As a reconstructive plastic surgeon, Dr Corey Maas has seen many changes within his industry as the popularity of surgery for cosmetic purposes rather than reconstructive purposes has skyrocketed. However, he believes it’s the injectible side of things that really shows promise.
As founder and director of The Maas Clinics we provide a surgical associated appearance care centre and medical spa. I also hold the position Of Associate Clinical Professor at the University of California, San Francisco. My practice is limited to facial, plastic and reconstructive surgery and is almost all cosmetic surgery now, but we still treat skin cancers and some facial trauma cases, especially at the San Francisco General Hospital where we volunteer and teach residents and fellows.
When I first started in residency we handled head and neck cancer surgery cases and I found the reconstructive aspect the most interesting element. Aesthetics is a vital component, especially in head and neck reconstruction. When I finished my training 1 decided to complete it with a facial plastic surgery fellowship which I undertook at the University of California, where they asked me to stay on the faulty for 12 years. I always thought I’d go back to Florida, where I grew up, but I ended up staying at UC and teaching. A lot of the work I had done in research involved implantable materials and it was a good environment for the development of new implantable materials. I published a number of papers and undertook a great deal of research on injectable materials and all kinds of synthetic, alloplastic materials. lt was the perfect environment in which to develop that research.
My practice is now limited really to three things, if you include my spa: ageing face surgery (eyelid & centring); surgery to change the balance or shape of the facial features (rhinoplasty, ears); and the skin. Our medical spa deals with the skin of the whole body, not just the face. I have five nurse practitioners who utilise various lasers, heat and RF’ technologies, peels etc to work on the skin and all areas of the body, tackling hair removal, pigmentation, spots, wrinkles and the like.
Injectibles have taken on an increasing importance in what we do. When I first started injecting, almost 20 years ago, there was really only one product, collagen. One of the things we developed was a permanent implantable material (which could be removed) known as Softform. I came to Australia and trained a number of surgeons in the use of this product. From that time when it was just collagen and nothing else, to 20 years later, it’s become such an integral part of what we do. They do stave off the need for surgery and all these devices (injectibles) are adjuncts to surgery. They work beautifully to soften lines, fill in depressions and perfectly complement other work.
A lot of what we do isn’t just about beauty, it’s about making people feel more comfortable and look like they feel They might not feel angry, for example, but they might have an angry scowl line and that’s where the neuromodulators come in.
Plastic surgery has trends that go way up and down and people tend to follow the leader – whether it’s good or bad, unfortunately! Sometimes these trends end up being very helpful, and sometimes not. I would say the trend for massive facial volumisation is probably going to go away as it’s been overdone. It’s like anything: just because a little is good doesn’t mean a lot is better.
Not to underplay the importance volurne, of course, as it went largely unaddressed for years. We used to work on re-draping by tuckling the sagging tissue but we didn’t really address the changes in volumetric proportions of the face. However it has gotten a little out of hand of late and it’s like anything you have a reaction and then it can become an over-reaction. My sense is we will dial back this over-treatment with volume but still keep it as an integral part of’ our strategies.
We are really close on some of these new modern-day skin tightening devices. Ultrasound in its current form isn’t the pinnacle but we are working towards an effective solution utilising heat energy into the tissue which can stave off lifting procedures for a while or work as an adjunct to them. Technologies that generate sub-ablative (below the level of injury) heat energy to the skin and stimulate regeneration or remodelling of the tissues are getting close to perfection. We aren’t quite there yet but in the next five years the technology will become a very important tool.
From a surgical standpoint, anesthesia has advanced to such a degree that we are a long way past the deep general or narcotic-based anesthesia. People can come in now and have a relatively long operation and walk out that same day, feeling comfortable. For patients it’s a relief and a move away from hospitals which is a good thing for the consumer and also the healthcare industry in general. We are refining surgeries so they are becoming shorter and more effective in outcome. The standardisation of these techniques combined with targeting the cosmetic surgery needs we have (shorter stars, faster recoveries, predictable outcomes) is honing things down effectively.
“As for the driving force behind the demand for cosmetic surgery, I think we have always sought to look better and it is hard-wired in us. It’s not something we really choose to do and I don’t believe it’s caused by undue pressure from media. It’s something all of us intrinsically want.”
As for the driving force behind the demand for cosmetic surgery I think we have always sought to look better and it is hard-wired in us. It’s not something we really choose to do and 1 don’t believe it’s caused by undue pressure from media. It’s something all of us intrinsically want. I think reaching more groups of people has changed the industry, it has become more accessible within the middle classes because it’s becoming more affordable. This means the number of people with access to cosmetic surgery is widening. It used to be quite elitist, affordable only for the wealthy and famous but nowadays you see more people being able to do a little something, cosmetic intervention-wise. Rightly or wrongly there is a stigma surrounding cosmetic surgery – we see people on TV or in magazines with overstretched faces and they look plain ridiculous. That stigma gives what we are doing a bad name, yet the vast majority of people simply want to look better – like themselves, but more energetic and vital. They also want to keep working, they don’t want to stop when they are 65 so if they feel better and feel they look better, they can stay out there and be productive.
There are a lot of advancements on the horizon. I have been involved in the trials for Xeomin and also for Johnson & Johnson’s Puretox, which will fast be available in the US. A number of new neuromodulators are coming to market and I believe they are all very good products with subtle differences including Botox and Dysport. What I see in the future is that they will all become commoditized. People won’t be coming in ten years from now and asking for Borax by name, they’ll be asking for a neuromodulator or describing their wrinkles and based on whatever the best deal, or the dome’s preference is, they’ll get that product rather than the physician defaulting to one brand. Rome had the monopoly for 12 years and became the Coca-Cola of the industry but, as with Coca-Cola, there are good competitors and in the next five years we will see a lot more commoditisation in this area. We can expect it with fillers too – particularly the HA fillers.
Dr Corey Maas is also known for his charitable work, which includes National Domestic Violence Project; and Books for Beauty (formerly Books for Botox).
