Non-Invasive/Minimally Invasive Rejuvenation (Facelift)
The treatments reviewed here have the advantage of relative ease of treatment. While the treatments may be “easy,” there is always some risk with any treatment.
Basic Skin Care: The simplest, most basic care combines mild chemical exfoliation, collagen stimulation, and sun screen. The overall treatment takes little more than the time to wash your face. Collagen stimulation can start with over-the-counter retinol, but usually better served with prescription Retin-A. Sunscreen can either be lotion or sun protective clothing. Lotion should be SPF 30 or above, applied every 2 hours. While moist skin is important, too much emphasis may be placed on skin moisturizers. When you continue to apply moisture, your skin will respond by decreasing production of its own moisture. While adequate moisture is important during very dry seasons, such as the winter, there is often minimal benefit from very expensive cosmetic counter moisturizers.
Plasma Skin Treatment: This treatment delivers pulses of ionized argon gas to your skin, which can both directly tighten the skin, as well as stimulate self-repair in your tissues. Treatment is done without anesthesia, and there is virtually no recovery time.
ThermiSmooth: This treatment uses radiofrequency to help tighten skin similar to the way you cook an egg in the microwave. This triggers heating in the skin, which results in tightening of collagen. In contrast to Thermage, ThermiSmooth is temperature-controlled, resulting in greater patient safety and comfort, as well as improved results. This is, used to treat lack skin around your eyes, as well as the lip lines. Most commonly done a series of 4 treatments, there is virtually no down time and minimal discomfort.
ThermiSmooth 250: Like ThermiSmooth, ThermiSmooth 250 uses radiofrequency delivered through the skin to treat your tissues. At this time, ThermiSmooth 250 is not yet FDA approved. Studies are ongoing to assess efficacy of treatment for skin tightening, treatment of cellulite, volume reduction, and soft tissue tightening. Patient’s treated are enrolled as part of an IRB approved research protocol.
Minimally Invasive Treatment: Fillers
Fillers may be used in the skin, just beneath the skin, or placed in deep soft tissue for support and augmentation. Most fillers will be temporary in nature, though they may last up to 2 years.
Fat Injection: The major benefit of fat injection is the permanence of your result. While the amount of fat volume that stays will vary from patient to patient, the results present at 1 year can be expected to stay for many years. While this is the most natural alternative for filler, it does require a minor procedure. Liposuction is performed to collect the fat. Minor processing is done, and this is used most commonly to fill the apple of your cheek, reduce the depth of the nasolabial fold, or restore volume to your lips. The most predictable results are for use in cheek volume and support.
Restylane Lyft/Juvederm Voluma: These are hyaluronic acid fillers intended for deep tissue support and augmentation. Hyaluronic acid is a natural substance found in your body. These are most commonly used for restoration of support and volume in the “apple” of your cheek or to reduce the prominence of your nasolabial fold (the depression running from her nose to the corner of your mouth). Results can last up to 2 years.
Sculptra: Ultimately, Sculptra is a natural filler. The Sculptra material is resorbed by your body, and replaced by your own collagen. The amount of volume generated will vary slightly from patient to patient. It may take 6 weeks or longer to see the full effect of Sculptra. Several treatments may be necessary. To minimize risk of forming a small nodule, you need to follow the “rule of fives.” This means she will massage the treated area for 5 minutes at a time, 5 times a day, for 5 days. While the manufacturer indicates Sculptra last 2 years, I have seen patients where it is essentially a permanent result.
BellaFill: Previously named ArteFill, this is a permanent filler. This is a mixture of bovine collagen with PMMA microspheres. As her body digest the collagen over 4 weeks, the PMMA microspheres are incorporated into her tissue. Ultrasound examination Shows that additional volume is created as your body reacts to the microspheres. PMMA is the same material used to anchor orthopedic prostheses, such as a total hip. The risk of reaction to the PMMA is extremely small. Because there may be a issue of allergy to the bovine collagen, skin testing is recommended before treatment.
Minimally Invasive: Skin Tightening/Support
“Baby” Facelift: This is a novel new natural treatment that treats aging like an injury. Baby facelift is the injection of human chorion (which is part of the placenta). It is unique as a biomodulator, working with your body to restore and repair your tissue. Chorion stimulates new blood supply, as well as attracting circulating stem cells. I’ve seen good results for crow’s feet, lip lines, cheek volume & support, nasolabial fold, and even rejuvenation of the back of the hand. Baby Facelift is unique in reducing the dynamic lines, those that form with animation, like smiling. This treatment is so new that I don’t yet know the long term results. Because it is a true rejuvenation, I anticipate good long term results, but as you will always continue to age, plan on future maintenance treatments.
ThermiTight: Using “injectable radiofrequency,” ThermiTight can provide tightening of the skin and subcutaneous tissue, as well as reduction in unwanted volume. While most commonly used for the jowl and neck area, this can be used to treat lax skin of your arms, abdomen, and around your knees. This can be used alone or in conjunction with other surgery, such as face or neck left, as well as augmenting the results of skin tightening after liposuction. Performed under local anesthesia, the radiofrequency is delivered to the tissue using a temperature-controlled needle. Tissue temperature is monitored both by the Thermi system, as well as by thermal imaging. While it is possible to see immediate results, improvement can continue for several months after treatment.
Mini-Facelift: Popularized by brand name such as Lifestyle Lift or Natural Lift, the mini facelift (or jaw line lift) addresses a combination of skin excess and support. While this was uses an incision in front of your ear and extending just behind her ear, the dissection is limited only to the areas of skin excess that can be “pinched.” For most patients, this is combined with fat injection for cheek support and volume. Liposuction to remove excess tissue under your chin is the most common fat donor site. Results can also be augmented with Quill suture support and ThermiTight. Recovery is usually within 5-10 days.
Kybella: This is a series of injections of a medication triggering disruption and absorption of fat cells. Usually performed and several sessions, the medication causes destruction of your fat cells, with the released fat process by your body, most efficiently with exercise. While Kybella is FDA approved, this is not a new treatment. Mesotherapy has been available for many years. This used a combination of medications and herbal agents to achieve a similar result. While this is a good option for many patients, for the fat volume in the neck I feel that the combination of liposuction with fat injection can be more effective for your overall facial rejuvenation.
To decide what treatment(s) are most appropriate, you need to have a good working relationship with your surgeon. There is often more than one way to achieve your desired result. Having a surgeon who takes the time to understand your unique circumstance is important. Too often people focus on the latest treatment seen on Dr Oz or published in NewBeauty. You should focus on what you want improved, and let your doctor help decide how to get there.
Be wary of the “free” consult. You get what you pay for. When we meet, you usually receive an hour or longer of my attention to your needs, doctor to patient. Too often, when your “free consult” is about a specific treatment, you do not meet the doctor, or even a licensed medical professional. You may be meeting with a person with no medical training beyond how to operate a piece of equipment. Of course you will be a candidate for treatment. I recently saw a patient who reported being offered a program of Ultherapy by her chiropractor!