Facelift Overview Syracuse
“Facelift” reflects the collection of treatments to address the effects of time and sun. I want to share my approach to the anti-age fight with you. First, I want you to understand aging and your appearance. Then I’ll outline the more common options to consider. As you will see, there are lots of choices, and it may seem overwhelming to sift the available treatments. Together we’ll discuss choices to achieve your goals.
Our bodies are very efficient at repairing damage. Unfortunately, small portions of life’s trauma are not repaired. Aging is the accumulation of these traumas. For me, the “Holy Grail” is true rejuvenation by treating aging as the injury it is. While I don’t have all the answers, we’ve made a good start. The promise of natural rejuvenation is its limitless potential. The problem is the separation between potential and your actual individual result.
Layers of Anti-Aging
Anti-aging is like caring for your home. You do weekly dusting, spring/fall cleaning, periodic painting, and rare major remodeling. Facelift works the same way: Daily treatment with skin care, Periodic non-invasive/minimally invasive therapies, and occasional surgery. Aging is not a straight line. It hits you in fits and starts. You will likely age the way your parents did
Focus on Aging
The cornerstone of youth is your midface, especially your eyes. The younger your eyes appear, the fewer years added for lip lines and neck skin. In my research, your eyes should be 50% or less of your midface, and the angle formed by your eyes and the tear shadow should be 20 or less. In simple terms, frame your eyes: Make-up, glasses, or skin treatments can take away years. Fillers, skin treatments, or surgery may be needed, but not necessarily as your first line treatment.
Your skin quality is critical to long term youth. Facial skin is different from anywhere else on your body. My research has shown that your nasolabial fold (which connects your nose to your chin) is the poorest quality skin. In general, your “best” skin is intimately associated with muscles that animate your face
Second to skin quality, volume and support affect both your midface and the lines around your mouth. Similar to a venetian blind tilting to one side, rather than sag straight down, your cheek rotates around the corner of your nose, creating jowls and the deep folds connecting your nose and chin. While there are many tools to help, I am still searching for the “Holy Grail” to re-animate your face rather than simply nip, tuck, and suck.
As I begin to discuss treatment options, remember that the treatments are not necessarily exclusive. Like an onion, there are often the layers to therapy. Except for temporary fillers, over time your treatments will continue to work with each other, building and maintaining a more natural version of your youthful appearance.
The most basic skin care protocol is fairly simple: Mild chemical exfoliation, collagen stimulation, and sunscreen protection. Chemical exfoliation uses glycolic acid to loosen the dead skin cell layer in your skin without the trauma of the abrasive grit of mechanical exfoliants. Aside from make your skin feel smoother, and also allows better penetration of other agents to stimulate your skin repair.
Retinol is available without a prescription. I recommend either the Neutrogena or ROC pharmaceutical formulations for retinol. Retinol is like Retin-A “light.” It works to stimulate repair of collagen in your skin.
Sunscreen helps to limit additional damage to your skin. Except for children under 13, I recommend SPF 30 or above applied every 2 hours. For children under 13, I recommend chemical free sunscreens. You also have the option of sun protective clothing, which gives a high level of sun protection without having to worry about reapplication. Such clothing has become much more affordable and widely available.
While maintaining the skin moisture is important, except in the winter time, additional moisturizer may not be necessary. I believe that the unneeded application of additional moisturizer can suppress your own body’s production of natural lubrication. This can create a self-fulfilling prophecy of skin being dry without moisture. The inherent low humidity of cold weather will adversely affect your skin. For the winter, I recommend applying moisturizer immediately after bathing.
Regenerative Therapy: Plasma & Placenta (“Injectables Facelift”)
Alone or in combination, my research has shown that plasma treatment and the “injectable” facelift truly reverse aging.
Plasma treatment has nothing to do with blood. Rather, plasma relates to the 4th state of matter (solid, liquid, gas, plasma). Pulses of ionized gas are delivered to your skin. No anesthesia is required, and you can resume normal activity essentially immediately. The effects collect over time, with improvement continuing for 6-12 months. My research shows improvements in skin thickness, moisture, and elasticity. Depending on your skin age (which can be different from your calendar age) up to 3 treatments may be recommended.
Plasma treatment may be combined with Quill threads for an augmented result. The Quill is a temporary absorbable suture that provides extra support for up to 4 months. The extra-support can influence the overall result by providing direction and support for your skin. Because there can be some “bunching” for several weeks in front of your ear, the best candidates have longer or thicker hair that can camouflage this temporary change while your skin heals.
