Sept. 21, 2022
T Minus 10 Years: Mini-Treatments Leading up to the Facelift
| You know you are not ready for a facelift yet but your face is not looking as youthful as you want. There are many non-surgical options and minimally invasive options that are increasingly important to maintaining appearance if a facelift might be in your future in the next decade. If you are counting down “T-Minus 10 Years” to a facelift or necklift, listen to Dr. Bass review your options to look your best until you are ready to launch a surgical project and to help extend the time until surgery is necessary.
Thirty years ago, the usual age for a facelift was around 50. Today it’s 60 or even later thanks to the non-surgical technologies and treatments available including injectables, Ultherapy, radiofrequency microneedling, threadlifts, and myEllevate. Depending on how close you are to needing a face lift, you can take small steps, or do a combination of treatments to optimize appearance and delay surgery.
If you already have significant skin laxity, Dr. Bass cautions that there’s no meaningful substitute for facelift and necklift and nothing on the horizon to replace them. In those circumstances, don’t waste your time and money on something that isn't surgery because you will only be disappointed.
Links
Learn more about facelifts, fillers, and Ultherapy on the Bass Plastic Surgery website |
| About Dr. Lawrence Bass Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond. To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass. |
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Welcome 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'm your cohost Doreen Wu.
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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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The title of today's episode
is "T minus 10 Years:
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Mini Treatments Leading
Up to the Facelift." I'm
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going to start off with a story. I'm
sure you've heard before Dr. Bass.
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And I think some of our listeners will
be able to relate to what I'm about to
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describe. I'm not looking young anymore.
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I look in the mirror and I'm seeing
more and more aging changes that I don't
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like. And don't really want,
I've thought about a facelift,
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but I'm not quite ready to go
there yet. Maybe in 10 years or so.
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Does this sound like you?
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If so you're in luck because this
is the episode for you, Dr. Bass,
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how do our listeners know
if they fit this example?
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It's likely by age, uh,
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that they can get a pretty good
indication of if this is where they
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are. Uh, they, they don't have
really obvious hanging skin,
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but they're seeing more and
more little things accumulate.
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And they're seeing that that hanging
skin is somewhere in their future.
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Uh, it may also be by what they've
done previously in the way of aesthetic
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surgery or aesthetic
medicine treatments. And,
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you know, but it's likely that
beginning of a little bit of,
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jowling a little bit of
irregularity to the jawline,
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a little bit of hangs under the
chin and lower down in the neck.
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And these are signs that,
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that facelift is going to be on the
program at some point in the future.
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If you want to look your
best, but not quite yet.
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How solid is this age? Is that
early or late in the game.
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We call this episode T minus 10
years, but by the same token,
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it may be T minus 20 years. If
you're not planning a facelift until,
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until your sixties, uh,
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the options will play out
a little differently in the
earlier time period with
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smaller treatments and a
little more invasively in the T
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minus 10 period. Uh,
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but that whole lead up to the
facelift is when we're pursuing
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definitively more minimal options.
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Okay, I hear you. I've worked
hard at taking care of my skin,
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but it's not enough anymore. Can you
break it down for me? What are my options?
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So, as you said, we have to break
it down and take it by category.
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The first thing which should have been
part of your beauty project for a couple
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of decades is the skincare.
This is for maintenance,
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and then
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increasingly a little bit more
medical treatments for restoration,
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deeper peels and more recovery
based energy treatments.
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These are chasing the surface,
changes in the skin, redness, pigment,
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like age spots and, and rough
texture and early wrinkles.
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That's definitely reassuring
to hear having a good
skincare regimen is something
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I've consistently been working
on since I was younger.
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Is this a small step forward in the
magnitude of all these treatments?
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Or is it a big one?
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It really depends on how
you want to approach it.
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There's a very broad range of
options in this category from
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many different manufacturers
and all different kinds of
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modalities. So you can do
this in a multi-step fashion,
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kind of like a maintenance program
where you're periodically doing light or
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no recovery treatments,
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or you can aim for a big
cleanup with a recovery based
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treatment that will hold you for a while.
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What is another category of aging
that plastic surgery can help address?
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Well, as you get into this
T minus 10 years period,
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before a facelift,
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you're at the age where you start
to see volume loss in the face is
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accelerating.
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It's not just the nasolabial
folds being a little deeper,
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but the accumulated fat loss,
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which has really been going on since
the late twenties is starting to add up.
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And in addition,
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you're at the point where we're seeing
the beginning of bone and muscle loss in
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the face to an extent that
it's actually starting to show.
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So this means not just, you
know, a little touch of filler,
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half a syringe or a
syringe in a, in a fold.
