MEDICAL FACE-LIFT 2010 

SURGICAL FACE-LIFT IS THE GOLD STANDARD FOR FACIAL REJUVENATION AND CORRECTION OF WRINKLES BY DIRECTED AND FOCUSED CONTOURING IN SELECTED PATIENTS.

The success and predictability of invasive surgical face-lift for wrinkle amelioration is based on:

• Suture anchorage of the flaps, pulling up the sagging and  redundant skin.
• Two dimensional skin tightening.
• Surgical results are far superior than non-invasive interventions, that are often fly by night, and are associated with non-lasting outcomes.
• Skin re-positioning.
• Fibroblast anchorage originating from the SMAS adipose tissue, and facilitates deep soft tissue augmentation.
• Soft tissue augmentation of lipo-atrophy by fat transfer or filling with your own fat: this results in three dimensional skin tightening. Non-invasive therapy has does not have this option.
• Post-procedural Quad™ radiofrequency or Thermage™ can be used to enhance the surgical rejuvenation effect as an adjunct intervention. By combining invasive face-lift surgery and non-invasive RF, IPL or fractional laser therapy an excellent  and durable result will be achieved in a focused way and addressing the peri-orbital, peri-oral,  mid-face ptosis, mandibular angle, vertical and horizontal crepe lines.
• Staged blepharoplasty rid the client of bags, upper-lid pillows and provides a nice brow lift.
• If necessary, planned Botox™ and filler such as Juvederm™ can be used as supplements, to touch up after surgery. Melanin spots can be ameliorated by the topical application of Dermamelan™ or Cosmelan™ facial masks followed by maintenance treatment (products are supplied by Leenyx). Local acne break-outs associated with hyper-pigmentation can be treated with topical Dermazelan™ or Cosmelan™ Active System( Leenyx).These are melanin directed anti-tyrosinase and non-hydroquinone topical face masks shown to be effective in persons with hypermelanosis and those with melasma.
• Eliminating unsightly eye-bags, sagging neck, double chins, bad crow feet, jowls and obvious wrinkling.
• Durable rejuvenation results that often last longer  than ten years, and are far superior to the results of chemical peels, RF, IPL, Lasers, LED. Results can be enhanced with Botox and fillers such as Juvederm™., as well as the optimal application of cosmetic creams and sunscreens.

RADIOFREQUENCY, MEDICAL FACE-LIFT: REMODELING, CONTOURING, SHAPING AND A LIFTING EXPERIENCE

There are many non-invasive devices to induce facial rejuvenation, but not as effective as surgical face-lift in the carefully selected patient. Changes are very gradual but at lower risk. Often only after 3-4 moths do the cosmetic changes of RF become visible. This is because the fibroblasts respond slowly to the heated skin, after the procedure. Multiple passes at  low levels of energy seem to be more effective than a single pass at high levels ( Ruis-Esparza 2003: see refs).

Radiofrequency can induce very modest facial and neck skin rejuvenation. Although temporary, skin lifting is visible just after treatment, the actual visible results are only discernable at 5-6 months. Devices such as Quad™, Syneron™, and Thermage™ are available in salons in South Africa.  Monopolar and bipolar devices are available. The effect induced is by deep volumetric thermal heating and electric current. This result is tissue tightening by fibrosis, dermal fibrous band thickening and collagen contraction ( see Goldberg 2008: cellulite). Contouring and remodeling occurs. Gentle heating of the dermis and deeper structures occurs whilst the epidermal-skin is cooled. Temperatures in the dermis can rise slowly from 35 -65 degrees centigrade. This is the range of non-ablative radiofrequency.

Some authors refer to the process of heat-induced collagen contraction and neocollagenosis. Skin histology shows a wound-healing response with features such as fibroplasia and increased collagen deposition. The outcome is dermal remodeling. The procedure has no down time, and if the device is carefully and correctly set, not painful. At an initial counselling session the outcomes of skin tightening and wrinkle reduction need addressing to manage patient expectation. New devices need no topical anaesthesia, only contact lubrication gel. Slight redness and swelling may be visible just after completion of the therapy. Usually 4-5 treatments are needed, at two weekly intervals in order to get results. RF should not be applied in persons with cardiac pacemakers, cancer, severe systemic disorder, bad skin disorders, and recent use of isotretinoin, HIV, immunosuppressive treatment, taking anti-coagulation, bleeding tendencies coagulopathies, pregnancy and nursing mothers. Post-procedural treatment will seldom need a cold compress. Avoid hot baths and the sun after treatment. The clinical indications for skin tightening include: facial laxity, facial folds. Wrinkle treatment should be directed at the peri-orbital, cheek, peri-oral and mandibular jaw-line. Fine wrinkles will respond with time. Great care must be exercised when working near the eye. Clients with moderate to deep wrinkles, redundant folds, advanced sagging and numerous lines, respond poorly.