Placental derived tissue injections (injectable facelift) are intended to restore your natural volume and support for deeper structures in your face. Currently, there are 2 forms of tissue that I use: Chorionic tissue or exosomes. Injected chorionic tissue attracts migratory stem cells, which then triggers a healing response, including the release of growth factors, anti-inflammatory factors, and over 100 healing agents. Improvement can continue for up to 11 months.
Exosome’s are created by stem cells. Functionally, they represent a “message in a bottle,” transferring programming information to local target cells, stimulating regeneration. Ultimately, it is the same mechanism as the chorionic tissue injection, though the exosome messages are derived from stem cells harvested from placental tissue rather than your own stem cells. While my experience is more limited with the exosome treatment, the early results have been a more rapid response than observed with the chorion injections. To date, I’ve seen skin thickness increase by up to 40%.
The combination of the plasma treatment with the placental injections creates a synergy, where the overall improvement can be greater than that seen with the individual treatments. While the improvements may be subtle in photographs, the dynamic result, which is the true reflection of youth, is more pronounced. Because it is a natural change, you are more likely to have friends and relatives, comment on your improved appearance, but without quite being able to identify what is different. By example, several patients have commented that their spouse was unsure about their treatment, but that they were now pleased with the results because they look much better, but did not look different. Another patient reported that each time her son came to visit and he commented that she was appearing younger, though she did not recognize the changes in her appearance until she saw the dramatic difference in her before and after photographs.
The benefit of regenerative therapy is that it is the most natural alternative I can offer. The disadvantage of regenerative therapy is that there is a wide variation of results from patient to patient. I continue my personal research and to try to understand and predict which patients will experience the best results, as well as what can be done to enhance results.
Whether you have the optimal or less than optimal result, there is a synergy between regenerative therapy and any other therapy you may choose.
Volume issues fall into 3 categories: Adding volume, repositioning volume, or both.
Adding/restoring volume may use either “off the shelf” filler or your own tissue. “Off the shelf” fillers are convenient, but most are temporary, a result you “rent,” not own. For scars, filler success depends on the ability to stretch the scar. If the scar is “stiff,” success is limited. Treating volume deficits require adequate support, otherwise the added volume may not give the desired result.
The most common filler is hyaluronic acid (Restylane, Juverderm). Depending on the formulation, it last 3 to 18 months. Hyaluronic acid is the only filler that can be injected into your skin.
Sculptra is a “natural” filler. The injected material is converted by your body to connective tissue. The results accumulate over time. Pro: Sculptra can be permanent. Con: The amount of volume created varies from patient to patient.
Bellafill is a permanent filler, but it is a foreign body. Bellafill is a blend of PMMA microspheres and cow collagen. As the collagen is absorbed, your body “sees” the PMMA, and replaces the cow collagen with your collagen. While PMMA is a foreign body, it has a long history of being well tolerated. The cycle to your final volume result may take up to 4 months.
Non-Invasive/Minimally Invasive Therapy
Skin Tightening (Does NOT restore elasticity)
ThermiSmooth is similar to cooking an egg in a microwave. It uses radiofrequency to help tighten your skin and subcutaneous tissue. Depending on the area of treatment, different size treatment disks are used. The radiofrequency can be effective in helping to tighten not only the skin, but deeper layers of tissue as well. Multiple treatments are necessary. Maintenance treatments are helpful, ranging from every 6 months to 2 years. In general, there is rarely any down time from treatment. Although there is a risk of a burn, because no anesthesia is required, your immediate feedback regarding pain will help to minimize risk of injury.
ThermiTight, like ThermiSmooth, uses radiofrequency to stimulate tightening of skin and supporting tissue. ThermiTight is “injectable” radiofrequency, where the energy is delivered via a probe beneath your skin. This does require the use of local anesthesia. While the recovery can be very quick, you need to allow several days for possible bruising. Results will accumulate for 3-6 months. Treatment results can last up to 2 years. To minimize risk of a burn, as well as to help soptimize results, tissue temperature during treatment is monitored by thermal imaging.
Quill & StrataFix are barbed sutures that add temporary support that can augment the results of other therapy. These sutures help with mini-neck lift, support for fat injection, placental derived tissue injections, among other treatments.
I don’t believe there is a “traditional” lift. That suggests a cookie cutter, one size fits all treatment. Facelift surgery is tailored for each patient. In my view, the key is “lift.” Your drooping cheek is elevated with sutures in a strong layer of tissue called the “SMAS.” For some patients, especially with excessive midface droop, additional temporary support may be added with Quill sutures.
Facelift uses an incision just in from of your ear starting at your temple, around your earlobe, and just behind your ear. The excess skin is elevated, the SMAS supported, then the excess skin is removed. Many patients benefit from restoring volume in your cheeks. Fat transfer is often part of facelift.
For most patients, initial recovery is 7-10 days.