Facelift Series #6: Facelift Fantasies

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Welcome to 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'm your co-host, Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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Today's episode is Facelift Fantasies,
another in our series about the facelift.

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What are we talking about
in this episode, Dr. Bass?

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Two things. Really,

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the topic for this episode is all
those things that patients believe

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about the facelift that may not be true,

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as well as some of the things that
are promoted about other treatments

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that wish they could do
what a facelift does.

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Those are the two broad
categories of things.

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So start us off with things
patients believe about the facelift.

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What kinds of things are we talking about?

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Well, things patients believe or
hope the facelift will do that.

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It simply won't. That would be
the first side of this category.

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The other side would be things that they
believe about the facelift that just

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aren't true. Things they
worry about but don't have to.

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And we covered some of these
in our facelift fears episode,

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so I won't repeat those here.

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Okay, that makes sense to me.

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What are some examples of
unrealistic hopes for the facelift?

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One example is when patients have a very
heavy neck with a lot of extra skin and

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fat,

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although these heavy necks
will be significantly improved
with the face and neck

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lift,

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patients really need to understand that
they will not be completely reversed

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with surgery. Every patient has
their own starting point in anatomy,

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and where they start will impact their
final result and where they end up.

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If you didn't start with a
tight neckline early in life,

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don't expect one after surgery.

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This is an important
reality check. I mean,

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as much as we'd like to make people
absolutely as beautiful as they could

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be, and that's why we went into this
field, that's what makes us happy,

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is making patients happy.

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We'd love to give you
the best possible result,

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but I can't take a subway car
full of people in the New York

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subway system and take those
50 people and turn them into

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supermodels.

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That's just realistically not
what plastic surgery does.

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It takes aging changes
and undoes them mostly,

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but not a hundred percent.

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We're re draping skin against
the underlying bone structure.

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We're not breaking your
bones and moving them.

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There is plastic surgery that does
that, but that's not facelift surgery.

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So if you're trying to change
your appearance and come
to a place you never were

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in youth, that's not where a
facelift is going to drive you.

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If you're trying to look more like
you looked at a younger stage,

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that is where facelift surgery is going
to drive you part of the way back to

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your fully youthful
appearance. Most of the way.

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There are things we can do where
we work on the chin or cheek

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implants that change your look a
little bit that amplify your bone

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structure and enhance the results,

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but most of that is not
part of where facelift goes.

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Another example is scars.
As much as we wish we could,

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we cannot perform scarless surgery.
There will always be a scar.

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Plastic surgery does make
the best scars in medicine,

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and we work very hard to hide those
scars in natural transition points of the

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face and contours along the ear and
within the hairline to hide them.

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But no scars are 100% invisible.

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Absolutely.

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And great scars are plastic
surgery's special skill,

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but that's not the same as no scars.

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So the ability to place many tiny
stitches to create the best possible scar.

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And in addition, if a
scar heals unfavorably,

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we have many options to chase
scars today and try to improve them

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with gel bandages and topical scar
applications that are used at home,

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but also with injected
anti-inflammatory medicines.

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And there are several kinds of
these as well as a variety of laser

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treatments to diminish
inflammation in scars and to

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soften and flatten them and eventually
blend the texture of the scar

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so it resembles the surrounding skin.

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What are other facelift
fantasies we should consider?

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Well, we talked about
one particular example,

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the heavy neck. And as I said,

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there's no perfect result
ever in plastic surgery,

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and that's very vexing because plastic
surgeons are perfectionists and

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so are most of our patients. But we
have to somehow learn to live with that.

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We expect most of the
laity to be corrected,

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but this will vary from individual
to individual based on your

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age, your skin type, and
the quality of your skin,

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the degree of laxity and other factors.

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But it's never going to
be a hundred percent.

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Many patients come in and pull on the
skin of their face or they look in the

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mirror and pull on the skin and say,
gee, if I can just look like this,

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I'd be happy.

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Facelift is not going to get
you quite to the point that you

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can achieve simply by pulling
on your skin with your fingers.