RF cannot reverse severe sagging and reverse deep wrinkles, lipoatrophy, midface-ptosis, diffuse telangiectasis, hyperpigmentation and melasma, bags under the eyes, deep horizontal and vertical crepe lines upper-lid pillows. The induction of skin dermal scarring is a little concerning.

Results from other workers show acceptable tissue tightening of the cheeks with improvement of the nasolabial fold, cheek contour, mouth mariotte lines, and possibly the mandibular inferior contour. Application of the Thermage™, has demonstrated effective tissue tightening of the cheeks and neck, that persisted for 6 months after a single treatment ( Alster 2004).

The end result may be skin or tissue tightening, skin contouring, microlifting contraction, heat-induced collagen contraction and remodeling. In some persons, there will be no response. Frederick Type-1 burn-type or photo-type may be intolerant to the collagen heat-induced contraction. These sensitive skins respond with severe erythema, and blotches.

OTHER IMPORTANT NON-INVASIVE BEAUTY TREATMENTS THAT SHOULD BE CONSIDERED WHEN OFFERING FACIAL REJUVENATION:

TROKEL Y FACE-LIFT: NEW COSMETIC FACIAL FILLER-LIFT AND CONTOURING TECHNIQUE WITH JUVEDERM™ AND AVOIDANCE OF SURGERY

Dr Yan Trokel MD, and innovative cosmetic surgeon from New York, has introduced a new non-invasive medical Juvederm™-based facial lifting and contouring technique during 2008, suitable for those on restricted budgets and wish to avoid invasive facial surgery and down-time. Dr Trokel offers hyaluronic acid, non-operative, filler-based medical facial contouring, under local anaesthesia, in numerous countries including London and New York. Current prices quoted in the literature, per session, are roughly $4500 or £2000, and the procedural time is about 30-45 minutes. A special propriety device is used to insert the filler (Juvederm™, Allergan©) under local anaesthesia, into the facial tissue-planes in order to induce sculpting and contouring of disfiguring wrinkles. Juvederm™, containing hyaluronic acid, is used widely in cosmetic practice for non-invasive dermal-filling , including contouring of upper lip wrinkles and naso-labial lines. It is one of many fillers used for wrinkle amelioration and as anti-aging treatment. The filler is safe and side-effects, rare. Individual cases of bruising and swelling ( technical or procedure-related) of the chin have been recorded, but these changes disappear with time and undergo resolution. With time the excess filler is absorbed into the body. Although restoration of youthful facial contours can be achieved by the Y-Lift, the replenishment of volume is not permanent and reinjection of the filler will be needed as maintenance treatment, in an attempt to reach permanence. The advantage of this approach, compared to the use of artificial fillers, is reversibility, and that “ bridges are not burnt”, needing further corrective surgery. As one ages, the skin is not damaged and altered as is the case sometimes when artificial fillers are used. Allergies are also uncommon. The Trokel-Y lift lasts about 2-years according to reports, at which stage further augmentation may be indicated to combat progression of sagging. The new lifting procedure does not address skin hyper-pigmentation, such as melasma, and bad scarring. In the interim period, facial peels or fractional laser may still be needed, to enhance rejuvenation, and IPL to remove unwanted chin hairs, and to ablate nasal telangiectasis. The combined costs of peels, RF, periodic supplementary Botox and fractionated laser therapy, beauty touch-ups, in combination with the Trokel Y Lift, will equal or surpass that of a one-off conventional face-lift costing. The costs of cosmetic interventions just shift from the cosmetic surgeon’s operating table, to beauty clinics, salons and medi-spa’s, but do not get less. Even in times of financial depression, the lips get redder. Surgical cosmetic face-lift in carefully selected patients, still remains the gold-standard of facial rejuvenation, especially for sagging, and is therefore not antiquated or irrelevant. The Y-lift is a valuable addition to minimally invasive cosmetic surgery, but can only be attempted by trained specialists in the surgical-art of aesthetics. The combined package of non-invasive beauty treatment, including lasers, is expensive, and over time exceeds the costs of surgical face-lift. At the end of the program surgical face-lift may well be still indicated for failure to correct accelerated neck sagging associated with aging. The non-permanence of non-invasive cosmetic and beauty treatment, needs to be taken into account, and the client should know that the results will not be dramatic and at best very modest or negligible. More details can be found at www.imageispower.com.

DISCLAIMER: This site does not supply any cosmetic advice or treatment. The client must visit an aesthetic practitioner, plastic surgeon or dermatologist.

POSTED 26/3/2009 and the contents has been reviewed by a Biomed Consultant for accuracy. Boland cell accepts no responsibility for the contents of the text, does not view it as treatment, and the client must see a dermatologist for advice, treatment, options, side-effects etc.

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