is a crime for a pharmaceutical company to proactively communicate truthful information to physicians about off-label uses of its products violates the First Amendment and is inconsistent with the Federal Food, Drug & Cosmetic Act," the release said. "The lawsuit does not involve Botox Cosmetic."

The suit does not challenge the government's ability to prohibit pharmaceutical companies from distributing false or misleading information about products.

"Rather, the lawsuit only seeks to permit Allergan to proactively provide the medical community with truthful, important information about common off-label uses of Botox," the release said. "Moreover, far from seeking freedom from regulation, Allergan hopes this suit will lead to clear regulatory guidance on how it can lawfully provide accurate and relevant information on the full range of issues physicians should consider in determining the best therapies for their patients."

Questions recently asked, and is more common than you would think: "I'm 13 and I hate my nose. I want it smaller. Everyone calls me names. Is there anything that I can do at my age to make my nose look a little more normal? I have a big bump at the bridge of my nose. By the way I am a 13 year old girl".

My answer: Kids can be very mean, I am sorry that you have to hear the mean words from those "bitter hearts". I would advise you to consult with a few rhinoplasty surgeons and see if they think that a little bit of Juvederm, Restylane, or Radiesse might be able to make your bump appear smoother until you are ready for rhinoplasty.

13 is a little young for the surgery. For best results, your bone growth should be mature. There are radiologists who can look at your X-rays and let you (and your parents) know when your bones will be mature enough for rhinoplasty.

Please try to not let their words bother you. They are immature and probably jealous of you in so many other ways. Don't stoop to their level. Treat others kindly and you will maintain your class and dignity (something that will take a lot more that a simple surgery for those insensitve kids to attain).

Be patient, and before you know it, that big nose of yours will be smaller.

Wednesday October 7, 2009 at 12:00pm to 1:00pm PST, Michael A. Persky, MD will be available live to answer your questions about facial plastic surgery. The program can be joined by simply going to www.drpersky.com and clicking on the "Livestream" icon in the upper right corner of the page.

You can Twitter your questions to "michaelperskymd". Dr. Persky looks forward to an exciting and informative hour interaction with you.