Question: I am going to be turning 40 this year, so I would like to have some sort of nonsurgical facelift procedure to help make me appear more youthful. I am particularly interested in a thread lift. How many threads are used in the procedure? How long do the effects of this procedure last for?
Answer: Well, at the time of this blog, as far as I am aware, there are no longer any companies that provide barbed threads for the procedure called a thread lift. There are certainly barbed sutures that are available, but in my opinion, the reason that these companies ended up going out of business is simply because the procedure of a thread lift is very short lasting, and it caused a significant amount of patient dissatisfaction due to the fact that anywhere from 6 to 18 months, the far majority of the result was then lost, and these procedures were typically quite expensive.
I was never a big believer in thread lifting, simply due to the fact that in my mind, I felt that these barbed sutures would eventually pull through the tissue, and the result would be lost; and for the patients that have had the procedure performed, I was unfortunately correct in my assumption.
In my opinion, a 40-year-old such as yourself that would like some sort of a nonsurgical facial rejuvenation would be best served by a treatment with the Ultherapy device. This device is a noninvasive, nonsurgical treatment of the deeper tissues of the face, which then causes new collagen deposition, tightening, and lifting. I would like to invite you to come into Quintessa Medical Spa for a personal consultation regarding Ultherapy so that we can discuss all aspects of this procedure and make sure that you would be a good candidate.
Question: I am considering trying a nonsurgical facelift procedure. I would like to know 1. Which method do you favor the most, and 2. Which method has the most long-lasting results?
Answer: I personally feel that there are very few techniques available that can provide a true nonsurgical facelift and, in fact, the only device that has ever been given a facial lifting indication by the FDA is a device called Ultherapy. Ultherapy is an ultrasound-based device that focuses ultrasound energy below the skin’s surface and causes the deposition of new collagen, which then tightens and lifts. It is FDA approved for lifting of the brows, but we also use it for the cheeks, jowls, and region under the chin. All other currently available devices have only been given a skin-tightening indication by the FDA.
There are other techniques that perform the appearance of a facelift, and these mostly involve the injection of filler materials in order to try to camouflage the effects of aging and enhance one’s appearance. These can certainly be quite effective, and certain filler materials can last for one to two years. Ultherapy, on the other hand, changes the tissue, and in my opinion, patients have to essentially age out of the improvement, and this should take many years. So in conclusion,
I feel that the Ultherapy procedure is the technique that I favor the most for a nonsurgical facelift, and I feel that more than likely it has the longest lasting results as well. I would like to mention, however, that for patients with more advanced signs of aging, a relatively simple in-office mini lift can do wonders for the appearance of the lower third of the face, and this is essentially a permanent result that the patient would then have to age out of.
Question: I am supposed to get Restylane injections for my wrinkles next week. I have never had any kind of cosmetic enhancement before, so I am really nervous, and bad possibilities keep popping into my head. I know that wrinkle solutions like Botox can cause facial paralysis. Will it be hard for me to move my face after the Restylane injections?
Answer: Restylane injections in no way prevent you from moving your face. Botox relaxes muscles and, therefore, can limit the amount of facial movement; but Restylane and Juvederm and other hyaluronic acid fillers simply provide volume in the area that we desire, and in no way limit your ability to actually have facial motion. With that said, you may feel like there is a slight limitation early on after the injection due to a small amount of swelling that can occur from the injection, but in reality, the muscle motion itself is unhindered.
Question: Since I have entered my 50s, I have gotten very bad crow’s feet, which makes me feel very self-conscious. I would like to get a dermal filler to fix this that is proven to be effective on crow’s feet specifically. Which injectable filler is recommended for filling in crow’s feet?
Answer: There actually is no injectable filler at this time that is recommended for filling in crow’s feet, as no injectable filler has ever been given an FDA indication for crow’s feet wrinkles. With that said, I have certainly performed injections of crow’s feet with hyaluronic acid fillers, using them in a way which we call off label, which means that they are an FDA approved product, but we are not using them in the area that they are FDA approved for. Ultimately, it would be very wise to seek out an experienced injector so that these issues can be discussed before you end up having an injection that you don’t desire. Frequently, the crow’s feet area is much better treated with Botox than an injectable filler, but there certainly are circumstances where I feel patients are better served with the injection of a hyaluronic acid filler, such as Juvederm Ultra or Restylane. These specific patients typically have very little activity in the lateral orbicularis oculi muscle, which is the muscle that causes some of the crow’s feet. If they have very little activity, then Botox will not be very effective, and these are the patients that I will then recommend consideration of a hyaluronic acid filler.
Question: As a 64-year-old woman, I have very deep wrinkles and folds all over my face. I have been hearing about dermal fillers like Restylane, Juvederm, Perlane, and Radiesse. I would love to be able to make my lines disappear, but they are quite deep. Are injectable fillers effective on very deep wrinkles?
Answer: That is a difficult question for me to answer without personally examining your facial features, but there are certainly some patients with very deep folds that can have a wonderful improvement with injectable fillers. There are also those that are much better served by some sort of a surgical intervention, such as a facelift or even deep laser resurfacing, for improvement in their deeper folds. Ultimately, a consultation with a board-certified facial plastic surgeon would be appropriate so that the best option for your personal needs can be performed.
Question: I am a 55-year-old woman, and I went in for a consultation on facial rejuvenation techniques. The surgeon I spoke to suggested Juvederm injections. I am not worried about an invasive procedure, and I want to get the best value for my results. Is it cheaper in the long run to get a facelift rather than dermal fillers every few months?
