After the Facelift: Prevention, Maintenance and Restoration Continue

Doreen Wu (00:00):
Welcome back to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I am your co-host Doreen Wu. And I'm here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of this episode is "After the Facelift: Prevention, Maintenance, and Restoration Continue." This is the episode for you if you've had a facelift, loved it, but now see that aging never stops and things are starting to creep back in that you want to fix. It's not quite time for another facelift yet, or you don't want another surgery or you can't do one right now. What are the options and how will you keep the results of the lift for as long as possible? Dr. Bass, is this a pipe dream? Is it time to hang it up and age gracefully into the sunset? Or do I still have some options?

Dr. Lawrence Bass (00:59):
Well, we'd like to say, okay, you've done the facelift and now you'll look your best forever, but we never stop aging. There is a honeymoon period after the facelift, but then maintenance needs to resume. If we'd like to look our best. And if we want to get the most mileage out of that, that first facelift,

Doreen Wu (01:20):
It's true. What they say, all good things must come to an end. What are some things patients can do to maximize the longevity of the facelift and ensure their results last as long as possible,

Dr. Lawrence Bass (01:33):
The starting point for maintaining the facelift is taking care of the skin. The biggest thing that the facelift does not address is the fact that the skin itself is not as youthful, not as elastic as it was when we were younger. So we've taken the laxity or slack out of the skin. We've repositioned the facial tissues, but we haven't de or improved the youthful biology of the skin itself. So doing things that help with that are the number one thing that you should be doing almost immediately. And increasingly, some energy treatments are done at the same time as the facelift or shortly before or after the facelift to actually impact the youthfulness of the skin itself, separate from how loose or how well-positioned that skin is. The same kind of aging changes that are taking place in the skin are also taking place deeper. So we need underneath treatments as well.

Dr. Lawrence Bass (02:40):
Uh, things that are used on the skin are things like intense pulse, light treatments, chemical peels, laser treatments, radio frequency, Tixel, Botox for the neck muscles to keep banding to a minimum. Uh, there are deep energy exposures, Ultherapy SoftWave and others. And usually 2, 3, 4 years after a facelift, it's a good time to consider one of those treatments to continue to push the tissues, to maintain their repositioned location, to knock back any laxity that's trying to creep in. There are many interventions. There are suspension procedures and use of injected diluted fillers that are, that are active dermal matrix fillers that stimulate collagen production in the skin. And these are all steps that can be taken to try to keep the face looking its best without any further surgery.

Doreen Wu (03:49):
It's reassuring to know that there are so many different things that I can consider doing to really get the most mileage out of my facelift. Like you said, getting a facelift is a big investment though, both in terms of time and money. And I wanna make sure that my efforts pay off. So do these options actually work and how much is needed.

Dr. Lawrence Bass (04:11):
These options are definitely worthwhile. Um, but the amount you need is never one size fits all. So it depends on your age, how long you waited before the facelift. Some people have the facelift with relatively moderate changes and other people really waited until there was a pronounced need. Um, and they're going to have to jump in sooner and with more activity in order to maintain their appearance, it's a product of how much sun damage you have, whether you smoke. And then it's also a product of where your beauty thermostat and beauty lens are, uh, which we talked about in the last episode. So if you're very sensitive to small changes in appearance, uh, you're going to be doing more. And if you just want to do what's sensible to maintain and maximize the longevity of the lift without taking a lot of extra steps, you're going to do less.

Dr. Lawrence Bass (05:12):
So again, you need to partner with a provider who's really going to customize that for you. And the goal is not to produce a big change. Often. You know, the surgical lift is a big change. You really cleaned up a lot of stuff. Now we just want to keep you looking good, not make big changes. Um, but the paradox of that is you're going to have to do more. You're going to have to push harder at this stage to stay in the same place that, that you are after the lift than somebody who's younger.

Doreen Wu (05:47):
Okay. I understand. Um, the facelift is not a magical cure after the facelift ongoing effort is still needed to maintain the results. What are the other things I can do? The episode title was prevention, maintenance, and restoration continue. What covers the ongoing restoration part of the process.

Dr. Lawrence Bass (06:09):
So restoration focuses around the things that the facelift is not principally designed to cure or repair. Many folks, by the time they're old enough to have a facelift, have a lot of sun damage on their skin. Their skin has a lot of wrinkles. Their skin has a lot of age spots and pigment. Just taking a lot of the pigment irregularity off of the skin has a very rejuvenating effect on your appearance. And that's an easy one. It's a few intense pulse, light treatments or broadband light treatments to knock back some of the pigment, keep the skin looking real, but much more even in color, take a lot of the age spots off. And just that single change makes you look quite a bit younger, quite a bit fresher than having that old irregular skin crepiness in the skin of the neck and chest is another thing that facelift predictably is not going to address.