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This is very frustrating,

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but we never obtain that degree
of red draping. And in fact,

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in the classic textbook on
aesthetic plastic surgery that was

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written and edited by one,
the professors who trained me,

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Thomas Reese,

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there's a picture of a lady looking
in the mirror and pulling expressly to

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teach surgeons this point that
we're not going to achieve

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that results surgically despite
the fact that it's simple to do

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with her own fingers in your
dressing room looking in the mirror.

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By the same token, the
durability of correction,

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while it is much greater for facelifts
than any of the alternative non-surgical

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treatments, is still not forever
and cannot be exactly predicted.

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The same factors that affect the degree
of correction like your age skin type

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and quality and your starting degree
of laxity also affect the durability of

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your correction. If you
start with very loose,

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lax skin that is aged and damaged,

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you'll have a result that does not last
as long as a younger patient who has

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preserved elasticity and skin quality,

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who is able to maintain and uphold
their surgical results for longer.

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So this is very much
like what we discussed,

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that there is this variation.

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You're going to continued age
aging never stops. However,

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you'll never look as bad
as you did had you done

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nothing even 10 years later.

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You may have regained some or
much of the laxity that you

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started out with right before the
facelift, but had you not had a facelift,

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you would've had what you started
with plus 10 years of aging.

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So the facelift benefit in that sense is a

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forever benefit, but at
some point, the facelift,

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if you want to look, your
best will need to be redone.

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Got it. Are there any
others in this category?

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Oh, there are some facelift
fantasies related to recovery.

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Many patients have a fantasy
about how long it will take for

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recovery,

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and sometimes that's very short
with no interruption of activities,

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and they're not expecting to
put a pause on some of their

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work or social activities
to allow some healing time.

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And other patients have an
image of facelift taking many,

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many months where you're
simply not presentable,

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don't look like yourself
and can't be out in public,

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and neither one of those are true.

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A typical time course for recovery is
generally a few days of rest and cool

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compresses one to two weeks out of
view for routine work and socializing,

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three to four weeks for no strenuous
heavy activity like exercising,

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and six weeks to three months for
higher profile events like weddings.

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It takes three to six months to
fully heal and scars to mature,

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but at this point, your
activities are no longer limited.

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You just need to know
that during this time,

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subtle swelling or firmness is settling
and scars are continuing to fade.

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This of course, varies
from person to person.

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Some patients have more swelling and
bruising while others hardly have any,

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and there is no great way to predict this.

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There are a lot of things we do
in modern face lifting to help

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minimize the recovery time.
Everyone has a busy schedule.

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It doesn't matter what your lifestyle is.

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In my marketplace in New York City,

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there are very few people who don't
have things packed in their schedule.

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And finding the recovery time is part
of the challenge of scheduling the

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facelift.

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So plastic surgeons have worked
very hard to try to minimize that

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recovery time and to try to make
it as predictable. In other words,

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try to make it match that time
course that Dr. Edinger listed

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for us so that you don't
get a surprise or an

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unexpected amount of recovery.

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And so plastic surgery has
succeeded increasingly in doing

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that,

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but there is potentially some variation as

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Dr. Edinger pointed out
in that recovery time.

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So you need to have a
little bit of buffer zone,

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but you can most of the time pretty
much plan on a time course that

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she outlined.

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Okay.

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Thanks for sharing fantasies that fall
into that first category that centers

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around what patients believe or hope
the facelift will do that it won't.

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Can we now talk about the
other category of fantasies,

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the one relating to treatments that are
trying to substitute for the facelift?

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There are many treatments like this.

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I firmly believe there's an
appropriate and valuable role for

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most aesthetic treatments,

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and when they're called on to
solve problems in the appropriate

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patient at the right stage of aging,

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these treatments can be
quite useful. However,

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in the setting where a
facelift is appropriate,

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the alternatives in a
best case scenario are a

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compromise giving you a
fraction of the degree of

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improvement and the
durability of improvement.

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And at worse,

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a lot of these alternatives
are a complete waste of time or

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potentially could distort your appearance.

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And Dr. Edinger,

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I mean you've had patients coming
in asking for a liquid facelift.

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Can you tell us what you
explained to them about that?

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I absolutely have, and it's
always a challenging conversation,

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especially when patients come in with
an ideal before they even walk in your

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door about they're hoping
to achieve non-surgically.