Answer: In the long run, it is definitely less expensive to get a facelift than to continue to pay for filler injections. However, it really depends on where these filler injections are going to be performed as to whether this is an area that a facelift will actually rejuvenate and correct. If the filler injections are between the lip and the chin, in an area that we call the marionette line, then more than likely your facelift will correct this in a relatively long-term fashion, and you will, overall, have a better value from the facelift than filler injections. If you are having the lines between the nose and the corner of the mouth filled, then the facelift may not be your best option if your surgeon performs standard facelift techniques, as these typically do not significantly correct this fold. If your surgeon performs a form of deep plane facelift, such as an extended SMAS deep plane facelift, which is my personal preferred technique, then you should get improvement in the nasolabial fold, and, once again, the facelift is most likely your better value. There are, however, many areas of the face that fillers can fill that a surgical procedure would be less effective or less desirable, and ultimately I would recommend a consultation with a board-certified facial plastic surgeon so that all of your options can be discussed before you make a decision regarding any sort of facial rejuvenation.
Question: I have been looking into the possibility of using injectable fillers to smooth out my face. I have been reading about the procedure online, and I read that a “dental block” is often used during the injection session. What is a dental block, and why would it be used during a dermal filler injection?
Answer: A “dental block” is the injection of anesthetic in and around nerves that exit the facial skeleton and provide sensation to large areas of the face. The most common areas to inject are in the cheek, near the infraorbital nerve that supplies sensation to the upper lip and cheek. Injections below the lower lip can anesthetize the mental nerve that provides sensation to the chin and lower lip. This anesthetic block then allows the injection or treatment to that area in a pain-free way. The downside is that the injections to perform the block are often rather uncomfortable. The good news is that if you are going to undergo filler injections, I have found that there is simply no need for a dental block in the far majority of patients with the newer hyaluronic acid fillers that have lidocaine in them. What I personally do is provide some extremely cold spray to the skin that allows for a painless initial injection. This injection then starts to numb that area due to the fact that there is lidocaine in the filler material, and subsequent injections then are also pain free. I have treated many patients in very sensitive areas, such as their lips, in an essentially painless fashion with this newer injection technique. I can therefore avoid the dental block that, as I have said before, can be rather uncomfortable. The numbness in the area lasts for about an hour to an hour and a half, and by the time it wears off, there is really no discomfort, and only a small amount of redness and mild swelling remain. This is why I recommended that they ice the area for the first 30 to 60 minutes after the injection, as this will minimize any sort of a visible abnormality due to the injection.
Question: I have the worst thin lips ever. I have been thinking about lip augmentation for a while, but I do not want to get an implant or go in for injections every few months. I have heard that there are some permanent injectable substances for lip augmentation. Why are these substances not used more often?
Answer: Well, there are some permanent injectable filler materials available, but none of these are FDA approved for injection into the lips and, in fact, I know of no filler material that is actually FDA approved for use in the lip itself. With that said, I would highly caution you against using a permanent filler in the lips due to the fact that, in my opinion, there is a relatively high incidence of migration of the product into an area that you may not want it in. If this would happen, this is a very difficult situation to correct, and I, therefore, feel that the benefit of an augmented lip is greatly outweighed by the risk of creating something that you do not desire. I, therefore, recommend the use of the hyaluronic acid products, such as Restylane and Juvederm Ultra, simply due to the fact that they are very consistent, very safe, and they typically will last at least six months in most patients. Therefore, you are looking at essentially two injections a year, which for most of my patients is acceptable. If you are looking for something longer term, then I would consider fat grafting to the lips, though I feel in my hands that this also can be somewhat unreliable, but if performed several times, can give a very natural-appearing lip that essentially has an augmentation permanently.
Question: I have always wanted a shapely cupid’s bow upper lip. I am not crazy about the idea of getting injections every few months, but I don’t know if I can get a more permanent fix. Are there implants made specifically to give women the cupid’s bow look?
Answer: If you do not naturally have a cupid’s bow, then I am unaware of any sort of implant that allows a patient to have a cupid’s bow. If you already have a cupid’s bow and you are looking for an augmentation of the size of the lip, then lip implants may be an option for you. If you do not have a cupid’s bow and desire a cupid’s bow, then you really need a customized filler injection that can provide you with volume where it is needed to create the appearance of a cupid’s bow. I would highly recommend that you seek out a very experienced injector since the lips, for one, are a very sensitive area, but secondly, are a very mobile and visible area, and we certainly would not want any sort of untoward side effects from an injection that would detract from your overall effects. I feel that the hyaluronic acid fillers, such as Restylane and Juvederm Ultra, are excellent at providing a customized lip augmentation and can typically last somewhere in the six to nine month range for most patients. With the addition of lidocaine to these injectable fillers, you also get a very comfortable experience.
Question: I have been tanning in preparation for a trip to Aruba. I would like to have laser hair removal at my bikini line. Does tanning affect this type of hair removal at all?
Answer: If the area that you require hair removal has a tan, this will affect our ability to treat the hair. Essentially, the laser that is used for hair removal targets the dark pigment in hair, and if you have a significant amount of pigment in the skin, then we get concerned that we may injure your skin during the laser hair removal, and we therefore have to adjust the settings appropriately. If you are not tan in the area where the hair is present, then this really is not an issue, and we should be able to treat you very successfully with laser hair removal. Realize though, that for adequate hair reduction, a series of laser hair treatments (needs) to be performed approximately 1 to 2 months apart so that we can catch all of the hairs in their growth phase and provide excellent hair reduction long term.