Lifting Without Cutting #2: MyEllevate w/ Dr. Gregory Mueller

PA056 LWOC ep2 MyEllevate.txt
Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, a podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. Today's episode is the second in our series, "Lifting Without Cutting." This series looks critically at all the non-surgical options to treat laxity in the face and neck. Today we're going to discuss MyEllevate. Dr. Bass, we've talked about neck lifting before and energy-based treatments for skin lifting. What else is there? I feel like this is a key question for everyone who is too young for a surgical neck lift, but they're seeing that they need something to make a real change in the neck area.

Dr. Lawrence Bass (00:49):
I think you're absolutely right, Doreen. There's a huge cohort of people who have done all the basic things, but they've aged enough that they've lost their jawline. Their neck has a blunted look, but they're not ready for a surgical neck lift. Fortunately, nowadays, there's another option called MyEllevate. There's a lot of detail to this story about how and why it was developed and who is a good candidate to help tell that story. I've invited the developer of the procedure to join us on this episode of the podcast. Dr. Gregory Mueller is a plastic surgeon who trained at USC. He's board certified by the American Board of Plastic Surgery and Practices in Beverly Hills, and he's the developer of this ICLED technology that is the underpinning of the MyEllevate procedure. He's also innovated in other areas in including the oVio360, which is an imaging system. And I love technology and I love new things in plastic surgery. It's one of the exciting things about plastic surgery that we get so many new options. So I'm very excited to have Dr. Mueller join us and share his experience with MyEllevate.

Dr. Gregory Mueller (02:12):
Well, thank you so much for having me on the podcast today. And wow, what a journey it has been. This is something that has been sort of my project, I would guess I would call it my professional endeavor since I first kind of thought about it up here in 2005 to where it is today.

Doreen Wu (02:31):
Welcome, and thank you for joining us today. I'm excited to hear the story. So can you tell our listeners how the development started? What problem were you trying to solve?

Dr. Gregory Mueller (02:41):
Yeah, so I trained at University of Southern California and finished there in 1998 and went out into practice and here in Beverly Hills and love doing facelifts and neck lifts and opening the neck and so on. But what I recognized early on in my practice was that a lot of people would come through the door and they were too young to have a big facelift or neck lift procedure, or they were simply just afraid of something so invasive. So I just thought there's got to be a way to sew the neck muscles without really opening the whole front of the neck. And that's where my search began. And I think it was my experience of training in general surgery where I saw the value of laparoscopic or endoscopic techniques, and that's where the search began. I thought there's got to be a way to see underneath the skin to sew.

(03:33):
And one day I was using my laparoscope, my endoscope, I had done an endoscopic brow lift and Dr. Bass, you know how we use those. And I thought, I'm going to just look underneath the neck skin and see maybe that I could do a endoscopic neck lift. And what I realized was the skin doesn't really lift up and you don't have an optical cavity like you do when you're doing an endoscopic brow lift. But I saw all the retaining ligaments and I was looking at the skin and I saw the light come through the skin and I thought, wow, if I had a needle that was illuminated, I can see where that needle was traveling. And that's where it sort of started.

Dr. Lawrence Bass (04:13):
That's great. And I've often said on the podcast we're surgeons, we like doing big operations, but patients don't like having big operations. And so if there's a way to avoid that, it's always preferable. And I think the other thing it really points up is that a lot of what's important about contouring the face and neck is about the deeper tissues and not the skin. Everyone thinks about taking out skin, taking out skin, and that's part of it to be sure, particularly at the extreme of age. But structuring the deeper tissues is really essential. So to try to make it clearer what the procedure accomplishes, maybe you could walk our listeners through the steps of the procedure.