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I have patients frequently inquire about
liquid facelifts and other nonsurgical

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modalities to really improve jowling,

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skin laxity and tissue
descent most commonly.

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I had a patient recently who came to
see me who had a significant amount of

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jowling and skin laxity as well as a lot
of tissue descent with loss of volume,

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a heavy neck and platysmal banding.

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She was convinced that she wanted a liquid
facelift and she wasn't interested in

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discussing surgical correction.

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I explained to her that she wasn't a
good candidate for a liquid facelift

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because the degree of skin laxity and
volume loss she had was simply not

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amenable to correction with fillers.

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It would've been a waste of her money
and it would've cost a significant amount

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of it that she would've had to spend on
filler to hopelessly combat aging with

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an inappropriate modality. The amount of
fillers she would've needed to improve

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her skin laxity would've left her with
grossly distorted and unnatural features.

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She really needed surgery to fix the
issues that were bothersome to her.

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I always try to be very honest with
patients about what will and will not give

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them the results they desire.

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And sometimes that means telling
them what they don't want to hear,

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including not being a candidate for a
nonsurgical modality that will not get

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them the results they're hoping for.

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If I think a liquid facelift is
appropriate and will help a patient,

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I am more than willing to offer that
service as long as they have realistic

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expectations and an
understanding of its limitations.

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But if a patient's a poor
candidate for these procedures,

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then I think we owe it to the
patients to be honest about that,

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even if it's not the answer
they we're hoping to hear.

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And I'm not wild about
the term liquid facelift,

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even though I brought it up here
because it's really not a facelift.

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It's a volume restoration,

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and I inject volume in
people's faces every day.

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I'm not against doing that.

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It's a critical part of
anti-aging treatment at almost

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every stage of aging from
just starting to age in your

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thirties to late stages
of aging in your eighties,

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seventies.

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So I'm not against that putting
back volume to the extent you

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lost. It is probably a good idea,

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but trying to tailor
laxity out of the skin

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in excess of that distort your appearance.

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And the other important point
about that is in the neck

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area,

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there is no role for volume injected

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filler to restore the neck.

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Energy treatments may, early in the aging,

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take a little bit of
laxity out in the neck,

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and that may be all
you need at that point,

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but filler or volume,

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if the aesthetic issue you're looking
at and concerned with is in the neck,

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is simply not one of the solutions,

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whether that change is mild or
that change is substantial. Now,

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the term facelift,

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like the liquid facelift has been
applied to many things that are in no

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way a facelift. In essence.

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Other treatments and products
are stealing the name facelift

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because it's the gold standard
for facial rejuvenation.

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Most of these things are not surgery
and either don't address the same

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features or don't work
in the same fashion.

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So the liquid facelift is,

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or filler facelift is one example.

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And some people are pumping so much
filler in their faces to tailor out skin

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laxity, they're grossly distorting their
facial shape and general appearance.

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And we can all name a celebrity or
two who's done this and taken what

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was a beautiful,

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gorgeous face and really ruined it.

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Thread treatments or suture lifts.

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Also say they're a non-surgical facelift,

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and there are many energy devices
marketed as a non-surgical

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facelift.

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And some of these non-surgical
lifters have specific FDA

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approvals for lifting and are an
appropriate treatment at an early

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stage of aging or maybe to
tailor out a little early

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recurrence of laxity after a facelift.

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But others are just general
energy delivery systems for

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tissue heating that may help with some
features of skin quality but have no

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demonstrated potential for skin lifting.

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And another whole category
that uses the facelift term,

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and I see this every night
during the evening news,

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during the commercials are skin products,

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creams and lotions marketed
as a non-surgical facelift.

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I know we discussed this in an
earlier episode in this series,

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but can you remind us what
a facelift does Dr. Edinger?

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Absolutely. Very briefly,

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a facelift adjusts the skin to pull out
laxity and tighten the deeper connected

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tissues and muscles of the face and
neck to restore a youthful position and

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configuration.

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Facelifts address both the skin laxity
and the tissue descent that alter the

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shape of the face as we age.

