The 3 Rs of Facial Plastic Surgery

The American Academy of Facial Plastic and Reconstructive Surgery (AAFRPS) recently declared rhinoplasty, rejuvenation, and reconstruction the pillars of facial plastic surgery. Modern Aesthetics spoke with AAFPRS President Anthony Brissett, MD, FACS, to discuss how this concept became what he called a “concise way” to understand the scope, focus, and depth of the field. (Editor’s note: This discussion has been lightly edited for clarity and conciseness).

How did this framework come about?
Dr. Brissett: We have been working to continue to define ourselves as facial plastic surgeons, and the concepts of rhinoplasty, rejuvenation, and reconstruction continue to emerge. It represents the pillars and the foundation of what we do as specialists in pursuit of excellence.

How can surgeons use this framework to help their patients better understand the qualifications of a surgeon and make safer, more informed choices when selecting a practitioner?
Dr. Brissett:  For surgeons, it helps communicate to colleagues and patients who we are, what we do, our levels of excellence, and our ability. It helps take away some of the complexity that is sometimes seen within healthcare in terms of having to identify a physician and evaluate their levels of expertise. As it relates to the face, the 3 Rs define who we are and what we do. Also, it helps refine what we do. It helps direct who we are and allows us to continue to be linear in our pursuit of excellence.

Data from the AAFPRS show that facelift patients are trending younger. What is driving that shift?
Dr. Brissett: We have always had pockets of patients who presented earlier for cosmetic procedures or rejuvenation procedures. We perform otoplasties for children as young as 5 years old. Patients often present for rhinoplasty in their teens. Still, we have been seeing a trend toward younger patients on the rejuvenation side, and several factors contribute to that.

One factor is greater broad-based awareness of opportunities, initiatives, and modalities that can address some of the early changes that we see in the younger patient. Additionally, we are now seeing ourselves in new ways. The COVID-19 pandemic made us all see ourselves on camera more often, which led us to focus on areas to consider for improvements. We also are in a selfie era and a social media era, always looking at images and opportunities to create enhancement and refinement.  

Additionally, technology has been introduced that brings rejuvenation in a less invasive form to many of our patients. Office procedures can be offered to patients at a younger age, whether it be fillers, lasers, or other modalities.

Finally, we are seeing a massive trend as it relates to weight loss. Many patients who have been the recipients of GLP-1 receptor agonists (RA) or even gastric surgery have had a change in their self-image and their self-confidence, and they also want to match how they feel with that change.

As experts in these fields, we must embrace this trend and all of these contributing factors but also temper some of that enthusiasm and make sure that we are approaching this in a discerning way.

How do you foresee GLP-1 RAs continuing to impact the surgical industry?
Dr. Brissett: I don’t think we know exactly what the impact will be, but we know it will be significant. What I do know is that, as we continue to see people improve their health, wellness, well-being, self-image, self-awareness, and self-confidence, patients will want their insides to match their outside. A recent study looked at how people perceived workplace success and how they are treated in the workplace. There is some evidence that people who feel good about themselves and have a level of attractiveness also have more success. That is an important consideration that patients are wanting to balance.