Dr. Gregory Mueller (05:05):
Sure, sure. So in simple terms, what it works like is it works as if you were taking your fingers and literally just kind of pushing up right underneath your ear lobes to lift everything up. And we all know how that looks in the mirror. We like the way that looks. And so what we're doing basically is injecting numbing fluid under the skin, which separates and lifts the skin up from the underlying muscle. So it creates a little passage that you can use. And between the skin and the muscle are all these attachments called ligaments, and we literally use the lighted needle and thread to pass through that space. The surgeon watches the skin on the outside and they see the light come through the skin, and we start in the center. We go up one side right around the jaw line behind the ear circle around, go all the way to the other side and then come back down to the center and out.

(05:59):
So you've got two little threads coming out and we have the patients tip the head back and we tie it down. So what it does is it is like a little corset that we've placed right on the muscle, and that's how we use the light guidance. And when we tie it down, it just lifts everything. So we don't have to go and open everything and move the muscles to the center and do things like that. We're just placing a little support system hovering right over the muscle, and that's how it works, and it lifts the glands and then just helps smooth the muscle contours, I might say. We also use it to make a little cut in the bands, and we do that through little needle punctures where we actually pass the thread around the edge of the muscle and then we just go back and forth with it and it makes a tiny little cut in the front of the band, and that helps to make these bands less visible.

Doreen Wu (06:49):
So Dr. Mueller, you said that a thread is used. How is this procedure different from a thread lift?

Dr. Gregory Mueller (06:55):
Yeah, we get that question asked all the time, and it's a great question because threads are very popular. A lot of people use them in the face to lift things and make things look better, but the difference is very substantial. MyEllevate is a light guided delivery of a normal suture material that surgeons would use in a surgery to sew things together, muscles and so on. It's a braided polyester stitch about the size of a thread you'd use to sew on a button, and we deliver it on the muscle and lift the skin and the muscle together as a composite. A thread lift on the other hand is usually a barbed suture that usually absorbs over time, and its really sort of goal is to place it right in the skin itself to kind of lift the skin envelope. So MyEllevate supports and lifts the muscle, thread lifts lift the skin and threads absorb. So the results last maybe a year at the most, whereas MyEllevate, you're looking at five plus years of durability.

Dr. Lawrence Bass (07:59):
And I couldn't agree more. I think that's really a critical distinction, the level at which the work is being done, and we're going to talk a little about outcomes later, but the durability of the procedure is substantially different, and that's really critical, critical when you think about when you're going to have to circle back and maybe work on these issues again, knowing that you've got half a decade plus and often quite a bit longer than that half decade is really a huge selling point for the procedure in my view. I know patients want to know how we're going to do it, how they're going to be improved, what's going to change, but the next question is always how long does it last? And we have a lot of longevity in American life today. We're blessed with decades and decades of late adult life, and so thinking about when we're going to have to repeat or return for additional work becomes a big part of the equation.

Doreen Wu (09:10):
So I think I'm starting to understand what's involved in the procedure itself, and let's say that I don't like my neck, but I'm not exactly sure that MyEllevate is right for me. Can you tell us who is the ideal candidate for this procedure?

Dr. Gregory Mueller (09:25):
Of course. Yeah. So MyEllevate is it's a great procedure for someone who is just starting to notice a little bit of droopiness underneath the chin. My patients will come in and they'll say, gosh, I looked at my photos. I was at a wedding and someone took a profile picture of me, and I'm noticing that things are starting to sag. I am 25, sometimes 25 year olds start having a little bit of sagging. But I would say my patient groups are usually 35 to 45 to 50, and they tell me, I don't want a facelift or a neck lift, but I just want to kind of shape things and make my jawline look better and underneath my chin, and I want something that will last a long time, definitely over a year and something that will be very effective. And so those patients are great ones.

(10:18):
And then also sometimes I have a patient come in and they might be in their twenties and they were born with a neck that's sort of like a ski slope where the chin kind of goes down to the chest and they're so unhappy because they just don't have a really nice jawline. And so those are great patients where you can actually kind of help with genetics, someone's inherited neck. So it really works for anybody who wants to improve their jawline contours, who doesn't have a lot of skin laxity. If somebody has a lot of loose skin, then we would think of a neck lift or a facelift for those folks.