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This is a revolumizing of the face, uh,
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or occasionally a round
of surgical fat grafting
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and not the small features, but
the big features, the jawline,
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the cheeks, the temples, if they need it.
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I don't know. That sounds
like a lot of filler.
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Will I still look natural
with all that filler?
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Well, this is a critical point. And we,
and we talk about this all the time on,
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on the Park Avenue Plastic Surgery Class,
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that always every intervention
we want to do in a fashion
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that preserves a perfectly
natural look. So the idea is this,
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if I put back volume
that you lost with aging,
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and I put it back where you
lost it, I'm not distorting you.
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I'm putting you back where you
were. So adding back volume,
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you lost is a good thing that
brings you the shape that your
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face had in youth. If I add more volume
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modestly, I can accent your
features and enhance them a little,
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or maybe harmonize them a
little, but I don't want to,
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for the sake of dealing with
something, that's not volume loss,
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I don't wanna just pump you up
because that will be distorting.
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And that's a big mistake. So there's no
reason you can't look perfectly natural,
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but it has to be artistically applied.
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And it has to be applied improper measure.
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And that's true with everything
we do in plastic surgery.
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That all makes sense,
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but aren't these things that I will
eventually address when I get my facelift.
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So that's a great question. And, you
know, we'd like life to be simple.
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We'd like one thing to go wrong.
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And we do one treatment
and it fixes everything,
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but this is just not how life
works. Everything is multifactorial.
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And the things we've been talking about
for the last couple of minutes are
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really other aging
features that are showing.
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And they tend to show earlier
than major laxity starts to
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trickle into the face.
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So they're really separate
issues from facelift. Now,
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if I put volume back, that
will take up, you know,
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a minimal amount of laxity or slack
in the face, and that's a good thing,
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but that only really helps
me when it's very minimal.
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And once it becomes more significant,
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then we have to start
looking at other options.
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Here's another scenario. What can I do
about skin laxity, short of a facelift?
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So this is, this is what I'm
saying, you know, early on,
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almost anything we do
has, you know, there's a,
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just a teeny drop of overlap
between all these different major
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categories, the volume loss,
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the skin surface changes and
skin laxity are the three big
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categories. And, you know,
almost any treatment we do,
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we do has a drop of effect on all of them,
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but it predominantly affects
only one of the categories.
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So when we're starting to see
more than very minimal skin and
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laxity, we have to start doing
treatments that are expressly designed
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to address skin laxity.
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So major laxity, this is the
most obvious sign of age.
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Major laxity is still
treated with the facelift.
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There's no replacement in,
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in any fashion that measures up to what
a facelift can accomplish in dealing
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with major laxity. But
this podcast is about
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T minus 10 for the facelift
you're years away from
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when you have to go to the facelift.
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And so there are all sorts
of mini options that are
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designed to address laxity, not
work on laxity in a backhanded way,
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uh, that are worth chasing down in this,
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in this T minus 10 stage.
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What are some of these options?
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So, you know, there are a range of
options. Some have a bigger effect,
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some have a smaller effect.
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The ones with the smaller effect
are things you're gonna work on.
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If you're thinking of a
facelift earlier in the game,
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and if you're really gonna hold off the
facelift until very late in the game,
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when you really, really
have no other option,
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then you're going to pick
some of the bigger options.
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The lighter options are things
that apply energy externally to the
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skin to create new collagen
and a tightening effect.
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These are things like Ulthera,
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which uses sound energy or wanding
techniques with radiofrequency
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energy. And, and there
are a number of, um,
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of different brand names for
these kind of treatments.
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The radio frequency wing is
typically a repetitive treatment.
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You may do three to five treatments
where something like Ulthera is typically
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done as a single treatment,
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or occasionally with a second follow
up treatment a few months later,
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if that's not likely to be enough,
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then you have to resort to some
of the treatments which are called
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microinvasive. And the big
category for that today is radio
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frequency microneedling.
So little needles,
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little arrays of needles go into
the skin to a defined depth.
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And most of the needle is insulated,
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but the tip is not and
energy is applied there,
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which creates a little thermal
injury as the body heals.
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You add collagen and you
get a little tighten up
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again, typically done as
a series of treatments,
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very often five,
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or sometimes more occasionally only three,
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um,
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and often a little bit of recovery because
there are multiple punctures in the
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skin.
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Now it's important to point out that
it takes a few months to really see the
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full effect of these treatments
as the body responds to the
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injury. And does the work
of tightening up the skin.
