Let me first explain that I’m a Facial Plastic Surgeon, trained at The Johns Hopkins Hospital. I “laid down my scalpel” in 2005 and since then, have devoted my practice solely to noninvasive and minimally invasive cosmetic procedures. The public has demanded cosmetic enhancement to have little to no downtime, appear natural, and be affordable. Surgical procedures such as facelifts, brow and forehead lifts, blepharoplasty have all had declines in their numbers while injectables, laser resurfacing, and noninvasive skin tightening are continuing to grow at a rapid pace.
Remarkably, it has been only over the last 10 years or so that the aging of the face has been recognized as primarily due to loss of volume. After landmark cadaver dissections, it was shown that there are several different fat pads in the face which all seem to atrophy over time. These are located in the temples, cheeks, under eyes, chin, preauricular (in front of ear) and above the lip. Using CT scan analysis, the boney structure of the face has been shown to change as well. The orbit (eye socket) enlarges leading to hallowing of the eye. The upper and lower jaw retract, and there is bone loss at the angle of the jaw. By losing fat and bone (as well as some muscle), the skin of the face loses support and droops. The strategy in the past by Plastic Surgeons was to cut the excess skin away. This lead to a face with tight skin and less wrinkles, but you looked like a skeleton. These days, it is all about filling the face to replace the lost volume from fat and bone loss.
After the science background above, we can now address why facelifts are a dying procedure. Facelifts have the following undesirable attributes:
- Requires a surgical procedure which inevitably leaves some type of incisional scar. Sometimes this is fairly noticeable and requires further procedures (more surgery, laser) or topicals to correct.
- There is the risk of anesthesia (cardiac, stroke, pulmonary) and the side effects of anesthesia (nausea, vomiting, etc.).
- There is pain requiring pain medication
- Recovery time can be lengthy, usually at least a couple weeks, sometimes up to a month for swelling and bruising to subside.
- The cost is significant. Frequently a facelift is bundled with neck lift, and blepharoplasty. Adding in the cost of anesthesia and the cost of lost wages for 2-4 weeks, you could easily be looking at $15-20,000.
- A facelift does not address volume loss, which would require fat grafting. Fat grafting adds in another cost, another procedure (liposuction), and additional anesthesia time. Fat grafting doesn’t always take, so further procedures are usually needed to get to full volume correction.
- Often people which have had facelifts don’t end up looking like “themselves” and there is nothing they can do about it.
- There are significant risks other than those mentioned which include permanent numbness, nerve damage, hemorrhage, need for corrective surgeries.
A little background about Sculptra and Ulthera is in order. Sculptra is a “collagen stimulant” which is used to replenish volume to a person’s face. It is injected in a series of treatments (usually 3) in the office in a 15-20 minute procedure. The results aren’t appreciated for about 6 weeks, the time it takes the body to create the collagen. It has been FDA approved since 2004. Initial concerns regarding nodules have been addressed with using different protocols and now that problem is less than 1%. Ulthera is a noninvasive skin tightening device. It has been FDA approved for over 3 years. It uses high frequency ultrasound to heat up the deeper levels of the skin to contract, lift, and produce collagen. It can improve the neck, brows, cheeks, and jawline. The procedure is done in the office with just topical anesthesia in 30-90 minutes, depending on how many areas treated. Further information on these procedures can be obtained by reading my blogs and watching my YouTube videos.
The reasons that Sculptra and Ulthera are better than a Facelift:
- There is no significant downtime with either Sculptra of Ulthera besides the possibility of some minor bruising.
- There are no scars, no anesthesia risk, and no post procedure pain significant enough to require pain medication
- There is no time required to stay out of work, therefore no lost wages.
- Ulthera can address skin laxity in the entire face – forehead, eyebrows, cheeks, jawline, upper and lower neck whereas these are all separate surgical procedures with their associated additional costs and risks.
- Ulthera can be repeated for additional tightening without any additional risk (a redo facelift has significant increases in risk) and there are NO LONG TERM reported risks.
- Sculptra is an “off the shelf” long lasting volumizer, not requiring liposuction (fat grafting does). Sculptra addresses the primary reason for facial aging by replenishing the volume in the areas where fat and bone have been lost.
- By addressing loss of volume with Sculptra, there is a lifting effect on the cheeks, jawline, upper neck, and around the eyes and eyebrows.
- The cost of the combination of Sculptra and Ulthera is much less than comparable surgical procedures particularly if you include loss of work compensation.
- The results take several months to achieve and are a gradual and natural enhancement. No shocking your friends with a different looking “you”.
We are entering into a new age of cosmetic enhancements. Procedures are less invasive, less downtime, less risk, and more natural. The Gold Standard of having a facelift for correcting the aging face is having some serious competition from the facial volumizer Sculptra and the noninvasive skin tightening procedure Ulthera.
This link shows the limited benefit of facelifts. Only 3 years knocked off your looks and no improvements in attractiveness. http://www.dailymail.co.uk/news/article-2382922/How-facelifts-make-look-younger-just-3-years.html?ito=feeds-newsxml
Dr. Steven Weiner is a Board Certified Facial Plastic Surgeon practicing in Santa Rosa Beach, Florida, between Destin and Panama City Beach, Florida. After laying down his scalpel in 2005 he has devoted his practice to Lasers and Injectables.
YouTube Channel: StevenFWeinerFacial