Question: I am a 25-year-old woman who has had drooping eyelids since I was a child. Would I need a cosmetic or medical blepharoplasty?
Answer: I would have to evaluate your eyes to assess this situation, but it certainly sounds as if you have congenital ptosis, which involves the lack of a levator muscle. This would be considered a medical problem and I personally would recommend seeing an oculoplastic surgeon for correction of this.
Question: I just read about a new alternative to the browlift that combines ultrasound imaging with focused ultrasound therapy to provide a noninvasive lifting of the skin. Will your practice be performing this soon and is it very effective?
Answer: Quintessa Aesthetic Center was one of the early adopters of the Ultherapy technology and we actually had the 9th unit in the United States, so we have some of the most experience in the world. Ultherapy does use focused ultrasound to create new collagen deposition, which in turn tightens and lifts the brow, face, and neck areas in a very effective manner. It has absolutely no downtime and about 95% of our patients can see an effect in the brow area after a single treatment. The effects are typically subtle when compared to surgery but due to the fact that this is a noninvasive, no downtime procedure, it is truly amazing technology.
Yes, there are certainly options for patients that are not healthy enough to undergo general anesthesia specifically regarding their lower face. Standard facelifts or certainly extended SMAS deep place facelifts are typically performed in the operating room setting under either deep sedation or general anesthesia. Options for patients that are not healthy enough to undergo these types of anesthetic care would be mini facelifts, which can be performed under local anesthesia in the office and I have certainly performed these on patients that are not qualified for procedures performed in an operating room setting. Though this treatment is compromised compared to the more sophisticated and technically demanding extended SMAS deep plane facelift, they nonetheless get a very significant improvement in the lower third of their face and these patients are quite satisfied with the results of this type of surgery. A more advanced and newer technology that is available now for patient that are showing the early signs of aging would be Ultherapy, which is an ultrasound device that can target the deeper layers of the skin and this ultrasound energy is then focused on the deeper layers thus heating up the collagen and causing new collagen deposition, which in turn results in tightening of the deeper tissue and lifting of the facial structures. This can be performed in the area around the eyes to cause a nonsurgical brow lift. This can also be used to treat the midface, jowl, and the area under the chin to create the lift of a miniature facelift. There is no need for any anesthetic and there is absolutely no downtime as this is performed in a medical spa setting and the patient’s own healing creates the lift over a three-month period. This would be an excellent alternative for any patient with early aging that is not a good candidate for a standard facelift.
I am 65 years old, but many think I am in my early 50’s – could I still be a candidate? And do you offer some type of a guarantee? I also have minimal spider veins on the face – does the procedure target this problem?
Ultherapy was tested for about one year before FDA approval. When all patients (many over age 65) were included in the studies, 80% responded to treatment and half of the non-responders had a response with a second treatment. Though we can not guarantee results, we will treat patients a second time at no cost. There have been a few changes to the protocols used to treat patients since the studies were done, and some centers are seeing a 100% response rate. We certainly can not say that it is 100% effective yet, but those are very encouraging statistics. Though you are not in our prime age range of 40-60 years old, it is really the patient’s ability to create new collagen that causes the lift, and not the failure of the device to cause denaturization of the collagen, as the science behind the method of injury is quite reliable and will work in 100% of patients. The only reason a patient would not have a response is if their tissue can not create enough new collagen (mainly due to age and sun damage). If your skin looks younger than your age, then you might still be an excellent candidate for Ultherapy. The results thus far have lasted 18 months and counting. By the mechanism of injury and healing, the result should really be “permanent” in that the patient will get the improvement and then age forward.
Ultherapy will not treat facial vessels, but we do have two lasers that are extremely effective at ridding patient’s of unsightly vascularity of the face, body, and legs. We would be happy to discuss this further at your consultation.
Ultherapy is a revolutionary treatment for the early signs of facial aging, such as low set brows, early jowling, and skin laxity under the chin. It uses ultrasound to visualize the tissue underneath the skin, then sends a focused wave of ultrasound energy that is targeted at the deeper tissues. This causes denaturization of the collagen, and the healing process then creates new collagen that tightens and lifts the soft tissue. The brows are lifted, and the jowls and laxity improved. The result is a more refreshed rejuvenated appearance. The procedure is performed in Quintessa Medical Spa, takes less than an hour, and has absolutely no downtime. Over the next 3 months, you should slowly see the improvement in your appearance. Right now, we have special pricing for Ultherapy saving you thousands. The area around the eyes including the eyebrow lift is $1500.00 (regularly $1800.00). The lower face is $2200.00 (regularly $2900.00), and both the upper and lower face together is $2900.00 (regularly $4700.00) Ultherapy seems to work best in patients that are 40-60 years old with early signs of aging, so you may be an excellent candidate.
I recommend you contact us for a complimentary consultation so we can evaluate your facial anatomy to make sure Ultherapy is right for you.
Overall this generalization about injectables is true. Botox, for the most part, is very effective in the upper portion of the face including the forehead, glabella or area between the eyebrows, as well as the crow’s feet area where as fillers are more effective down in the area of the smile lines and lips and marionette lines. However, there are some patients that would benefit from fillers in the upper third of the face as well as Botox in the lower third of the face such as patients that have very deep creases between the eyebrows. These creases can be filled with hyaluronic acid fillers though one has to be quite judicious in the amount that is applied to these areas due to the fact that significant complications can occur when performed inappropriately. I therefore recommend patient seek someone with a significant amount of experience using fillers in these types of areas. Furthermore, fillers can be used in the lower eyelids quite successfully, but again, this area is fraught with complications when performed by an inexperienced injector. Furthermore, Botox can be used in the lower portions of the face such as into the depressor anguli oris that can help lift the corners of the mouth and prevent the downturned look. Furthermore, it can be placed above the lips in the levator labii superioris to prevent a gummy smile. Botox or Dysport can also be placed in the bands below the chin, which are caused by the platysma muscle and the relaxation of this muscle will visibly diminish these lines or bands. In summary, Botox typically is used in the upper portion of the face and fillers are typically used in the lower portion of the face, but when highly skilled injectors evaluate patients, we can use these products in areas that cannot only enhance one’s appearance and significantly rejuvenate the patient, but can also be used in an extraordinarily safe manor when compared to a more inexperienced injector.