Lasers and Non-Surgical Rejuvenation
Edited by Barry E. DiBernardo and Jason N. Pozner. Series Editor: Mark A. Codner. Pp. 256. Saunders/Elsevier, St. Louis, Mo. 2009. Price: $169.
Lasers and Non-Surgical Rejuvenation is one text from the five-volume Techniques and Aesthetic Plastic Surgery series overseen by clinical editor Mark Codner, who accurately depicts the goal of these timely and informative volumes in the Foreword. This practical interdisciplinary volume is edited by plastic surgeons DiBernardo and Pozner, two well-recognized and well-respected authors on their topics.
When I began researching the review of this volume, I encountered Dr. James Stuzin's May 2010 book review of Cosmetic Medicine and Aesthetic Surgery: Strategies for Success, edited by Dr. Renalto Saltz. We three contemporaries came of age when the field of plastic surgery was limited to surgical procedures. Basically, the only nonsurgical aesthetic procedures were bovine collagen injections, phenol peels, and dermabrasion. The last two decades have witnessed an explosion in minimally invasive surgical procedures and a plethora of nonsurgical options for our patients. Indeed, the field of cosmetic medicine probably represents the greatest advance in aesthetic surgery since liposuction and has become a bona fide branch of aesthetic plastic surgery. These nonsurgical procedures complement, enhance, and expand our surgical repertoire and offer options for problems that many times were heretofore considered untreatable. These modalities fall into three broad categories: neurotoxins (covered in the Minimally Invasive Facial Rejuvenation volume edited by Drs. Fazad Nahai and Foad Nahai), fillers (covered in the Facial Rejuvenation and Fillers volume edited by Drs. Steven Cohen and Trevor Born), and lasers (including ablative lasers) and light radiofrequency energy, which are covered in this book and discussed in this review.
The text contains 15 chapters by 18 well- regarded authors and/or their trainees. It is accompanied by a DVD containing 13 sections that correlate with, but are not exact parallels to, the text. The book appropriately begins with a comprehensive overview of aging skin and ends with a chapter on clinical photography for these procedures, consequently setting the tone for the necessity of these treatments and providing an appropriate photographic method for documenting the outcomes of the treatments from the chapters sandwiched between these two bookends.
The chapters, despite being written by different authors, are uniformly even and accurate. All of the chapters follow a standard format: key points; introduction; indications; patient selection; “operative” technique (the only “operation” presented is a section on laser blepharoplasty; the rest would be considered “procedures”), which is then divided into the different instruments available for the condition being discussed; operative steps; postoperative care; results; pitfalls and how to correct them; conclusion; and, finally, a reference list for further reading.
I consistently found each chapter to be well written, easy to understand, comprehensive, and accurate. The text provides interested surgeons with an excellent means of entering the arena of nonsurgical cosmetic medicine; it basically offers “everything you need to know” to identify what conditions exist and how to treat them. The biggest conundrum with this book is actually a reflection of the field itself: there are many different soft-tissue conditions, such as fine lines, skin irregularities, pigmentation, melasma, and pores, as well as hypertrichosis, acne, hair loss, tattoo removal, adipose tissue, and so on, and there are multiple methods and instruments to treat those conditions. The field of cosmetic medicine almost begs for a chart summary guide, matching the condition with the instrument [e.g., the condition/method of treatment (such as lasers, radiofrequency, light therapy) and the various machinery options within that category and a discussion of each instrument]; this was done in the “Laser Hair Removal” chapter. Algorithms can be useful starting points to organize one's thinking, and they are perhaps even more important in the world of nonsurgical rejuvenation, because unlike surgery, there may be many treatment options for one problem. With nonsurgical rejuvenation, there are not only many options (e.g., ablative versus nonablative treatment) but also numerous machines and manufacturers whose players change more rapidly than the pages of a book. This will also help with the inevitable first question physicians ask when entering this arena, which is, “if I have to buy one laser, which one should it be?”
Plastic surgery statistics serve to confirm how enthusiastically our patients have embraced these nonsurgical options. If, and this is a huge caveat, they are appropriately presented to patients not as an “alternative” to surgery, which unfortunately is all too common, particularly if all you have to offer is a hammer (the whole world becomes a nail), but as an adjunct to our ability to rejuvenate the aging process, either alone or perhaps in conjunction with surgery, these options represent a tremendous advance in our ability to treat a wider array of “disagreeable biologic conditions.”
For patient safety and satisfaction, it is important that these new modalities be integrated into plastic surgery in the appropriate manner and that patients are evaluated in the context of all the available surgical and nonsurgical options.
This book is an excellent, well-organized, and well-written reference for practitioners interested in this interesting and expanding arena of aesthetic plastic surgery and cosmetic medicine. Together, the three volumes in this series covering neurotoxins, fillers, and lasers provide a firm foundation and a good entry into this field.
Alan Matarasso, M.D.
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