Non-Surgical Facelift Techniques

When it comes to non-surgical facelift techniques, there are two basic categories people talk about when discussing the techniques.

FIRST CATEGORY

The first category is a facial rejuvenation procedure that is done in an office with fillers and Botox.

Patients come in for injectable materials to rejuvenate the face. There are brand names such as Botox, Dysport, and Xeomin that are all essentially the same thing. They work by freezing the muscle. In other words, when it is injected into the muscle of a particular part of the face, it soaks in and actually blocks the nerve from transmitting to the muscle. It prevents the electrical signal from the muscle to the brain.

There are also different categories and types of fillers. The most popular filler is hyaluronic acid. Restylane was the first brand of hyaluronic acid injection. Some of the others include Juvederm and Perlane. Essentially, the way they work is they are injected into the area of the face that the patient wants to fill or plump up. As people age, they start getting troughs and depressions in the face as the fat in the face either atrophies away or descends. Patients want to accentuate the highlights and reduce the shadows and make the face look fuller and younger. This is accomplished with fillers.

SECOND CATEGORY

The other category is to use a device-based non-surgical face lift. There have been a number of different technologies over the years that were based on the idea to actually tighten or lift the tissues of the face non-surgically. The very first non-surgical face lift device was called Thermage and it came out in 2001 or 2002.

The latest device that is popular is Ulthera. That is an ultrasound-based device that uses ultrasound to focus energy on the deeper tissues of the face and coagulate the collagen and make it tighten up.

The studies regarding the efficacy of these devices are not strong and the devices themselves are not a replacement for a surgical rejuvenation of the face, neck, or forehead. Most of its popularity is due to marketing. Somebody at the age of 55 with a lot of neck skin laxity and platysmal bands and jowls is not going to get great results with these Thermage or Ulthera. These devices are not at a point where they can give a really dramatic and natural-looking facial rejuvenation.

GOOD OPTION FOR PATIENTS WHO CANNOT HAVE SURGERY

Not every patient is going to be a candidate for a surgical procedure so the non-surgical filler and neuromodulator (the Botox family) is great for a lot of patients who do not want to or cannot go under the knife.

The different Botox options are a good way to go until the patient is ready to have a surgical procedure.  The Botox and fillers can be used in the same setting on the same patient but they will not be mixed together.

NON-SURGICAL ADVANTAGES

The main advantage is the minimal downtime. With fillers and Botox, the patient might get a little bruise here or there that will last for a few days. They can be covered with makeup. There is no anesthesia as well as no real significant recovery time. The risks are pretty minimal.

Another advantage of the fillers and Botox is that an experienced doctor can develop a style and artistry in terms of how they apply them to give a really natural result.

One other advantage is the patient can do a non-surgical procedure in the office during lunch since there is really no downtime.

RELIABILITY AND LONGEVITY

When it comes to fillers, there are multiple companies that make the hyaluronic acid types and there is one company that makes the calcium-based type.

The hydroxyapatite calcium-based injectable lasts the longest. Most studies have shown that the calcium does not break down as easily as the hyaluronic acid.  Having said that, it can last in the area of the lips for as little as six months. In the area around the eyes, it can last over a year after being injected.  Calcium can last a year to a year and a half and it dissolves away over time.

The length of the results is filler-dependent and technique-dependent. In general, injections around the mouth and the lips do not last as long as injections around the eyes. The theory is that because there is more movement around the mouth, injections break down more quickly and kind of dissolve. There is less activity around the eye allowing the injections to last longer.

There are some filler types that are “permanent.” The disadvantage of these fillers is that long-term means 10 to 20 years down the road, it may look unusual because the face changes around it.

LIMITATIONS

Non-surgical options will only help so much on patients who are a bit older and have a lot of aging issues such as extra skin and wrinkles on their face. Some wrinkles can be treated but not extensive and permanent wrinkles of the cheeks and all other places. In most cases, those patients may need laser peel or a chemical peel.

If a patient has a lot of extra skin in their neck, no non-surgical procedure is going to completely remove the excess skin. They are going to need a surgical procedure on the lower face and the neck to improve that area. Surgical procedures will give the patient more dramatic results.

COMPLICATIONS

The main potential side effect of Botox is if it works on a muscle the doctor or patient did not want it to work on. For example, if it is injected around the eye and some of the Botox gets into the eyelid, the upper eyelid can droop down. It is not permanent. The effects of Botox last about three to four months.

Injecting fillers is technique-dependent so sometimes patients can get little lumps and bumps if the doctor is not careful. They can sometimes be massaged away or they can be injected with something that dissolves the filler.

There are more serious complications that can occur with filler injections. When a lot of filler is injected really close to the skin, it can cause the skin to kind of die in that spot. It is very rare but it can happen.

The most devastating complication can happen if the filler is injected around the eye. Blindness can occur in one of the eyes. The theory is that some filler gets into a blood vessel and goes to the back of the eyeball and blocks off the blood vessel to the retina. This happens on an extremely rare basis.

The use of Thermage did cause some burns on patients because of the high settings on the machine about 12 or 13 years ago. These days, the incidence of the burns and the swelling with the Ulthera and Thermage machines is pretty rare.

RECOVERY

The difference in the recovery process for botox and fillers is for fillers there can be some bruising and swelling that lasts for a few days.  After being injected with Botox, bruising rarely happens and there is generally no swelling.

FINAL THOUGHTS

The non-surgical procedures that exist today give doctors more options for patients that they did not have 15 years ago. Patients can increase the volume around the face without doing a facelift. It gives them a really nice rejuvenated result when they are not quite ready for a surgical procedure.

Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Sam Most, MD in Stanford, CA