After the Facelift: Prevention, Maintenance and Restoration Continue

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Welcome back to another episode of
Park Avenue Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I am your co-host Doreen Wu.

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And I'm here with Dr. Lawrence Bass
Park Avenue plastic surgeon, educator,

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and technology innovator. The title
of this episode is after the facelift:

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prevention, maintenance,
and restoration continue.

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This is the episode for you. If
you've had a facelift, loved it,

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but now see that aging never stops and
things are starting to creep back in that

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you wanna fix. It's not quite
time for another facelift yet,

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or you don't want another surgery
or you can't do one right now.

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What are the options and how will you
keep the results of the lift for as long

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as possible? Dr. Bass,
is this a pipe dream?

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Is it time to hang it up and
age gracefully into the sunset?

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Or do I still have some options?

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Well, we'd like to say, okay,

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you've done the facelift and now
you'll look your best forever,

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but we never stop aging.

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There is a honeymoon
period after the facelift,

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but then maintenance needs to resume.
If we'd like to look our best.

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And if we want to get the most mileage
out of that, that first facelift.

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It's true. What they say, all
good things must come to an end.

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What are some things patients can do to
maximize the longevity of the facelift

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and ensure their results
last as long as possible.

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The starting point for maintaining the
facelift is taking care of the skin.

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The biggest thing that the facelift
does not address is the fact that the

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skin itself is not as youthful,

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not as elastic as it was
when we were younger.

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So we've taken the laxity
or slack out of the skin.

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We've repositioned the facial
tissues, but we haven't

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de or improved the youthful
biology of the skin

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itself.

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So doing things that help with that are
the number one thing that you should be

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doing almost immediately.
And increasingly,

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some energy treatments are done at
the same time as the facelift or

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shortly before or after the facelift to
actually impact the youthfulness of the

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skin itself,

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separate from how loose or how
well-positioned that skin is. The

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same kind of aging changes that are
taking place in the skin are also taking

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place deeper. So we need
underneath treatments as well. Uh,

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things that are used on
the skin are things like

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intense pulse, light
treatments, chemical peels,

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laser treatments, radio frequency, Tixel,

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Botox for the neck muscles to
keep banding to a minimum. Uh,

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there are deep energy exposures,
Ultherapy SoftWave and others.

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And usually 2, 3, 4
years after a facelift,

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it's a good time to consider one of
those treatments to continue to push

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the tissues, to maintain
their repositioned location,

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to knock back any laxity
that's trying to creep in.

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There are many interventions.

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There are suspension
procedures and use of injected

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diluted fillers that are,

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that are active dermal matrix fillers
that stimulate collagen production in

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the skin.

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And these are all steps that can be
taken to try to keep the face looking its

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best without any further surgery.

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It's reassuring to know that there are
so many different things that I can

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consider doing to really get the most
mileage out of my facelift. Like you said,

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getting a facelift is a
big investment though,

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both in terms of time and money.

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And I wanna make sure
that my efforts pay off.

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So do these options actually
work and how much is needed.

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These options are
definitely worthwhile. Um,

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but the amount you need is never one
size fits all. So it depends on your age,

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how long you waited before the facelift.

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Some people have the facelift
with relatively moderate changes

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and other people really waited
until there was a pronounced need.

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Um, and they're going to have to
jump in sooner and with more activity

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in order to maintain their appearance,

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it's a product of how much sun
damage you have, whether you smoke.

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And then it's also a product of where
your beauty thermostat and beauty lens

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are, uh, which we talked
about in the last episode.

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So if you're very sensitive to
small changes in appearance, uh,

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you're going to be doing more.

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And if you just want to do
what's sensible to maintain and

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maximize the longevity of the lift
without taking a lot of extra steps,

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you're going to do less. So again,

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you need to partner with a provider
who's really going to customize that for

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you. And the goal is not to produce
a big change. Often. You know,

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the surgical lift is a big change.
You really cleaned up a lot of stuff.

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Now we just want to keep you
looking good, not make big changes.

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Um,

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but the paradox of that is
you're going to have to do more.

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You're going to have to push harder at
this stage to stay in the same place

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that, that you are after the
lift than somebody who's younger.

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Okay. I understand. Um,

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the facelift is not a magical
cure after the facelift

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ongoing effort is still needed
to maintain the results.

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What are the other things I can do?
The episode title was prevention,

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maintenance, and restoration continue.

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What covers the ongoing
restoration part of the process.

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So restoration focuses
around the things that the

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facelift is not principally
designed to cure or repair.

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Many folks, by the time they're
old enough to have a facelift,

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have a lot of sun damage on their
skin. Their skin has a lot of wrinkles.

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Their skin has a lot of
age spots and pigment.

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Just taking a lot of the pigment
irregularity off of the skin has a

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very rejuvenating effect on your
appearance. And that's an easy one.

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It's a few intense pulse,

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light treatments or broadband light
treatments to knock back some of the

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pigment, keep the skin looking
real, but much more even in color,

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take a lot of the age spots off.

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And just that single change makes
you look quite a bit younger,

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quite a bit fresher than
having that old irregular skin

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crepiness in the skin of the neck and
chest is another thing that facelift

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predictably is not going to address.

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And so evening up your
appearance on the neck,

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chest hands using energy based treatments,

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including no recovery energy

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treatments is going to push that skin
to towards being a better match with the

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face and doing that is going
to help you look your best,

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not have the facelift stand out as
being mismatched with the rest of your

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appearance. That's an important
second step and fillers and Botox

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can still add restoration to again,

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areas of the face that the facelift
predictably is not going to address.

