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Adjuvant therapies should be included in the repertoire of every aesthetic surgeon. It would exceed the scope of this manual to describe all adjuvant therapies in detail. Anyone who wishes to undertake further training in this field can find detailed information primarily in dermato-logical textbooks.

Therefore, a few important adjuvant therapies will be dealt with only briefly in this volume. Please refer to the texts in Volume I of the manual for the basic information.

Dermabrasion, chemical peeling, and erbium-YAG laser treatment are examined methodically, but only very briefly to provide an understanding of the basic principles. Adjuvant therapies are very often combined with surgery, and an experienced aesthetic surgeon will choose appropriate treatments, depending on the types of wrinkles and skin type.

We do not use injectable alloplastic materials, as damage may occur that is extremely difficult to correct and, in a few cases, even irreparable. The use of autologous fat injections (Mang's spacelift) and biological implants, such as collagen and hyaluronic acid, is preferred. The decision to use botulinum toxin injections must be based on stringent criteria. The results for forehead wrinkles are good and the treatment can be repeated at intervals of 6 months.

The euphoria generated by laser therapy in the early 1990s has not entirely satisfied expectations for the treatment of the "aging face." The laser is not a "miracle weapon," but has now attained an established place in the field of adjuvant therapies. We primarily use the ultrapulse CO2 laser for skin resurfacing. This has already been described in detail in the audiovisual aids in Volume I (pp. 258-268).

The surgeon must decide whether to perform dermabrasion, chemical peeling, or laser therapy for wrinkles in the perioral region on the basis of his/her experience and his/her own judgment. Dermabrasion with a diamond cylinder gives good long-term results with no scarring or abnormal pigmentation for moderately deep lip wrinkles in younger patients. Chemical peeling (e. g., trichloroacetic acid 35 %) may be useful for older patients with deeper wrinkles. Erbium-YAG laser provides the best results for wrinkles in the perioral region and particularly the area of the lower eyelids.

Supraorbital nerve

Infraorbital nerve

Mental nerve

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