As patients become more aware of their options related to facial enhancement, nonsurgical offerings will become an ever larger component of the cosmetic practice. Patients will continue to demand rejuvenating options but will desire a minimum of downtime, discomfort, and invasiveness. The use of traditional skin care approaches such as microder abrasion, botulinum toxin, injectable fillers, and prescription-grade skin care products will be accentuated by the advances in laser and IPL technology. Using these new technologies effectively, knowledgeably, and safely is crucial for the maxillofacial surgeon to maintain the leading role in facial cosmetic surgery.

Currently, dozens of lasers exist for noninvasive cosmetic procedures. This wide range of options, with each option having its own claims of efficacy, superiority, and ease of use, is beyond this review. The reader is encouraged to investigate thoroughly any claims, studies, or promises made by any manufacturer. It is wise to test any equipment in the clinic for as long as possible before purchase.

In addition, local, state, or regional rules and regulations may impact the use of laser technology in any given practice.

In conjunction with prescription skin care products, botulinum toxin, microdermabrasion, injectable fillers, and so forth, these laser procedures provide a comprehensive menu of services for contemporary maxillofacial surgery practices.

An increasing number of procedures, including elective cosmetic surgery, are being performed in independent outpatient surgical centers. Ambulatory surgery in an once setting has several potential advantages over hospital based care, including greater patient privacy, cost containment, easier scheduling, and convenience for the doctor and patient.

Anesthesia for oncebased facial cosmetic surgery can be delivered in a safe and efficient manner. The surgical facility should be accredited by a recognized accrediting agency, such as Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or Accreditation Association for Ambulatory Health Care (AAAHC). Accreditation is a voluntary process through which a center is able to measure the quality of its services and performance against nationally recognized standards. Through self assessment and review by expert surveyors, the center can improve its care and service. The accreditation process helps ensure that quali'ed health care professionals are delivering anesthesia care in a safe environment.

Anesthesia should be administered by or under the supervision of an anesthesiologist or other quali'ed physician or dentist who has been trained appropriately in anesthesia and rescue techniques. An oral and maxillofacial surgeon should hold a permit from the state dental board to administer deep sedation and general anesthesia and should meet the minimum standard of care requirements set forth by the board. If a certi'ed registered nurse anesthetist administers the anesthesia, he or she should be under the direct supervision of an anesthesiologist or quali'ed doctor at all times. The patient should be informed in advance as to who will administer the anesthesia.