Dr. Lawrence Bass (10:52):
I think that's a great summary, and I do the procedure. I haven't had the length or depth of experience that Dr. Mueller does, but I've had very favorable experience with the procedure. And I think because of that patient selection, if you're using the procedure for the right reasons in the right person, it totally delivers. And interestingly, I had a young lady in her twenties with some heaviness in her neck, but also some anatomic features that contributed to bluntness there. And I had liposuctioned her and the fat was gone, but she still didn't have the definition and the sharpness of the cervicomental angle, medically what we describe as the angle between the horizontal part under the chin and the vertical part of the neck. So I circled back and did MyEllevate on her, and that sharpened her up and gave her a level of definition that in youth she never had just because of the way her anatomy was.

(12:03):
The other place that I'm curious though, to hear about your experience, because I've thought about this quite a lot, is looking at patients who have had a facelift or an neck lift because the usual failure point a number of years down the line is some return of the vertical banding, some gland ptosis, the salivary glands that start to droop under the jaw and create fullness in the neck and some loss of definition or sharpness in that area. So I've thought a lot about, and now that I have you here at my mercy, I can ask you this question, are those patients good If there's not a lot of skin laxity return, but you're seeing the banding or the gland or one of those issues, is this a good minimal way to take someone who might be five or seven years out from a lift, really not ready for another full surgical lift and clean them up and give them that extra measure of longevity?

Dr. Gregory Mueller (13:10):
Yeah, no, I love the point you're making when you talk about the bands, the visibility of the bands or the glands and just like what you talked about earlier about your patient who'd had liposuction and you were able to bring that patient back and really optimize the results. So with facelift patients, it's a great tool to sort of bridge the procedure, give that patient a really renewed neck because you know how it is that the face always holds up when we do facelifts and neck, it's the neck that kind of gives out first.

Dr. Lawrence Bass (13:45):
Exactly.

Dr. Gregory Mueller (13:45):
So the ability to go in, use MyEllevate, make a little cut in those bands, sometimes we treat the skin with energy and there's many different types to help kind of tighten that skin envelope and then place MyEllevate. It's a great way to just give your patient a little re-up of their procedure. So yes, I use it in that application quite often.

Dr. Lawrence Bass (14:07):
Yeah, again, I'm newer to this procedure, so I'm starting in that direction, but I thought about it for a long time and I just think it's those bands that they're notorious sometimes even within a year or two, but certainly after a number of years, that's what you start seeing in the neck lift that's starting to wear out, and it's really great to have a way to give that a little freshening without going back for a full relift.

Dr. Gregory Mueller (14:44):
Oh, absolutely. And the nice thing too is you can do it under local anesthesia, do it in about an hour. They have this new contour, renew the results, and they're out the door. And same thing is true with younger patients. You're giving them results that will really overperform what you do with liposuction alone, which I love that as well. It really kind of sets me apart from my competitors here in Beverly Hills.

Dr. Lawrence Bass (15:12):
And that banding in the neck, it is again, a notorious failure point either in the early result and certainly in the late result. And there are a lot of very aggressive approaches to trying to treat the muscle in the neck, very extensive kinds of reworkings of the muscle, but it's not clear on a database that they're any better on average than MyEllevate. That might be an interesting area for study. And at the Aesthetic Society meeting a month ago, there was a whole panel on these very aggressive neck approaches, but it just strikes me that this is a very effective way of dealing with the vertical banding without taking that kind of recovery and that kind of risk on. And as a plastic surgeon and a researcher, I'm sort of a data guy, so I think a lot about outcomes and evidence-based medicine, we've discussed this on the podcast multiple times, which devices and treatments have data associated with them and which are driven purely by marketing. And so Dr. Mueller, there've been a few excellent publications dealing with outcomes, including durability with MyEllevate. Can you just outline the findings in those studies?