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It's also important to point
out that these treatments have a
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wide variation in response based
on how old you are and how much
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remodeling ability your skin has
because we're pushing the skin and we're
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counting on the skin to respond. The final
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set of options are
internal energy options.
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Things like laser
liposuction or face tight,
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which uses radio frequency in
an attempt to put more energy
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under the skin in a
minimally invasive fashion,
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through small incisions of
a couple of millimeters,
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or just needle punctures and
push the skin hard to tighten up.
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Let's say, I've waited and I'm
still not ready for a facelift,
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but there's more laxity showing what can
I do short of a facelift to address my
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concerns.
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So now you're getting to a
set of treatments that are
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minimally invasive to actually
surgical treatments that are
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smaller than a facelift in
an effort to actually pull
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and lift the skin.
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And in some cases to actually
remove excess skin just in a smaller
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zone than a full face lift does.
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And these are things like thread lifts,
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which are sutures that have
either barbs or cones that
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can slide in one direction. And
one pulled in the other direction,
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exert a lifting or traction
effect on the skin.
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There are pinch lifts and mini lifts,
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and there are all kinds
of variations of these,
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but these are small surgeries
that actually make incisions
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to remove skin in small focused
areas where it's most prominent.
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I'm not a huge fan of these procedures.
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They're useful for very
specific individuals,
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but the recovery from those
procedures is often very close to the
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recovery that you get in a full facelift,
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just in a smaller part of the face
because you focused your surgery there.
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And so for a lot of folks,
by the time they need that,
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if they did the full face lift,
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they would get the much more complete
correction and the much longer durability.
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Uh,
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but those are options in some cases where
there's just a particular part of the
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face that really gave out. Um,
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and another example of that
is a surgical platysmaplasty,
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uh, where a small incision
is made under the skin.
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And there's an attempt to correct the
vertical banding in the neck by rejoining
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the platisma muscle edges that
have separated with aging and
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trim sometimes trim extra
muscle tailor off excess fat,
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if there's a blanket of fat
in the neck. So, uh, again,
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if that's the focused area of trouble,
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sometimes that smaller procedure
with a somewhat smaller recovery than
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facelift will, will hold
you for a few years.
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And a more recent development
is something called the
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trampoline platysmoplasty. So this is a
procedure that does not make incisions.
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It's done through needle punctures,
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using a suture to divide the
muscle banding and to suspend and
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support the tissues along
the jaw line and under the
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chin in the,
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in the neck to sharpen the contour
in the neck and to sharpen the
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contour in the jaw line. And
so if there's some sagging,
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not a facelift level of sagging,
that procedure can work well.
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And compared to things like thread
lifts, it has much more durability,
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typically five years, or maybe
several years beyond that. Uh,
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and it's got a little recovery bruising
and swelling as all of these treatments
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do, but again, substantially
less than a facelift.
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So that's a good procedure.
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If you have the specific
findings in your neck and jawline
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that make you suitable for it,
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once you have a substantial amount
of hanging skin in the neck,
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that procedure is not going to tailor
out that significant amount of excess
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skin. And so it's not a good
option, but if you're short of that,
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if you can pull a trigger on going
forward with a small recovery needle,
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puncture local anesthesia procedure, uh,
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that's done in about 30, 40 minutes, uh,
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that can be a, a great help to the
appearance of the neck and jawline in,
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in this T minus 10 stage
of, uh, before the facelift.
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Our discussion today has shown me
that I have a plethora of options,
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but how should I pick, what
are the key takeaways Dr. Bass,
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so that I don't end up disappointed?
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Yeah, that's a great
question because you know,
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like everything in plastic surgery,
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we have to be real mother
nature, doesn't blank,
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and we have to understand the
biology and understand what the
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treatments can do and not
hope that against every,
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every understanding it's going to
do more than it's designed to do.
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So, the first takeaway is if
you really need a facelift,
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whether you're ready for it or not,
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there's really no meaningful
substitute in 2022.
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And I do a lot of technology
development research,
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and I don't see anything on the horizon
right now that I think is gonna come
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online in the next five,
or maybe even 10 years,
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that's going to put facelift
into an obsolete category.
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Um, so you may not want to do it,
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but if you really need a
facelift doing something,
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that's not a facelift is probably
going to be disappointment.
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Uh, as I said earlier, the
small surgery procedures,
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the mini lifts and other things
that actually make incisions
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have
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three quarters of the recovery of a
facelift or some something that ballpark
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is the same recovery.
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And so I think only for certain
selected cases where that's really the,
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the trouble area, are those
procedures very useful,
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uh, the short durability treatments. I
mean, sometimes that's the right choice,
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cuz they're so quick and easy to do.
