Non Surgical Facelift (Philadelphia)

After more than 20 years in practice, one thing is clear:  no one wants a facelift.

A facelift is the last alternative, something that you might consider after all the other alternatives have been explored, and have failed.

The reasons that people might want to avoid a facelift?

• The Cost – A facelift generally costs upwards of $ 10,000, and times are changing and the price is rising. A recent article in the New York Times talked about the rise of the $ 250,000 facelift.
• The Incisions – The procedure is assumed to involve large incisions that  begin in the scalp and extend well behind the ear, with lots of sutures and the potential for visible scars.
• The Recuperation Period – The assumption is that recovery will take months and that you will need to hide from everyone while nursing yourself back to health.  Who can take the time from a job, from children, and from others to concentrate on getting better, getting the sutures removed and the healing happening, when so much is going on socially?
• The Pain – Such big incisions with all that muscle lifting must be painful.
• The Gossip – People will know you had “work”—especially if it’s bad.
• Looking like you’ve been in a windtunnel. – We all see these men and women in restaurants or at the mall or on TV—they look distorted– sometimes things don’t move right—sometimes  they look like pumpkins or puppets.  It’s fine for Halloween—but the rest of the year?

Most of these reasons are moot. Myths.

• Alternatives to a facelift sometimes end up costing as much as the procedure after they have all been explored. Really. You can try everything before deciding that what you were offered as an alternative just didn’t give you the result you wanted—or made you end up looking even more artificial than if you’d had a lift.
• The incisions are almost invisible once healed in most cases.
• Recovery from a facelift in our practice takes from two to three weeks.
• There is little to no pain, or pain that is easily manageable without narcotic medications.
• With good surgery, after you’ve healed, you will get complimented on your hair or your weight or just complimented about how much better you look– no one should know.

However, to reiterate, no one wants a facelift.  Here then are the alternatives that you should explore with your surgeon, from least invasive to microincisional—but all are alternatives that are less invasive than a facelift.

The Botox Facelift

In our practice, Botox or other neurotoxins can be used to produce changes that temporarily weaken muscles.

Some of the muscles in our faces pull aspects of the face down, and so, with appropriate treatment, those muscles can be weakened resulting in elevation of the face.  We have described the Botox facelift which with Botox injection:

• Softens facial wrinkles
• Lifts and recontours the eyebrows
• Lifts the mouth corners and reduces jowls and marionettes.
• Reshapes the face.
• Relaxes spasms of the neck muscles thus reducing cording in the neck

The injections need to be repeated every 3-4 months, but produce reliable changes.

Fillers

Fillers, whether hyaluronic acid, fat or biostimulatory such as Sculptra or Radiesse, expand areas in the face that have collapsed and as such, produce reliable improvement in certain areas.  We have found in our research that little actual lifting occurs.  There is nonetheless the illusion of improvement when adding volume to areas that have collapsed.  Fillers are done on an approximately yearly basis.  Usually more than one syringe is used to target areas of advanced gravitational changes.  The costs can add up for a temporary result.

Energy Based Treatments

If you can’t use a knife to nip and tuck, then you have to find another way to tighten things.  All of the treatments listed below have this in common:  they harness the effect of energy:  light energy or sound energy or radiowave energy or plasma energy to cause changes in the collagen and the collagen framework underneath the skin to reshape and tighten the face. Plasma energy is the latest modality to be introduced into the mix of potential nonsurgical facelift treatments.

Lasers

LASER stands for Light Amplification by Simultaneous Emission of Radiation and, whether you have watched James Bond or Austin Powers, the power of the laser is used either to destroy the hero, or, in the case of aesthetic medical lasers, to reshape or tighten the skin.  Laser energy is delivered controlling the power of the device either fractionally or using a computer pattern generator.  Based on the amount of tightening required, a laser facelift can have a significant downtime—sometimes longer than the downtime of a surgical facelift.  However, gentler laser treatments, delivered sequentially over a series of days allowing for recovery in between, can definitely cause improvements in the skin tantamount to a lift, producing shrinkage of jowls and reduction and even elimination of wrinkles while also imparting a healthy glow to the skin.

Ultrasound

In medicine, ultrasound has been used to localize and diagnose. For example, ultrasound is used to look at babies and how they are faring in their mom’s womb.  In addition, ultrasound can be used to image thyroid nodules and tumors.

High frequency focused ultrasound, also called HIFU, has been used to treat and shrink tumors such as prostate cancer.  Highly focused sound waves cause destruction of tissue that is targeted producing shrinkage, and hopefully, destruction of the cancer.  The energy from the device causes heating of the targeted tissue and kills it.  Because it is highly focused, it can avoid injuring adjacent tissues including the skin.  Focused ultrasound is also used now to treat uterine fibroids and bone pain from the spread of cancers.

The HIFU devices that are now used to treat the face as nonsurgical facelift alternatives are Ultherapy and Softwave.  There are also home based devices, which must be used on a continual basis under supervision by a provider in order to produce results.  These devices are expensive, and, while some claim improvement, the results we’ve seen have been disappointing.