Dr. Gregory Mueller (16:43):
Absolutely. There were two studies, really the two cornerstone studies for MyEllevate, and the first one I published with Sherrell Aston in 2012. And in that paper we showed the strength of the retaining ligaments, and that's what we used to anchor the sutures. And so that shows that those ligaments will hold 10 pounds of force before they break, and we prove that they're the same as muscles. So right there, it shows you that anchoring sutures around those ligaments is as good as anchoring sutures in muscles. That was very important. That's sort of the basic science. Then I spent the next decade perfecting the MyEllevate procedure, and I'm so proud. We published a paper in April of 2023 in the Aesthetic Surgery Journal, 391 patients, five surgeons, four different centers, all with less than 5% complication rate. And this is insurgents with varying years of experience, which prove that the learning curve is quick, the procedure is safe, and outcomes were very consistent, which made me very happy. And I was an equal contributor to this study. I didn't have all my patients in there than just a few from the others.

(17:58):
So I love it. I mean, that makes me really happy. Now, the follow-up was a little short on the paper because it's a brand new paper, but the good thing is that paper, what it shows is this is a procedure that can be taught and can give really nice results with a very low complication rate.

Dr. Lawrence Bass (18:16):
And let me ask you one more thing, which we didn't touch on yet, but is also a really important feature. The procedure. Say a little bit about what the recovery time is like because facelift is not a disaster as a recovery procedure, but there is a significant period of time where there's swelling and firmness and the potential even for quite a bit of bruising if you get a little unlucky. So contrast that with what MyEllevate is able to accomplish in a typical treatment.

Dr. Gregory Mueller (18:49):
Sure, sure. So the beautiful thing about MyEllevate is we're doing everything through little punctures, and these are just a little bit smaller than two millimeters. And so we're not opening the skin, we're not making big incisions like you would in a facelift or a neck lift. And I think the key component is we're not lifting that skid up off the muscle, meaning that we're cutting away those little attachments, the ligaments. So the procedure is sort of, I always tell my patients sort of organic meaning that we're just keeping everything together and all we're doing is just weaving in a little suture in there to help lift everything. So the recovery times are much shorter. We're talking bruising for six to 10 days versus a facelift or a neck lift. You're looking at 10 days to 14 days of some bruising. And then the scar tissue sometimes can be lumpy, bumpy in those cases because there's that potential space for fluid to collect when you've lifted up the skin. So everything just by design of the procedure makes it less invasive. And then just keeping the skin connections to the muscle, I think that helps a lot.

Dr. Lawrence Bass (19:55):
Yeah, because drainage of swelling, I mean the less tissue you're disrupting all the normal channels for drainage of swelling that that causes that firmness in the tissues that still intact and allows speedy recovery. I have to say, I've really been struck by how short and how minimal the recovery is with this procedure. And my patients constantly make me a little crazy by going out in public, going back to work the same day of the procedure or the next day when I ask them to please rest quietly at home for a day or two so they don't bruise or swell unexpectedly, but they feel well enough. And you do wear a garment in that first couple of days and some neck support for a longer period of time. But for my patients who feel comfortable being out in public with that, it really hasn't slowed them down much. And I've really been very pleasantly surprised by how well they look when I see them back in the office at five days and at a couple of weeks and so on. So the recovery in the busy 21st century lifestyle is another key component of what the procedure can offer.

Dr. Gregory Mueller (21:21):
Yeah, I think that the true value of the procedure is as you were saying, that short recovery time and also just the patients feeling confident enough to go back out and go back to work or do their normal activities. And there's so much value in that because when I used to open the neck and I love technically challenging procedures, my patients don't though, I don't think, they would be beat up for a long time, and they were mad at me. And so the nice thing about this procedure is they're always very happy. I'm very happy, but it kind of flips the paradigm I believe of minimally invasive because usually minimally invasive is minimally effective. I feel like this is quite effective. And then you have the long durability, and I think that's because it's a low tension support system and we're using the normal structures of the body to anchor it, and we're not putting things in places they never were.