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You need to look good now and you'll
deal with looking good later later. Uh,
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but recognize that's a big compromise.
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And often the cost of those procedures
is the same as things that would give
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you much more durability.
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So everybody loves minimal
options because they're less cost
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less recovery and less
or no scars or incisions,
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but the,
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what you're buying at the
same time with those options
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is less degree of improvement,
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less durability of improvement
and less predictability or
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consistency, how much
improvement you're going to get.
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So everyone likes those first advantages,
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but you have to live with the second
half as well when you pick a smaller
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option. So it's okay to compromise.
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As long as you're being
real about the trade offs,
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your plastic surgeon should explain the
pluses and minuses of all these options.
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And if you accept the
trade offs, then you know,
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it can be a good choice for you.
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It's just a good fit for your
individual circumstances,
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but don't hope you're
not going to get the,
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the negative tradeoffs you're gonna
get the whole package. So, you know,
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my father used to have a saying, you know,
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don't expect a gourmet eight
course meal for a dollar 50
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and the same is true when you're
picking these kind of treatments.
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That's a great point.
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And something very important that we
shall all keep in mind. Thank you,
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Dr. Bass for sharing your
expertise regarding the
options and planning I should
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consider in the decade leading up to the
facelift and thank you to our listeners
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for joining us today.
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It was definitely encouraging to hear
that there are so many options to keep us
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looking good before it's time for a
facelift, especially with new innovations,
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like the, my elevate procedure. As always,
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if you think of other exciting
developments or trends
in plastic surgery that
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00:20:05,941 --> 00:20:08,140
you would like us to discuss
in an upcoming episode,
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please reach out by email or
Instagram. We'll see you next time.
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This is Doreen Wu,
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thanking you for joining Dr. Bass on me
for this discussion of treatments and
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procedures T minus 10 years until the
facelift. Be sure to tune in next time.
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And don't forget to
subscribe to our podcast,
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to stay up to date with all of the
exciting content that is coming your way.
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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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00:20:42,880 --> 00:20:45,340
The commentary in this
podcast represents opinion.
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00:20:45,490 --> 00:20:48,040
This podcast does not
present medical advice,
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00:20:48,340 --> 00:20:52,360
but rather general information about
plastic surgery that does not necessarily
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00:20:52,420 --> 00:20:55,520
relate to the specific conditions
of any individual patient.
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00:20:55,900 --> 00:21:00,560
No doctor-patient relationship
is established by listening
to or participating
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00:21:00,700 --> 00:21:01,533
in this podcast,
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00:21:01,750 --> 00:21:05,720
consult your physician to advise you
about your individual healthcare.
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If you enjoyed this episode,
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00:21:07,780 --> 00:21:11,920
please share it with your friends and
be sure to subscribe to our podcast on
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00:21:12,160 --> 00:21:15,840
Apple Podcasts, Google, Spotify, Stitcher,
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00:21:16,320 --> 00:21:18,400
or wherever you listen to podcasts.
00:00:02,340 --> 00:00:06,190
Welcome to another episode of
Park Avenue Plastic Surgery Class,
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00:00:06,450 --> 00:00:10,030
the podcast where we explore controversies
and breaking issues in plastic
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00:00:10,031 --> 00:00:12,310
surgery. I'm your cohost Doreen Wu.
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00:00:12,610 --> 00:00:16,630
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:00:17,310 --> 00:00:18,870
educator, and technology innovator.
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00:00:19,130 --> 00:00:21,990
The title of today's episode
is "T minus 10 Years:
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00:00:21,990 --> 00:00:24,430
Mini Treatments Leading
Up to the Facelift." I'm
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00:00:26,430 --> 00:00:29,230
going to start off with a story. I'm
sure you've heard before Dr. Bass.
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00:00:29,370 --> 00:00:32,630
And I think some of our listeners will
be able to relate to what I'm about to
10
00:00:32,830 --> 00:00:35,760
describe. I'm not looking young anymore.
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00:00:36,000 --> 00:00:39,640
I look in the mirror and I'm seeing
more and more aging changes that I don't
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00:00:39,641 --> 00:00:42,880
like. And don't really want,
I've thought about a facelift,
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00:00:43,020 --> 00:00:46,600
but I'm not quite ready to go
there yet. Maybe in 10 years or so.
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00:00:47,560 --> 00:00:48,610
Does this sound like you?
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00:00:49,270 --> 00:00:53,370
If so you're in luck because this
is the episode for you, Dr. Bass,
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00:00:53,510 --> 00:00:55,570
how do our listeners know
if they fit this example?