We do not have these devices in our practice because we feel that the treatments are excruciating and the results discouraging, though many practices in the Philadelphia area offer these treatments.  Go on-line and discover the results for yourself—they do not approach the results that can be obtained with other types of nonsurgical energy based facelift in our experience.

Radiofrequency

Radiofrequency energy uses the energy of radiowaves to stimulate the growth and reorganization of the collagen that lies underneath the surface of the skin.  RF energy also does this through the application of heat energy.  There are external treatments which focus the RF heating without directly heating the skin surface—which if not focused would produce a skin burn –the latest devices directly measure the skin surface temperature. These external treatments include Thermage, Thermismooth, Exilis, Profound, and Vanquish. Evoke MD is the latest introduction in the market that measures skin heating at its surface through the application of facial probes.  The procedures are not painful in general but produce a warm sensation.  They need to be repeated several times in order to see results.  We have experience with Thermismooth.  At this point, our patients are looking for more dramatic results (see below!)

RF Microneedling

How do you get the energy to the area where it’s required without burning the skin?  That is the problem that physicians, researchers, and industry are trying to address.  One way to do this is by bypassing the skin surface using needles.  RF energy is delivered through the skin with an array of microneedles that protect the skin surface with insulation at the skin surface only putting the energy where it’s required—namely to the deeper dermis and subcutaneous tissues.

Microneedling alone can produce skin textural improvement because the act of skin injury stimulates collagen which leads to reorganization and increased deposition.  Add RF to this mixture, and some of the changes are astounding, producing tightening of skin and even fat loss from the tissue that lies under the skin.

RF microneedling devices include Morpheus 8, Intracel, Infini, Endymed, Vivace and VirtuRF.  We utilize the Morpheus 8 and Intracel and have huge experience with these modalities.  The treatments can be painful and we utilize anesthetics, ice and, rarely, injections of local anesthetic to make the experience more comfortable.

RF microneedling needs to be repeated 3 or 4 times based on the device in order to produce it’s benefits, and, they become more visible over time—we’ve seen improvement 3 to 36 months following the treatments. We were the first in the Philadelphia area to have the Intracel device.

RF Subcutaneous

Another way to deliver energy to the dermis and under the skin framework to produce skin tightening is through the introduction of a wand beneath the skin.  This is done with small ports 2 -5 mm in size .  The energy is spread out under the skin by applying the wand to all areas where tightening is desired and going slightly beyond.

It is important with these devices to monitor the outer skin temperature to produce controlled heating over time, otherwise the skin can burn.  The Thermitight device monitors the external skin tissue temperature using an infrared real time camera so that the surgeon can control the skin temperature and cool when necessary.  The Facetite device delivers the energy using what looks like tongs with one prong above the skin and one under the skin, automatically adjusting the energy so most is delivered deeply and adjusting so that the skin surface is not injured.

A more exciting technology has been developed that uses Helium plasma to create RF energy that spreads diffusely under the skin surface that produces tightening of the skin, but also produces tightening of the collagen framework that holds our skin in place—the ligaments and collagen septae that extend from the bones of our face and neck through the muscles and fat and skin.  This creates a dramatic 3-dimensional contraction that mimics the benefits of a facelift.  This device is called the Renuvion.

Plasma is derived by the radiofrequency heating  of helium gas causing excitation of electrons and the emission of energy.  Plasma is the so called “fourth state of matter”—there’s solid, liquid, and gas, and then plasma.

The Renuvion, is a fascinating and game changing technology, which is still in its infancy.  The skin is numbed with a local anesthetic.  The device is introduced through tiny incisions and used like the wands listed above with many passes, always avoiding overtreatment of the skin surface.  The difference is that the effects are created in a much faster fashion because this energy produces the desired heating hundreds of times faster.

We were the first in the Philadelphia area to have the Renuvion device and utilize it in both nonsurgical facelifts and also perform all our facelifts with this device, because it adds another element of skin tightening to the mixture, producing additional collagen that supports the lift. The procedure is called the JZ plasty.

Plasma Skin Resurfacing

Plasma energy is also used to produce skin tightening by treating the skin surface—using the plasma energy directly on the skin by applying it with a plasma wand.  While Renuvion and other technologies are coming into acceptance for resurfacing (Renuvion was approved for skin surface tightening June of 2022 ),  we have seen too many unacceptable results with these technologies to offer this to our patients at this time.

MyEllevate

Even after these tightening procedures, sometimes looseness of the underlying muscles can be visible, producing the so-called turkey neck.  In these situations, a minimally invasive nonsurgical facelift can be performed called MyEllevate.  This device is essentially a light based technology that uses a suture, placed through perforations made with a needle only (no large incisions) in the neck and utilizes this suture both to weaken the neck muscles and to suspend it.

Are people looking for nonsurgical facelift alternatives?  The answer is yes!  In our practice, these machines are turned on all the time—treatments are done 5 days a week– day in and day out!

We are excited to offer this technology to our Philadelphia patients and have worked on and continue to work on other groundbreaking minimally invasive technologies to lift the neck and face, some of which are patented and in development, and others which are now commercially available.  Please ask us about these treatments in your consultation with us—especially if you are looking for a nonsurgical alternative to facelift.