Dr. Lawrence Bass (07:15):
And so evening up your appearance on the neck, chest hands using energy based treatments, including no recovery energy treatments is going to push that skin to towards being a better match with the face and doing that is going to help you look your best, not have the facelift stand out as being mismatched with the rest of your appearance. That's an important second step and fillers and Botox can still add restoration to again, areas of the face that the facelift predictably is not going to address. We talked about how in a facelift, if you're trying to get rid of the nasolabial fold and marionette line, if you pull on your face, looking in the mirror, you'll see that it distorts the shape of the mouth. We don't want the facelift to do that. So predictably, the facelift does not correct more than modestly the nasolabial fold and the marionette line areas.

Dr. Lawrence Bass (08:18):
So we still need fillers. The unfortunate thing is it's going to take more filler, more Botox, more energy treatments than a 30 something or a 40 something is going to have to use to maintain your face. If you're in your sixties or seventies, that's very unfair, but, but it's also something that's very real life. Uh, so we just know we can't do a little teeny drop of things. We're going to have to hit them a little bit harder than we do in someone who's a few decades younger, but the beauty of it is it's still, non-surgical no surgery, anesthesia incisions, recovery times. So if you're not ready or don't want to go back for another facelift or you don't need another facelift, but you just want to look your best. You're doing all of that without any further surgery.

Doreen Wu (09:19):
That's a very real point of view and perspective that you're coming from, but I appreciate it as a New Yorker, tell it as it is. Um, what about relifting, when is it time to consider getting a revision or maybe a secondary facelift? Are there any alternatives to this?

Dr. Lawrence Bass (09:37):
So there are a few really important questions in there. Um, you can get a second or third facelift in skillful hands and look perfectly natural. Some people choose to do that and some never come and relift. That's a personal decision based on how you look, but you'll never look as bad as if you've done nothing. Once you've had a facelift, even though you'll continue to age. And most of the time when we come back and look at the face, we see there's very little to do, except for again, skin surface things and volume things. The face itself often does not need a lot of work and sometimes not any work on relift, even though we're 10 or 15 years down the line, the neck, however, is a completely different story. 10 or 15 years down the line, almost in everyone. The neck is going to need summary boosting or is going to show some laxity or some muscle banding that likely could be addressed surgically. So the neck is still a very surgical arena in 2021 with very little in the way of options except for people very early in the aging stage. So unfortunately for people who have aged enough to have a facelift and then aged another 5, 10, 15 years, the chance that they're going to substantially improve in neck laxity without more surgery using energy devices is very low.

Doreen Wu (11:19):
Um, and I, I just had a quick follow up to that. So with neck laxity, skin laxity in the neck area, it seems like surgery is the only option currently. What about if you have some fat underneath there in the neck area is surgery, the only option,

Dr. Lawrence Bass (11:37):
There are a few different options for dealing with fat in the neck, whether you're young or whether you're older, whether you've had a facelift or not. And we typically will liposuction that fat, which is a small procedure with very little recovery. A lot of people do it on a Friday and go to work on Monday. And it's done just under local anesthesia, but if someone's trying to avoid even a small procedure like that, there are now a few other options for dealing with that neck fat. One is an injected medicine, Ella, which breaks up the fat and it's reabsorbed by the body that will give a flattening of the contour. Another is using one of the nonsurgical fat reducing devices, and examples would be cool sculpting or sculpture, which use cold or laser energy and heat respectively to damage and break down some of the fat in the neck without any surgery, anesthesia or recovery time.

Doreen Wu (12:46):
So, Dr. Bass, before we close, can you give us your most important tips for maintaining the results of a facelift years after surgery?

Dr. Lawrence Bass (12:56):
So the first thing is when we do come to a secondary lift, it's often mostly in the neck with just some volume or laser treatment in the face. A secondary lift can still be natural and usually as less recovery. But some people are just not at a life stage where they can consider another surgery. There's still many other things that are very meaningful. If you're not pursuing a secondary facelift things like filler Botox, intense pulse, light treatments, these things address what remains in the face after the facelift, even as the facelift is trickling out, you're starting to show some laxity changes. Again, these other features may actually be the dominant aging changes in your face and correcting them with these non-surgical options will give you a much enhanced, much more youthful appearance as always though follow your beauty thermostat. If it bugs you work on it. If you're not feeling surgery is an option, there are compromise approaches, but it takes a little more work than if you're in your thirties and forties.

Doreen Wu (14:08):
Thank you for sharing all this information with us today. I look forward to talking with you again on our next episode, where I have a couple questions about common pitfalls that patients encounter when picking the right provider and how to prevent them. This is Doreen Wu, thanking you for joining Dr. Bass and me for this discussion of the approach to aesthetic care after the facelift. Be sure to join us next time for our episode on why you can't return a bad face, how to avoid buyer's remorse with a facelift laser filler or Botox stream the episode to find out.

Speaker 3 (14:44):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor-patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.