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00:00:57,070 --> 00:00:59,270
It's likely by age, uh,
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00:00:59,510 --> 00:01:04,270
that they can get a pretty good
indication of if this is where they
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00:01:04,550 --> 00:01:09,070
are. Uh, they, they don't have
really obvious hanging skin,
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00:01:09,790 --> 00:01:12,990
but they're seeing more and
more little things accumulate.
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00:01:13,350 --> 00:01:17,830
And they're seeing that that hanging
skin is somewhere in their future.
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00:01:19,430 --> 00:01:24,350
Uh, it may also be by what they've
done previously in the way of aesthetic
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00:01:24,870 --> 00:01:29,230
surgery or aesthetic
medicine treatments. And,
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you know, but it's likely that
beginning of a little bit of,
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00:01:34,750 --> 00:01:38,670
jowling a little bit of
irregularity to the jawline,
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00:01:39,470 --> 00:01:44,190
a little bit of hangs under the
chin and lower down in the neck.
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00:01:44,870 --> 00:01:46,310
And these are signs that,
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that facelift is going to be on the
program at some point in the future.
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00:01:51,670 --> 00:01:55,350
If you want to look your
best, but not quite yet.
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00:01:56,610 --> 00:01:59,910
How solid is this age? Is that
early or late in the game.
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00:02:01,060 --> 00:02:05,520
We call this episode T minus 10
years, but by the same token,
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00:02:05,700 --> 00:02:10,160
it may be T minus 20 years. If
you're not planning a facelift until,
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00:02:10,610 --> 00:02:12,600
until your sixties, uh,
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00:02:12,620 --> 00:02:17,520
the options will play out
a little differently in the
earlier time period with
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00:02:17,521 --> 00:02:22,480
smaller treatments and a
little more invasively in the T
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00:02:22,481 --> 00:02:24,640
minus 10 period. Uh,
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00:02:24,641 --> 00:02:29,440
but that whole lead up to the
facelift is when we're pursuing
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00:02:29,800 --> 00:02:32,240
definitively more minimal options.
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00:02:33,850 --> 00:02:37,380
Okay, I hear you. I've worked
hard at taking care of my skin,
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00:02:37,560 --> 00:02:41,300
but it's not enough anymore. Can you
break it down for me? What are my options?
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00:02:42,440 --> 00:02:45,860
So, as you said, we have to break
it down and take it by category.
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00:02:46,700 --> 00:02:50,980
The first thing which should have been
part of your beauty project for a couple
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00:02:51,220 --> 00:02:54,980
of decades is the skincare.
This is for maintenance,
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00:02:55,700 --> 00:02:56,740
and then
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00:02:58,300 --> 00:03:02,120
increasingly a little bit more
medical treatments for restoration,
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00:03:03,600 --> 00:03:06,960
deeper peels and more recovery
based energy treatments.
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00:03:08,160 --> 00:03:12,720
These are chasing the surface,
changes in the skin, redness, pigment,
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like age spots and, and rough
texture and early wrinkles.
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That's definitely reassuring
to hear having a good
skincare regimen is something
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I've consistently been working
on since I was younger.
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Is this a small step forward in the
magnitude of all these treatments?
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Or is it a big one?
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00:03:32,770 --> 00:03:35,350
It really depends on how
you want to approach it.
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There's a very broad range of
options in this category from
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00:03:40,260 --> 00:03:44,710
many different manufacturers
and all different kinds of
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00:03:44,840 --> 00:03:48,790
modalities. So you can do
this in a multi-step fashion,
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kind of like a maintenance program
where you're periodically doing light or
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no recovery treatments,
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00:03:56,930 --> 00:04:01,430
or you can aim for a big
cleanup with a recovery based
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treatment that will hold you for a while.
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What is another category of aging
that plastic surgery can help address?
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Well, as you get into this
T minus 10 years period,
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before a facelift,
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you're at the age where you start
to see volume loss in the face is
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accelerating.
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It's not just the nasolabial
folds being a little deeper,
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00:04:25,830 --> 00:04:27,510
but the accumulated fat loss,
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which has really been going on since
the late twenties is starting to add up.
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And in addition,
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you're at the point where we're seeing
the beginning of bone and muscle loss in
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the face to an extent that
it's actually starting to show.
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So this means not just, you
know, a little touch of filler,
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half a syringe or a
syringe in a, in a fold.
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This is a revolumizing of the face, uh,
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or occasionally a round
of surgical fat grafting
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and not the small features, but
the big features, the jawline,
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00:05:08,510 --> 00:05:11,110
the cheeks, the temples, if they need it.
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I don't know. That sounds
like a lot of filler.
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Will I still look natural
with all that filler?
