As I write this preface, the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons (ASAPS) are releasing their procedural statistics for 2015. Both plastic surgery societies reported an increase in nonsurgical and minimally invasive procedures for the year. ASAPS members reported a 22% increase in nonsurgical procedures alone. This represents a dramatic change from 15 or 20 years ago. During that period, a significant percentage of plastic surgeons were content to limit their nonsurgical options for patients seeking facial rejuvenation to a chemical peel, dermabrasion or, perhaps, an injection of collagen. The last two decades have seen a transition in the aesthetic practice of plastic surgeons as a result of the utilization of multiple devices, including lasers and radiofrequency, and the availability of a virtual cupboard of fillers and neurotoxins for volume replacement and softening of lines and wrinkles.
The reasons for this change in practice and methods are multiple. Physiologically, the aging process involves more changes than can be corrected by surgery alone. In addition to tightening, trimming, and repositioning the skin, muscle, and fat of the aging face, the aesthetic surgeon must be prepared to restore lost volume. Resurfacing a pigmented and altered skin envelope is key in order to adequately counteract the natural and inevitable aging process.
Furthermore, the aesthetic plastic surgeon faces competitive forces from many fronts as multiple other specialties—surgical and nonsurgical—enter the aesthetic marketplace. A plastic surgeon must offer more than a facelift or a blepharoplasty to retain the aesthetic patient after the last suture is removed. Most importantly, patients are now demanding nonsurgical and minimally invasive option.
For the purposes of this issue, the definition of minimally invasive is any procedure that can be performed under a local anesthesia without the need for sedation and which does not require the placement of a suture to close the skin. Thus, it would include everything from a fractional laser treatment to fat injections to the placement of a subcutaneous radiofrequency fiber. One goal of this issue of Clinics in Plastic Surgery is to provide those surgeons new to an aesthetic practice with a thorough starting point from which they can effectively offer a diverse range of treatment options. For those of my colleagues already in practice, this issue is intended to serve as a comprehensive review of this field that may provide inspiration for further innovation.
As the editor, it was my good fortune that my co-authors, a very distinguished and skilled group of aesthetic surgeons, agreed to participate in the writing of the articles of this volume. I thank them and deeply appreciate their contributions, time, energy, and expertise. My editors at Elsevier, Jessica McCool and Donald Mumford, are most deserving of my sincere thank-you because without their patience and guidance this issue would never have taken shape.