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We talked about how in a facelift,

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if you're trying to get rid of the
nasolabial fold and marionette line,

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if you pull on your face,
looking in the mirror,

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you'll see that it distorts
the shape of the mouth.

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We don't want the facelift
to do that. So predictably,

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the facelift does not correct
more than modestly the nasolabial

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fold and the marionette line
areas. So we still need fillers.

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The unfortunate thing is
it's going to take more

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filler, more Botox,

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more energy treatments than a 30
something or a 40 something is going to

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have to use to maintain your face.

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If you're in your sixties or seventies,

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that's very unfair, but,

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but it's also something
that's very real life. Uh,

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so we just know we can't do a
little teeny drop of things.

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We're going to have to hit them a little
bit harder than we do in someone who's

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a few decades younger,

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but the beauty of it is it's
still, non-surgical no surgery,

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anesthesia incisions, recovery times.

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So if you're not ready or don't want
to go back for another facelift or you

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don't need another facelift, but
you just want to look your best.

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You're doing all of that
without any further surgery.

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That's a very real point of view and
perspective that you're coming from,

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but I appreciate it as a New Yorker, tell
it as it is. Um, what about relifting,

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when is it time to consider getting a
revision or maybe a secondary facelift?

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Are there any alternatives to this?

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So there are a few really
important questions in there. Um,

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you can get a second or third facelift
in skillful hands and look perfectly

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natural. Some people choose to do
that and some never come and relift.

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That's a personal decision
based on how you look,

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but you'll never look as bad
as if you've done nothing.

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Once you've had a facelift, even
though you'll continue to age.

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And most of the time when we
come back and look at the face,

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we see there's very little
to do, except for again,

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skin surface things and volume things.

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The face itself often does
not need a lot of work and

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sometimes not any work on relift,

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even though we're 10 or 15 years
down the line, the neck, however,

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is a completely different story.
10 or 15 years down the line,

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almost in everyone.

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The neck is going to need summary
boosting or is going to show

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some laxity or some muscle
banding that likely could be

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addressed surgically.

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So the neck is still a
very surgical arena in 2021

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with very little in the
way of options except

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for people very early in the aging stage.

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So unfortunately for people who have
aged enough to have a facelift and then

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aged another 5, 10, 15 years,

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the chance that they're going
to substantially improve in neck

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laxity without more surgery
using energy devices is

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very low.

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Um, and I, I just had a quick follow
up to that. So with neck laxity,

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skin laxity in the neck area,

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it seems like surgery is the only option

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currently.

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What about if you have some fat underneath
there in the neck area is surgery,

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the only option.

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There are a few different options
for dealing with fat in the neck,

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whether you're young or
whether you're older,

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whether you've had a facelift or not.

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And we typically will
liposuction that fat,

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which is a small procedure
with very little recovery.

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A lot of people do it on a
Friday and go to work on Monday.

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And it's done just under local anesthesia,

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but if someone's trying to avoid
even a small procedure like that,

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there are now a few other options
for dealing with that neck fat.

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One is an injected medicine, Ella,

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which breaks up the fat and it's
reabsorbed by the body that will give

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a flattening of the contour.

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Another is using one of the nonsurgical

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fat reducing devices,

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and examples would be cool
sculpting or sculpture,

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which use cold or laser
energy and heat respectively

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to damage and break down some of the
fat in the neck without any surgery,

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anesthesia or recovery time.

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So, Dr. Bass, before we close,

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can you give us your most important
tips for maintaining the results of a

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facelift years after surgery?

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So the first thing is when we
do come to a secondary lift,

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it's often mostly in the neck with just
some volume or laser treatment in the

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face.

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A secondary lift can still be
natural and usually as less

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recovery.

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But some people are just not at a life
stage where they can consider another

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surgery. There's still many other
things that are very meaningful.

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If you're not pursuing a secondary
facelift things like filler

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Botox, intense pulse, light treatments,

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these things address what remains
in the face after the facelift,

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even as the facelift is trickling out,

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you're starting to show
some laxity changes. Again,

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these other features may actually be
the dominant aging changes in your face

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and correcting them with these
non-surgical options will give you a much

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enhanced, much more youthful appearance

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as always though follow your beauty
thermostat. If it bugs you work on it.

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If you're not feeling surgery is an
option, there are compromise approaches,

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but it takes a little more work than
if you're in your thirties and forties.

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Thank you for sharing all this
information with us today.

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I look forward to talking with
you again on our next episode,

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where I have a couple questions about
common pitfalls that patients encounter

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when picking the right provider and
how to prevent them. This is Doreen Wu,

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thanking you for joining Dr. Bass and
me for this discussion of the approach

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to aesthetic care after the facelift.

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Be sure to join us next time
for our episode on why you
can't return a bad face,

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how to avoid buyer's remorse with
a facelift laser filler or Botox

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stream the episode to find out.

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Thank you for joining us in this episode
of the Park Avenue Plastic Surgery

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Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,

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educator, and technology innovator.

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The commentary in this
podcast represents opinion.

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This podcast does not
present medical advice,

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but rather general information about
plastic surgery that does not necessarily

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relate to the specific conditions
of any individual patient.

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No doctor-patient relationship
is established by listening
to or participating

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in this podcast,

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consult your physician to advise you
about your individual healthcare.

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