Non-surgical facelift
Bovine collagen injections, Zyderm and Zyplast, were the only augmentation materials available in the United States for the treatment of wrinkles and furrows for two decades, and I was one of the first cosmetic dermatologists to use them when they were first introduced in 1983 From the very beginning, injectable collagen treatments were plagued with drawbacks.
For one thing, while they were adequate for treating fine wrinkles, they were often inadequate for treating deeper wrinkles and furrows, and certainly of little value for plumping and contouring the face. Additionally, nearly 3 percent of people were allergic to the products, and two pre-treatment skin tests spaced a month apart were required before the actual treatment could begin. Ultimately, the benefits lasted only three to six months before further treatment was necessary. For severe wrinkles, jowls, and sagging, going under the cosmetic surgeon’s knife, with all its risks and drawbacks, remained the only recourse.
Fortunately, the last five years have seen a literal explosion in the number of FDA-approved injectable fillers and volumizers in the United States: fillers for fine and moderate wrinkles, and volumizers for correcting sunken areas, reshaping the surface and restore fullness to the skin. Along with Botox Cosmetic (not technically a filler, but certainly a top-tier injectable for improving all types of fine lines, motion-related wrinkles), which received FDA approval in 2002, many fillers were introduced and volumizers without collagen. These included hyaluronic acid products, such as Hylaform, Captique, Elevess, Restylane, and Juvederm, and volumizers, such as Radiesse and Sculptra. Unlike collagen, these substances, largely synthetically produced (with the exception of Hylaform which is derived from the cockscomb of roosters), did not require any prior allergy testing. This meant that a person could literally walk off the street and be treated the same day. Plus, their results lasted much longer, especially for volumizers, whose benefits can last 12-24 months or even longer. For that reason, they are labeled as semi-permanent fillers, rather than temporary.
Between 2000 and 2005, the use of soft-tissue fillers and volumizing agents for non-surgical rejuvenation procedures increased by a staggering 34% and, unsurprisingly, the number of surgical face-lift procedures decreased by a staggering 20% during roughly the same time period. The “liquid facelift” had come of age.
I want to make it perfectly clear that I am not claiming that there is no longer a place for the aggressive surgical facelift, technically known as a “rhytidectomy” or “rhytidectomy.” For extreme cases of large jowls, excessively sagging and redundant skin, and deep furrows, facelift remains a suitable therapeutic option. However, I am saying that we now have the tools to compare many of the benefits of facelift without even touching a scalpel to the face. Furthermore, we can even improve the appearance in many ways that traditional surgery cannot.
We have recently discovered that shrinkage of the underlying dermal tissue, changes in fat depots, and alterations in bone and cartilage as we age are responsible for many of the changes we see in facial aging. In short, the stout, heart-shaped fat pads that sat directly above our cheekbones and gave our face fullness when we were younger not only shrink over time, but sink downward and inward toward the nose. , leaving the telltale signs of its descent. in its wake When this happens, we find lower eyelids that appear hollow, darkened and wrinkled or bulging, and pronounced expression lines on the sides of the nose. The weight of this fall also accentuates the unsightly double chin along the jawline.
A traditional surgical facelift, simply by tightening the skin, can smooth the lines around the nose and mouth and lift the jowls, but it does nothing to address the underlying volume loss and displacement. In fact, very often we saw people who appeared “skeletonized” by the operation. They were left with unnaturally tight skin that was a sure sign of “Oh, you’ve had a face lift.”
Of course, it goes without saying that in truth, surgical facelifts are real surgery that carries the risks of general or intravenous anesthesia, significant postoperative pain, bruising and swelling, long recovery times (two weeks off work and several months before it all finally swells up). disappears), scars and a considerable financial outlay. Contrary to popular belief, the benefits of facelift surgery are not permanent. The surgery can be repeated once or twice in life.
The non-surgical facelift, combining Botox Cosmetic with fillers and volumizers, goes to the heart of the underlying problems: dynamic wrinkles (wrinkles caused by the muscles of facial expression), and the replacement of lost or displaced volume. A few micro-drops of Botox are quite efficient at removing or softening horizontal “worry” lines on the forehead, crow’s feet lines on the sides of the eyes, and frown (or “frown”) lines between the eyes. eyes. It can also alleviate wrinkled “bunny” lines along the bridge of the nose and a “pebbly” chin. For deeper wrinkles, the effects of Botox can be supplemented by the use of fillers, such as Restylane or Juvederm. This combination has been found to be particularly effective, and the benefits of combined therapy last much longer than when each material is used alone. These same fillers can be injected to enhance smile lines and sadness lines.
Double chin along the jawline can be smoothed with Radiesse by adding volume to the indented areas surrounding the double chin, eliminating the appearance of double chin and contouring the jawline back to the smooth, straight line of jawline. youth. And finally, volume can be restored and contoured over the cheekbones with Radiesse.
To minimize discomfort, designated areas are pre-frozen with a small amount of local anesthetic, usually lidocaine, a faster-acting anesthetic than the novocaine traditionally used by dentists. Although I personally find it unnecessary, some doctors choose to use a nerve block, that is, anesthetize the larger branches of the nerves that innervate the face, to supplement the local anesthesia.
Once the treatment area is numbed, the volumizer or filler is injected and then molded like clay in place to correct the deformity or irregularity. The entire procedure usually takes only about thirty minutes to complete and, to the delight of the patient, in most cases, the results are immediate. Afterward, he may experience some redness, mild swelling, and tenderness, which can last from one to three days. Occasionally, he may develop some bruising that may take several days to fade, but can be easily covered with proper masking makeup.
