March 22nd, 2010
Non-surgical facelift, can you get away with it or do you need the real thing?
New York, N.Y.
There is much buzz in the media and on the internet about non-surgical or alternative less invasive procedures instead of facelifts. These treatments include fillers, neurotoxins (Botox and Dysport), and devices such as lasers and radiofrequency machines. Many of these procedures can help restore a more youthful look, but none really lifts the face. You can follow this link to my website for a more comprehensive discussion of the 5 ways the face ages:
- Skin changes
- Dynamic lines from muscles underneath
- Loss of volume
- Effects of gravity
- Loss of tissue elasticity
To treat these aging causes, treatment needs to be targeted to the cause. Of course, most patients experience all 5 in some capacity. I then break down their priorities by need, time frame, importance to them, time off to heal and cost.
Targeted treatment for each or some combination is really what is best:
- Skin changes Lasers and peels for the skin
- Dynamic lines Botox or Dysport to relax muscles
- Loss of volume Facial Fillers (Juvederm, Restylane, Radiesse, Sculptra, Fat)
- Effects of gravity Surgery
- Loss of elasticity Surgery
Fillers, Botox and Lasers can go far to make someone look younger, but to lift a drooping jowl, treat a “turkey neck” or low brow, nothing works like a surgical facelift or browlift.
Don’t get me wrong, my new techniques in facial fillers are really getting beautiful results. Now that I target cheeks and the mid-face with fillers, entire faces light up. But this is not a lift. There is a doctor in New York advertising a “insert letter here” lift (I am leaving out the letter as not to offend); but all he is doing is placing many syringes of facial filler deep in the face and under the skin. It’s not a lift but volumizing the face. Fillers are a good thing, but more is not better. Plump is good but so is lifting.
Lasers and RF machines don’t really lift the face either. Most reports have been disappointing and based more on subjective findings instead of objective long term results.
So, for comprehensive facial rejuvenation, all 5 areas of the face need to be examined and treated.
Steven Pearlman, MD, FACS
Posted in Facelift, Home, facial fillers | No Comments »
October 12th, 2009
I recently returned from the annual Fall meeting of the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) in San Diego, California. I look forward to that meeting every year as the Academy’s premiere meeting. It is a forum for experts to discuss procedures on panels, new innovations being presented by researchers, new products from medical vendors, and last but not least – the chance to catch up with good friends from all around the country. I missed only one of these fall meetings since my fellowship (1988), and that was two years ago when my twins were due. My next few blogs will be devoted to advances in plastic surgery that premiered at the meeting.
The meeting started off with a superb panel on facelifts. Panelists were chosen to discuss the various popular techniques practiced around the country. These ranged from mini-facelifts to (open) suture suspension lifts, MACS lifts, deep-plane facelifts, bi-planer extended SMAS lifts and the latest: laser lifts featuring the new laser SmartLiftTM.
The goal of facelifts are to re-suspend drooping facial tissues by tightening the underlying muscle layer called the SMAS, then gently laying down the skin, without tension, to obtain natural long lasting results. Each of the above techniques has advantages and disadvantages. My main take home lesson was that there is no one facelift for every patient. Mini-lifts have a place for patients who need minor improvement of the jowls, jawline and mild skin excess under their chin. For patients with heavy faces, the deep-plane facelift is still king.
I was enthralled by the laser lift. I recently purchased the SmartLipo Laser to use for neck contouring and to enhance liposuction results. I have been using it since August for neck liposuction, skin and jowl tightening and getting fabulous results. This laser can also be used to raise the skin for a facelift. By using the laser there is less bleeding and the skin flat is elevated more smoothly and rapidly… which all leads to less downtime and recovery, which gets the patient back to work quicker.
Posted in Facelift, Home | 2 Comments »
March 3rd, 2008
I have had a number of patients, friends and family of friends ask me about the Lifestyle lift. This is a company with very enticing advertising and superb before and after photos. I have a few problems with this approach. According to the Hippocratic oath, medicine is supposed to start with a doctor-patient relationship. Before embarking on an invasive surgical procedure it is important to know your doctor and his capabilities; yes this is invasive and major surgery no matter what people tell you. The lifestyle lift is a company based in Detroit that opened centers throughout the country where patients are directed from their advertising. They employ dozens of surgeons of varying skill and experience to perform a basic suture plication facelift.
Consultations, as well as the follow-up, are performed by various individuals, it might be the doctor who will be doing your surgery or it might be a nurse or physicians assistant. Please ask yourself these questions before signing on:
Do you really know the credentials of the doctor who will actually be doing your surgery?
How many years have they been in practice?
Are the before and after photos in the advertisements from this doctor? Are there options or differences between this procedure and other facelifts? Where these options discussed?
What are the advantages and disadvantages of the lifestyle lift?
What are the limitations of this lift as compared to other available procedures?
Do you really know and feel comfortable with the surgeon who will be doing your surgery? Like other areas of cosmetic surgery, cookie-cutter procedures do not always give the best results. A recent study by a very highly respected surgeon and teacher, Dr. Peter Adamson, as published in the Archives of Facial Plastic Surgery, demonstrated a longer lasting result from the deep plane facelift over a SMAS plication facelift. Plus, the SMAS plication is actually a more highly accepted procedure than that done in the lifestyle lift by most facelift experts. What does this mean? A more comprehensive facelift technique will last longer than a simpler one. Which is best for you? That really depends on your anatomy and what needs to be lifted. So, to lump all patients into a very simple procedure under local anesthesia might sound enticing, but might not give you the most long lasting results.
As for the procedure to be done under local anesthesia: sure, it sounds very nice not getting anesthesia other than local. General anesthesia (and deep sedation) has been around for many decades. As a matter of fact the incidence of serious complications from general anesthesia has gone down by more than 1000 times over the past 30 years. Anesthesia is one of the few specialties where malpractice rates have actually gone down. Yes, this is preferable for a more aggressive facelift, but then again you will get a result that will likely last for many more years. So, in reality, you will likely be getting what you pay for; a simple procedure that is safe and performed under local anesthesia.
Would you rather have a longer lasting result from a doctor who you have researched and likely with more experience?
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