For decades, the standard for surgical facial rejuvenation has been the facelift—a procedure designed primarily to reposition sagging skin and tighten the underlying musculature. While effective at addressing the structural "gravity" of aging, traditional facelifts have long faced a common critique: they address the architecture of the face but often neglect the canvas. Patients frequently found that after undergoing surgery to address loose skin, they were still left with surface-level concerns such as sun damage, fine lines, textural irregularities, and the inevitable loss of facial volume.
However, a groundbreaking study published in the July issue of Plastic and Reconstructive Surgery—the official medical journal of the American Society of Plastic Surgeons (ASPS)—suggests a new paradigm. By combining traditional face and neck lift surgery with plasma skin resurfacing, fat grafting, and regenerative medicine, surgeons are now offering a more holistic, "total-face" approach to aging. This multi-modal strategy, pioneered by Dr. Melinda Lacerna Kimbrell of LA Plastic Surgery, demonstrates that the most effective way to reverse the signs of aging is to treat the skin from the inside out and the outside in simultaneously.
The Multi-Dimensional Nature of Facial Aging
To understand the significance of this study, one must first recognize that facial aging is not a monolithic process. It is a complex interplay of three distinct factors: gravitational descent (sagging), volume depletion (hollowing), and solar/environmental damage (skin quality degradation).
A traditional facelift addresses the descent by tightening the SMAS (superficial musculoaponeurotic system) and removing excess skin. However, as Dr. Lacerna points out, "Facelifts alone do not address the skin aging. Facelifts alone do not address volume loss." Without addressing these peripheral elements, the result of a surgery can sometimes look "strained" or incomplete—the skin is tight, but it remains weathered and thin.
The new approach documented in the study integrates these elements into a single operative session. By pairing structural surgery with regenerative fat grafting—which restores the youthful contours lost to age—and plasma skin resurfacing, the procedure targets the skin’s cellular health, its structural volume, and its surface aesthetic.
A Chronology of the Research
The study represents a rigorous review of 96 clinical cases performed by Dr. Lacerna. The clinical journey for these patients was far from the traditional "surgical-only" model. The protocol followed a specific, multi-layered sequence:
- Surgical Repositioning: The foundation begins with a standard face and neck lift, addressing the deep tissue laxity.
- Volumetric Restoration: Once the structure is addressed, full-face fat grafting is performed to restore the "youthful fullness" that disappears as adipose tissue migrates or atrophies over time.
- Surface Resurfacing: The third phase utilizes deep plasma skin resurfacing. Unlike traditional laser resurfacing, which can be harsh on darker skin tones or require long, delicate recovery periods, the use of helium or nitrogen plasma devices allows for a controlled, thermal injury that stimulates collagen production without the risks often associated with high-intensity laser treatments.
- Regenerative Integration: The final, and perhaps most crucial, step involves the application of topical regenerative treatments. This includes the use of nanofat cream and exosomes—biologic messengers that accelerate cellular repair and modulate inflammation.
By stacking these procedures, the researchers aimed to observe whether the simultaneous approach created a synergistic effect—a "1+1=3" scenario—where the healing mechanisms of one procedure enhanced the efficacy of the others.
Supporting Data: Measuring the "Age Reversal"
The results of the study were quantified using advanced imaging technology. Before and after the procedures, patients underwent comprehensive skin scans to objectively measure changes in skin quality. The data provided a compelling argument for the combined approach:
- Skin Age: On average, patients experienced a reduction in "skin age" by four years.
- Elasticity: The study recorded an almost 10-year improvement in skin elasticity.
- Wrinkle Depth: There was a marked seven-year improvement in the appearance of fine lines and deep-set wrinkles.
Perhaps most importantly, the safety profile was a focal point of the research. Historically, many plastic surgeons hesitated to combine aggressive resurfacing with major surgery due to concerns regarding the blood supply to the skin flaps created during a facelift. If the skin is stripped of its blood supply by surgery and then subjected to intense thermal energy, the risk of necrosis (tissue death) increases.
Dr. Lacerna’s study, however, concluded that when performed with precise technical control, the combined approach does not increase the risk of complications. The integration of regenerative medicine—specifically the exosomes and nanofat—appears to play a protective role, facilitating faster healing and mitigating the risks that previously kept surgeons from combining these modalities.
Official Perspectives and Clinical Insights
The significance of this study lies in its shift toward "regenerative plastic surgery." According to Dr. Lacerna, the inclusion of regenerative components is not merely a luxury but a fundamental requirement for the success of the procedure.
"This is a very safe and effective procedure combination," Dr. Lacerna stated in her summary of the findings. "But I think the key is regenerative medicine. I would not do this without regenerative medicine, without the fat grafting, without using nanofat cream, without exosomes for topical healing."
This perspective highlights a shift in the plastic surgery community from "subtractive" surgery (removing skin and fat) to "restorative" surgery (replacing volume and refreshing the skin surface). Furthermore, the study addressed the often-cited limitation regarding skin tone. By carefully selecting between helium and nitrogen plasma devices, the protocol demonstrated that these advanced resurfacing techniques can be adapted for a wide variety of Fitzpatrick skin types, making the procedure more inclusive and accessible.
Implications for Patients and Future Practice
For the patient, the implications of this study are multifaceted, offering both clinical and practical advantages:
Practical Efficiency
One of the most immediate benefits is the "single-session" nature of the treatment. Patients undergo one period of anesthesia, one recovery phase, and one total cost structure. In an era where patient time is a precious commodity, the ability to achieve comprehensive rejuvenation in a single operation is a significant logistical advantage.
Enhanced Aesthetic Outcomes
The synergy mentioned by the researchers is the most promising takeaway. By healing the skin from the "inside out" (fat grafting and regenerative treatments) while simultaneously treating it from the "outside in" (plasma resurfacing), the skin is effectively remodeled. The result is not just a tighter face, but a face with improved texture, luminosity, and structural support.
The Future of the Field
While the study results are promising, the authors are careful to note that this is only the beginning of a larger conversation. The field of regenerative medicine is advancing rapidly, and the study calls for further research. Future investigations are expected to focus on:
- New Technologies: Integrating newer, FDA-approved "cool" plasma devices that may offer even greater precision.
- Patient Satisfaction Metrics: Moving beyond objective skin age scans to include qualitative, patient-reported outcomes to better understand how these physical improvements translate into perceived quality of life and confidence.
- Longitudinal Studies: Tracking the long-term durability of the combined results compared to traditional, standalone surgeries.
Conclusion: A New Standard?
The study published in Plastic and Reconstructive Surgery serves as a landmark document in the evolution of facial aesthetics. It challenges the traditional limitations of surgical practice and encourages surgeons to adopt a more comprehensive view of the aging face. By moving away from silos—where a facelift is a facelift and a laser treatment is a laser treatment—and toward a unified, regenerative approach, the medical community is moving closer to providing the "gold standard" of facial rejuvenation.
For patients, the message is clear: when considering facial surgery, the conversation should no longer be limited to "lifting" the skin. It should encompass the entirety of the skin’s health, volume, and texture. As clinical research continues to validate these synergistic methods, we are likely to see this "combined approach" become the standard of care for patients seeking to turn back the clock with precision, safety, and efficiency.
For those interested in the technical details of the surgical protocols and the specific outcomes of the 96-patient series, the full study, "Taking Face Lifts to the Next Level: Case Series Reflecting the Safety and Efficacy of Plasma Resurfacing with Face and Neck Lifts," is available through the Wolters Kluwer medical journal platform.
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