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When you understand what facelifts
do and how they accomplish this,

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it becomes clearer why
there's no nonsurgical

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facelift. For example,

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liquid facelifts fill tissues out,

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they increase projection,
fill in depressions,

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contour depressions,

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or amplify contour convexes,

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but they have little ability
to suspend tissue or lift them,

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and it's so if we can
leave you with one message,

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it's that there is no such thing as a

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non-surgical facelift in
existence now. If there was,

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it would not be a secret.
It might be very expensive,

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but it would be widely available.

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There are things that can
help very early with laxity,

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and there are things that can
help with volume restoration,

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which is a separate aging change,

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but there is nothing that
currently can replace the degree of

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improvement or durability
of improvement of the

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surgical facelift, neck
lift. And not only that,

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but I'm very involved in looking at
and helping develop new technologies,

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both device-based treatments
and bio technologies. And from

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what I've seen, what I've
heard companies talking about,

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there's nothing on the horizon in the
next five or 10 years that will be a

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substitute for the facelift.

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And so if you're on the
cusp of needing a facelift,

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you are extremely unlikely to have
another meaningful substitute.

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That doesn't mean you can't do things
to help slow down aging or make minor

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corrections,

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but to really chase the
types of facial aging that

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facelift corrects, there's
currently no other option,

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and there's no foreseeable
option. If you're 25 years old,

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I tell you, stay tuned.

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Who knows what may come by the
time you need a big correction.

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But for folks on the verge
of needing a facelift,

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you'll need to make the decision
to go ahead with a facelift or to

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let aging have its way with you. As
I've said many times on this podcast,

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either decision is okay,

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but you have to accept the good and bad
aspects of either of those decisions in

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a realistic way.

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Thank you for that refresher on
what facelifts do. Dr. Edinger,

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do you have any takeaways
to share with our listeners?

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I think the best place to start with
dispelling fantasies and understanding the

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00:19:31,440 --> 00:19:35,850
limitations and applications of surgical
and non-surgical modalities is to meet

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with a trained plastic surgeon.

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There are so many things on the internet
and so many people offering treatments

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for skin laxity and volume loss and
so many miracles out there that can

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be really overwhelming for patients.

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The best thing to do is just speak with
an expert to find out what treatments

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you are a candidate for and which ones
will give you the results you're hoping

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for. Some patients want to avoid surgery
and that's okay, that's their decision.

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But speaking with a board certified
plastic surgeon is a way that you can

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express your desires and get honest
answers and solutions to the issues that

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bother you so that you can make
the best decision for yourself.

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And Dr. Bass, would you
give us your takeaways?

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So fantasies speak to
our emotional wants and

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needs and to our anxieties. Unfortunately,

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they provide little support at the end
of the day because they won't occur in

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real life, only in our imagination.

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Having realistic expectations
of the facelift is key to

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00:20:37,500 --> 00:20:42,420
fulfilling our hopes and dreams in
the best way possible in the real

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world, and that's never a hundred
percent correction. That's a fantasy.

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It's never perfect
symmetry. That's a fantasy.

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There's no symmetric human.

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There's no meaningful substitute
for what a facelift can provide in

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terms of treating laxity and
restoring a youthful facial shape.

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Everyone has to accept the
presence of permanent scars,

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but these are minimally
visible in almost all cases

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once the healing is complete.

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Thank you, Dr. Edinger and Dr. Bass.

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Debunking myths is definitely part
of our goals here on the podcast,

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and your discussion of facelift fantasies
has certainly done a great job getting

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at a bunch of them.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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00:21:29,470 --> 00:21:31,360
Follow us on Apple Podcasts,

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00:21:31,420 --> 00:21:33,640
write a review and share
the show with your friends.

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00:21:33,820 --> 00:21:37,330
Be sure to join us next time to avoid
missing all the great content that is

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00:21:37,330 --> 00:21:40,900
coming your way. If you want to
contact us with comments or questions,

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00:21:40,900 --> 00:21:42,100
we'd love to hear from you.

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00:21:42,190 --> 00:21:46,840
Send us an email at
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00:21:46,870 --> 00:21:48,700
Instagram @drbassnyc.