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Well, this is a critical point. And we,
and we talk about this all the time on,
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on the Park Avenue Plastic Surgery Class,
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that always every intervention
we want to do in a fashion
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that preserves a perfectly
natural look. So the idea is this,
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if I put back volume
that you lost with aging,
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and I put it back where you
lost it, I'm not distorting you.
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I'm putting you back where you
were. So adding back volume,
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00:05:49,290 --> 00:05:54,170
you lost is a good thing that
brings you the shape that your
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00:05:54,450 --> 00:05:58,160
face had in youth. If I add more volume
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00:06:00,200 --> 00:06:03,800
modestly, I can accent your
features and enhance them a little,
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00:06:04,040 --> 00:06:07,280
or maybe harmonize them a
little, but I don't want to,
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for the sake of dealing with
something, that's not volume loss,
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00:06:10,880 --> 00:06:15,360
I don't wanna just pump you up
because that will be distorting.
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And that's a big mistake. So there's no
reason you can't look perfectly natural,
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but it has to be artistically applied.
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00:06:22,460 --> 00:06:25,400
And it has to be applied improper measure.
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And that's true with everything
we do in plastic surgery.
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That all makes sense,
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00:06:31,050 --> 00:06:34,710
but aren't these things that I will
eventually address when I get my facelift.
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So that's a great question. And, you
know, we'd like life to be simple.
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We'd like one thing to go wrong.
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And we do one treatment
and it fixes everything,
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but this is just not how life
works. Everything is multifactorial.
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And the things we've been talking about
for the last couple of minutes are
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really other aging
features that are showing.
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And they tend to show earlier
than major laxity starts to
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trickle into the face.
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00:07:05,470 --> 00:07:10,290
So they're really separate
issues from facelift. Now,
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00:07:10,291 --> 00:07:12,850
if I put volume back, that
will take up, you know,
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a minimal amount of laxity or slack
in the face, and that's a good thing,
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but that only really helps
me when it's very minimal.
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And once it becomes more significant,
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00:07:23,240 --> 00:07:25,650
then we have to start
looking at other options.
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Here's another scenario. What can I do
about skin laxity, short of a facelift?
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So this is, this is what I'm
saying, you know, early on,
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almost anything we do
has, you know, there's a,
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just a teeny drop of overlap
between all these different major
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categories, the volume loss,
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00:07:46,570 --> 00:07:51,130
the skin surface changes and
skin laxity are the three big
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00:07:51,810 --> 00:07:55,370
categories. And, you know,
almost any treatment we do,
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we do has a drop of effect on all of them,
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but it predominantly affects
only one of the categories.
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So when we're starting to see
more than very minimal skin and
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laxity, we have to start doing
treatments that are expressly designed
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to address skin laxity.
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So major laxity, this is the
most obvious sign of age.
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Major laxity is still
treated with the facelift.
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There's no replacement in,
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in any fashion that measures up to what
a facelift can accomplish in dealing
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with major laxity. But
this podcast is about
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T minus 10 for the facelift
you're years away from
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when you have to go to the facelift.
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And so there are all sorts
of mini options that are
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designed to address laxity, not
work on laxity in a backhanded way,
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uh, that are worth chasing down in this,
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in this T minus 10 stage.
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What are some of these options?
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So, you know, there are a range of
options. Some have a bigger effect,
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some have a smaller effect.
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The ones with the smaller effect
are things you're gonna work on.
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If you're thinking of a
facelift earlier in the game,
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and if you're really gonna hold off the
facelift until very late in the game,
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when you really, really
have no other option,
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then you're going to pick
some of the bigger options.
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The lighter options are things
that apply energy externally to the
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skin to create new collagen
and a tightening effect.
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These are things like Ulthera,
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which uses sound energy or wanding
techniques with radiofrequency
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energy. And, and there
are a number of, um,
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of different brand names for
these kind of treatments.
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The radio frequency wing is
typically a repetitive treatment.
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You may do three to five treatments
where something like Ulthera is typically
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done as a single treatment,
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or occasionally with a second follow
up treatment a few months later,
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if that's not likely to be enough,
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then you have to resort to some
of the treatments which are called
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microinvasive. And the big
category for that today is radio
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frequency microneedling.
So little needles,
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little arrays of needles go into
the skin to a defined depth.
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And most of the needle is insulated,
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but the tip is not and
energy is applied there,
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which creates a little thermal
injury as the body heals.
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You add collagen and you
get a little tighten up
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again, typically done as
a series of treatments,
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very often five,
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or sometimes more occasionally only three,
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um,
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and often a little bit of recovery because
there are multiple punctures in the
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skin.
