The aging face presents a therapeutic challenge. It is necessary to comprehend the anatomical alterations that the face undergoes in order to be able to offer a treatment regimen that will give the most beneficial outcome and result in a natural appearance. An optimal outcome cannot be achieved by a single therapeutic agent, however excellent it is. A favorable treatment regimen requires full understanding of the aging processes that constantly take place in the facial tissues over the years and the command of a wide repertoire of therapeutic methods, both non-invasive and invasive, that can be integrated in order to achieve the best aesthetic results. The face is composed of several layers, and the changes that come about during the aging process take place in each one of these. As a rule, these changes can be divided into two categories:  sagging and atrophy. Sagging affects mainly the dermal layer, whereas atrophy appears in the deeper layers, the fat, muscles and bone. Atrophy is, in fact, more difficult to detect and it can set in at a much younger age.

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The optimal treatment combination will depend on the changes that the face has undergone. A wide range of treatment possibilities is available today and these include peeling (chemical, mechanical or laser), enhancement of the skin texture with the aid of medicinal creams, application of agents that encourage growth of collagen and elastin, various types of threads and more. Dynamic wrinkles that have arisen from use of the face muscles can be treated with Botulinum Toxin (manufactured under the trade names of Botox, Dysport or Xeomin). Other types of wrinkles can be obscured by filling with hyaluronic acid, calcium or autologous fat (taken from the patient's own body). The fillers, and in particular autologous fat, are exceptionally beneficial in treatment of atrophy. It is necessary to be versed in the areas where the facial fat lies and the exact boundaries of these areas in order to perform the filling process at the correct level and by the method that is most suitable for obtaining optimal results.

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In advanced cases of facial flaccidity, or where particular focuses are to be treated such as the eyelids, eyebrows, jaw, neck - the surgery can be attuned to the expected improvement. The procedure can be performed under local anesthetic, sedation or general anesthesia, depending on the extent of the surgery, the willingness of the patient and his/her medical condition.

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Sometimes the first signs of aging appear in the areas of the eyelids and eyebrows.  Before any decision can be made as regards treatment for this, an assessment must be made of the position of the eyebrows and the condition of the eyelids. An understanding of the changes that these areas have undergone will provide a directive as to the therapy that is most appropriate and prevent unsuitable treatment (for example, with Botulinum Toxin in certain cases).  In some cases, it is sufficient to lift the brows without having to touch the eyelids, with satisfactory results. In other instances, a combination of procedures will provide an optimal outcome. Since the brows are set in different positions in men and women, this has to be considered when planning the treatment schedule. Blepharoplasty and brow lifting can both be performed under local anesthetic and can be combined with other operative procedures that include parts of the face, for example: injection of filler material such as fat, or treatment with threads.

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The decision as to which treatment combination is appropriate is made after a meeting with the patient for in-depth consultation. The entire facial area will be thoroughly examined to assess the condition of the tissues, the medical condition presenting and the patient's expectations.

Dr. Gronovich is a lecturer at international symposiums and a Key Opinion Leader (KOL) of the Galderma Company, manufacture of RESTYLANE, the filler materials that have been under intensive study for over 20 years. He instructs physicians from all over the world in advanced injection techniques whereby these materials can be applied as fillers and participates in many studies related to this field.   

 Dr. Gronovich has specialized in aesthetic surgical procedures involving the face, and has employed the most up-to-date and advanced techniques currently available for blepharoplasty, brow lifting, facial sculpting and lifting and neck lifting. He has, in fact, developed a breakthrough procedure for lifting the neck which is registered world-wide as a patent. This method involves insertion of a special mesh that secures all the tissues and assures optimal and long-lasting results.