Managing the Thick Skin in Facial Plastic Surgery

Roxana Cobo, MD

The skin is the biggest organ of the body serving as a physical barrier that is constantly renewing itself and protecting the internal body organs against the external environment. In the face, this barrier has particular characteristics: it redrapes over the mounds and grooves created by the facial skeleton and its overlying muscles and tissue giving each face a unique identity. Depending on how thick this skin is, some features will be more noticeable; and depending on the quality of this skin, elasticity, moisture, highlights, and brightness will be perceived more easily. With aging, there is a progressive involution of the different facial structures, increasing laxity and excess of skin that result in prominent folds and presence of rhytids.

Facial plastic surgeons are constantly working on the different facial characteristics of patients trying to improve features, correct deformities, or rejuvenate aging features. Over the years, it has been shown that not all techniques used work the same way or give the same consistent results. Among the features found that impact results in a more negative way is the thick skin. Although characteristics of thick skin vary, there tends to be among other things more bulk and less elasticity and redraping qualities. Postsurgical swelling can be increased making these patients a lot more difficult to treat.

The question that needs to be answered is: how do we deal with the thick skin? Can we really change its unique characteristics? Can we improve elasticity, moisture, and brightness? What surgical and nonsurgical techniques can we use to improve the negative features seen in patients with thick skin?

In this edition on the “thick skinned patient,” experts in the field will be trying to answer some of these questions and share some tips and recommendations on how to improve and treat the problems encountered with these patients. It is an edition dedicated to the whole face where the different areas will be addressed and new surgical and nonsurgical approaches will be presented and discussed. I hope you enjoy reading this edition as much as I did putting it together and reading the different articles. There are many new and interesting concepts that I hope can be as helpful to you as they have been to me.