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Now it's important to point out that
it takes a few months to really see the
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full effect of these treatments
as the body responds to the
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injury. And does the work
of tightening up the skin.
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It's also important to point
out that these treatments have a
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wide variation in response based
on how old you are and how much
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remodeling ability your skin has
because we're pushing the skin and we're
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counting on the skin to respond. The final
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set of options are
internal energy options.
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Things like laser
liposuction or face tight,
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which uses radio frequency in
an attempt to put more energy
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under the skin in a
minimally invasive fashion,
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through small incisions of
a couple of millimeters,
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or just needle punctures and
push the skin hard to tighten up.
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Let's say, I've waited and I'm
still not ready for a facelift,
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but there's more laxity showing what can
I do short of a facelift to address my
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concerns.
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So now you're getting to a
set of treatments that are
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minimally invasive to actually
surgical treatments that are
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smaller than a facelift in
an effort to actually pull
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and lift the skin.
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And in some cases to actually
remove excess skin just in a smaller
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zone than a full face lift does.
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And these are things like thread lifts,
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which are sutures that have
either barbs or cones that
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can slide in one direction. And
one pulled in the other direction,
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exert a lifting or traction
effect on the skin.
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There are pinch lifts and mini lifts,
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and there are all kinds
of variations of these,
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but these are small surgeries
that actually make incisions
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to remove skin in small focused
areas where it's most prominent.
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I'm not a huge fan of these procedures.
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They're useful for very
specific individuals,
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but the recovery from those
procedures is often very close to the
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recovery that you get in a full facelift,
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just in a smaller part of the face
because you focused your surgery there.
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And so for a lot of folks,
by the time they need that,
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if they did the full face lift,
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they would get the much more complete
correction and the much longer durability.
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Uh,
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but those are options in some cases where
there's just a particular part of the
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face that really gave out. Um,
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and another example of that
is a surgical platysmaplasty,
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uh, where a small incision
is made under the skin.
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And there's an attempt to correct the
vertical banding in the neck by rejoining
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the platisma muscle edges that
have separated with aging and
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trim sometimes trim extra
muscle tailor off excess fat,
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00:14:14,720 --> 00:14:19,220
if there's a blanket of fat
in the neck. So, uh, again,
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if that's the focused area of trouble,
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sometimes that smaller procedure
with a somewhat smaller recovery than
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facelift will, will hold
you for a few years.
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And a more recent development
is something called the
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trampoline platysmoplasty. So this is a
procedure that does not make incisions.
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It's done through needle punctures,
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using a suture to divide the
muscle banding and to suspend and
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support the tissues along
the jaw line and under the
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chin in the,
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in the neck to sharpen the contour
in the neck and to sharpen the
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contour in the jaw line. And
so if there's some sagging,
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not a facelift level of sagging,
that procedure can work well.
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And compared to things like thread
lifts, it has much more durability,
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typically five years, or maybe
several years beyond that. Uh,
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and it's got a little recovery bruising
and swelling as all of these treatments
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do, but again, substantially
less than a facelift.
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So that's a good procedure.
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If you have the specific
findings in your neck and jawline
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that make you suitable for it,
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once you have a substantial amount
of hanging skin in the neck,
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00:15:46,690 --> 00:15:50,850
that procedure is not going to tailor
out that significant amount of excess
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skin. And so it's not a good
option, but if you're short of that,
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if you can pull a trigger on going
forward with a small recovery needle,
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00:16:01,450 --> 00:16:05,610
puncture local anesthesia procedure, uh,
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00:16:05,890 --> 00:16:08,650
that's done in about 30, 40 minutes, uh,
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00:16:10,030 --> 00:16:14,750
that can be a, a great help to the
appearance of the neck and jawline in,
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in this T minus 10 stage
of, uh, before the facelift.
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Our discussion today has shown me
that I have a plethora of options,
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00:16:25,320 --> 00:16:28,420
but how should I pick, what
are the key takeaways Dr. Bass,
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so that I don't end up disappointed?
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Yeah, that's a great
question because you know,
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like everything in plastic surgery,
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we have to be real mother
nature, doesn't blank,
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and we have to understand the
biology and understand what the
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00:16:46,761 --> 00:16:51,560
treatments can do and not
hope that against every,
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00:16:52,090 --> 00:16:55,920
every understanding it's going to
do more than it's designed to do.
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So, the first takeaway is if
you really need a facelift,
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whether you're ready for it or not,
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there's really no meaningful
substitute in 2022.
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And I do a lot of technology
development research,
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and I don't see anything on the horizon
right now that I think is gonna come
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online in the next five,
or maybe even 10 years,
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that's going to put facelift
into an obsolete category.