Dr. Lawrence Bass (22:19):
And I also think it flips the paradigm in another way, and I just thought of this as we are sitting here chatting, that most patients sort of put off and put off and put off getting something done with their neck. They're waiting till they're ready to pull the trigger on getting a neck lift. And with a short recovery, a long durability correction, a meaningful correction of the deep support in the neck, really, it's much to your advantage once you see some changes there that are starting to detract from your appearance that are starting to give you a little bit of an aging look to jump in and get it corrected rather than dragging it out until you need a major restoration.

Dr. Gregory Mueller (23:12):
Absolutely. And today with everybody using social media and so aware of their jawlines and so on, this just gives patients an earlier way, as you were saying, to kind of slow down the process of aging, but to also use that younger skin elasticity because it's there, but those muscles are the darn things that cause everything to kind of collapse. So you're getting in there and lifting the foundation and then keeping that patient looking great for a longer period of time, and maybe later down the road they'll need a facelift or a neck lift. But the nice thing is all you've done is placed two little strands of suture there, so it's an easy one to go in and do a facelift or a neck lift later.

Doreen Wu (23:59):
Now let's look to the future for a moment, Dr. Mueller. What might be coming next to improve MyEllevate?

Dr. Gregory Mueller (24:06):
I think MyEllevate, because I've been working on it for so long, I can say this, that my dream was always to get it into other surgeon's hands, the technology and the procedure and see what they would come up with. And already a couple surgeons, Dr. Barry DiBernardo and Jason Pozner came up with a way of anchoring the suture behind the ear when we do a little skin removal. So we can also use the procedure combined with a little bit of a skin tuck. And so the nice thing is if you have a patient who's got a little bit of excess skin and the patient doesn't want to have a big facelift or a neck lift, we can do this sort of what we call a MyEllevate Plus. So they came up with a way of anchoring it behind the ear, which I think is great. So I think surgeons are very creative by nature, so I think surgeons will find sort of little different applications of weaving a suture underneath the skin. We've used it on midface lifting. It's a little bit more challenging because you've got to balance the right face with the left face, whereas with the neck, the thing I love is it's one continuous half arc suture passage, so it kind of equalizes asymetry for you, but also the brow using it as a way to elevate and shape the eyebrows. I think there's a lot of different things that we can do with it, but I'm looking to other surgeons to come up with crafty ways of using the technology.

Doreen Wu (25:37):
Dr. Bass, would you like to add any takeaways?

Dr. Lawrence Bass (25:40):
This is all related to all the basic principles we often talk about on the podcast. It's essential to have a good working relationship with your surgeon, who's someone who's experienced in facial rejuvenation. There's no one best procedure or treatment for all patients. It's about matching your needs at your stage of aging and what works well in your selected surgeon's hands. Everyone feels differently about when or even if they will ever get a surgical neck lift. MyEllevate is something that can address significant concerns in the neck that offers research-based data-driven approach with obvious improvement, minimal recovery time, and excellent durability. It doesn't fully replace the neck lift for older patients with substantial skin laxity, but it's an outstanding option for patients at the right stage of aging that preserves the neck lift option for later in the game. And Dr. Mueller, it's been a delight to have you and to hear about the journey of innovation and the way you problem solve from things that were observed in the clinic and the long period of time that you persevered to really make it happen, rather than just either giving up or doing something that wasn't effective to really get to the point of perfection.

(27:23):
So thank you for joining us and sharing the experience. I really appreciate it.

Dr. Gregory Mueller (27:27):
Thank you so much. It's been a true honor and have a wonderful day. Thank you.

Doreen Wu (27:33):
I'll echo Dr. Bass and say thank you again to Dr. Mueller for joining us today and sharing your innovative journey in plastic surgery with all of our listeners. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.