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Um, so you may not want to do it,
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but if you really need a
facelift doing something,
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that's not a facelift is probably
going to be disappointment.
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Uh, as I said earlier, the
small surgery procedures,
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the mini lifts and other things
that actually make incisions
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have
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00:17:46,550 --> 00:17:51,520
three quarters of the recovery of a
facelift or some something that ballpark
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is the same recovery.
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And so I think only for certain
selected cases where that's really the,
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the trouble area, are those
procedures very useful,
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uh, the short durability treatments. I
mean, sometimes that's the right choice,
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cuz they're so quick and easy to do.
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You need to look good now and you'll
deal with looking good later later. Uh,
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but recognize that's a big compromise.
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And often the cost of those procedures
is the same as things that would give
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you much more durability.
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So everybody loves minimal
options because they're less cost
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less recovery and less
or no scars or incisions,
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but the,
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what you're buying at the
same time with those options
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00:18:42,040 --> 00:18:43,800
is less degree of improvement,
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00:18:44,200 --> 00:18:48,480
less durability of improvement
and less predictability or
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00:18:49,640 --> 00:18:51,760
consistency, how much
improvement you're going to get.
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So everyone likes those first advantages,
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00:18:55,580 --> 00:18:59,760
but you have to live with the second
half as well when you pick a smaller
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option. So it's okay to compromise.
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00:19:02,420 --> 00:19:04,840
As long as you're being
real about the trade offs,
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00:19:05,270 --> 00:19:09,640
your plastic surgeon should explain the
pluses and minuses of all these options.
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00:19:10,420 --> 00:19:15,200
And if you accept the
trade offs, then you know,
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it can be a good choice for you.
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It's just a good fit for your
individual circumstances,
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00:19:19,860 --> 00:19:22,360
but don't hope you're
not going to get the,
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00:19:22,760 --> 00:19:26,720
the negative tradeoffs you're gonna
get the whole package. So, you know,
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my father used to have a saying, you know,
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don't expect a gourmet eight
course meal for a dollar 50
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00:19:34,060 --> 00:19:38,000
and the same is true when you're
picking these kind of treatments.
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That's a great point.
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And something very important that we
shall all keep in mind. Thank you,
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00:19:43,980 --> 00:19:47,620
Dr. Bass for sharing your
expertise regarding the
options and planning I should
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00:19:47,860 --> 00:19:51,540
consider in the decade leading up to the
facelift and thank you to our listeners
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00:19:51,541 --> 00:19:52,500
for joining us today.
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It was definitely encouraging to hear
that there are so many options to keep us
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00:19:56,381 --> 00:20:00,100
looking good before it's time for a
facelift, especially with new innovations,
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00:20:00,101 --> 00:20:02,420
like the, my elevate procedure. As always,
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00:20:02,480 --> 00:20:05,940
if you think of other exciting
developments or trends
in plastic surgery that
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00:20:05,941 --> 00:20:08,140
you would like us to discuss
in an upcoming episode,
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00:20:08,240 --> 00:20:11,900
please reach out by email or
Instagram. We'll see you next time.
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This is Doreen Wu,
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00:20:14,181 --> 00:20:17,780
thanking you for joining Dr. Bass on me
for this discussion of treatments and
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procedures T minus 10 years until the
facelift. Be sure to tune in next time.
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And don't forget to
subscribe to our podcast,
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00:20:24,800 --> 00:20:28,380
to stay up to date with all of the
exciting content that is coming your way.
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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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00:20:40,700 --> 00:20:42,580
educator, and technology innovator.
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00:20:42,880 --> 00:20:45,340
The commentary in this
podcast represents opinion.
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00:20:45,490 --> 00:20:48,040
This podcast does not
present medical advice,
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00:20:48,340 --> 00:20:52,360
but rather general information about
plastic surgery that does not necessarily
317
00:20:52,420 --> 00:20:55,520
relate to the specific conditions
of any individual patient.
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00:20:55,900 --> 00:21:00,560
No doctor-patient relationship
is established by listening
to or participating
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00:21:00,700 --> 00:21:01,533
in this podcast,
320
00:21:01,750 --> 00:21:05,720
consult your physician to advise you
about your individual healthcare.
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00:21:06,220 --> 00:21:07,600
If you enjoyed this episode,
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00:21:07,780 --> 00:21:11,920
please share it with your friends and
be sure to subscribe to our podcast on
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00:21:12,160 --> 00:21:15,840
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00:21:16,320 --> 00:21:18,400
or wherever you listen to podcasts.