Lifting Without Cutting #4: FaceTite & AccuTite w/ Dr. Sherrell Aston

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, the 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. This is episode four in our series, Lifting Without Cutting, where we explore non-surgical options for skin laxity. In today's episode, we are discussing FaceTite and AccuTite. FaceTite sounds like what everyone wants. What a brilliant name for a technology and easy for me to understand still. I know there's always a backstory. Can you share it with us, Dr. Bass?

Dr. Lawrence Bass (00:42):
Well, FaceTite is a device that uses radio frequency. In this regard it's in a large class of devices using this type of energy to heat and remodel tissue.

Doreen Wu (00:56):
So what's different about FaceTite?

Dr. Lawrence Bass (00:59):
Well, the device is applied using an electrode that's placed under the skin through a tiny incision. This brings a lot more energy to the target tissue, the deep or underneath surface of the skin and the fat and connective tissue fibers that hold skin down compared to other technologies that try to put energy through the skin for safety and to better assure heating to the right endpoint. There are various forms of feedback control that dose the correct amount of energy with the FaceTite device. So this is a really important feature with radio frequency. The amount of energy absorbed is based on the resistance called the impedance in the tissues, and this varies a lot from person to person and then limits the precision of a lot of RF devices that don't employ feedback control.

Doreen Wu (02:01):
It's a better treatment through science. Sounds like an advanced approach, but what can you tell me about what the device can do and who is the right candidate for this treatment?

Dr. Lawrence Bass (02:11):
Well, to answer those questions, I've brought an expert to share his experience with the device. Dr. Sherrell Aston is my chairman and mentor in aesthetic plastic surgery. He is one of the most accomplished aesthetic plastic surgeons in the world, practicing very successfully in New York City. He is a professor of plastic surgery at New York University, a past president of the American Society for Aesthetic Plastic Surgery for more than 23 years, chairman of plastic surgery at Manhattan Eye, Ear and Throat Hospital. And he's also taught a cutting edge symposium on technologies and techniques in plastic surgery. That was one of the largest aesthetic symposia in the world, attended by leading surgeons from all over the world to upgrade their capabilities. So I'm very happy to have Dr. Aston join us today.

Dr. Sherrell Aston (03:20):
Thanks, Dr. Bass for that introduction. It's a pleasure to be here with you. I must say you've been a part of these educational teaching programs that we've had for many years and I recognize you as one of the world's leaders in aesthetic surgery, particularly the new technology section of facial rejuvenation or body rejuvenation in general. And so your accomplishments are well known by the world also. So it's a pleasure to be here with you and I've enjoyed having you on my radio show over the past 15 years on multiple times. So we've shared a lot of educational materials for the public for many years together. Thank you for having me this time.

Dr. Lawrence Bass (04:04):
My pleasure.

Doreen Wu (04:06):
Welcome Dr. Aston. Thank you for joining us on the podcast today.

Dr. Sherrell Aston (04:09):
Thank you, Doreen.

Doreen Wu (04:10):
So Dr. Bass touched on it, but can you detail how the treatment is performed? What is involved for the patient in terms of local anesthesia treatment experience and time, and what is the surgeon doing?

Dr. Sherrell Aston (04:23):
Okay, so let me tell you a little bit more, just amplify a little bit of what Dr. Bass said. The thing about FaceTite is it's a bipolar radio frequency, which means that the electrode that Dr. Bass spoke of that goes under the skin is delivering the heat energy, but there's also an electrode on the surface of the skin. So heat from internal electrode to the external electrode bipolar radio frequency, which makes this technology very different and the heats that's generated from the internal electrode can be very intense. In fact, Dr. Bass indicated that the machines have controls on 'em, so you can't generate too much energy, it'll turn the machine off before it'll burn the skin. Now the technology itself has expanded a great deal. I first started doing the bipolar radio frequency technology in 2017 I think it was, and we've expanded the use of that technology greatly today.

(05:37):
Initially we used it for, we thought it was going to be used for what we would call treatment gap patients. That was three groups of patients that we didn't have a procedure for that was a young person that had some changes in their face that really wouldn't be ready for one of our surgical procedures. Patients who needed a facelift but didn't want it, we said, I'll be happier with something that's less than a great result, but would make me better. And the patients who had had facelift surgery and they got some recurrent laxity in the face collections of jowls, et cetera. Now we've expanded this technology. I incorporate it in almost every facelift that I do today as well as a number of standalone procedures. And your question, you asked me, what is the patient doing about local anesthesia? Yes, we use local anesthesia for many of these patients when you're treating specific areas and we can go into that area and we can talk about it when you're ready.

Doreen Wu (06:45):
And is there any recovery time after FaceTite treatment? Is it a single treatment or series?

Dr. Sherrell Aston (06:51):
Well, FaceTite itself, and we'll get into AccuTite a little bit later. FaceTite itself is usually a one and done procedure. It's a procedure that we use primarily for the neck, the jawline, the cheeks. The other bipolar radio frequency that we use in conjunction with the FaceTite is called Morpheus8, which is fractionated bipolar radio frequency and something people call that a radio radiofrequency microneedling. So we combine 'em together. The recovery process depends on how much you have to do and it's just like a facelift procedure, any other aesthetic surgery procedures we perform, it depends on what you need to do for the patient. So if you have somebody who just has a little bit of jowls, you can take it away and they're not going to have much of recovery times. Some people will, they'll bruise like crazy and others will have minimal bruising. You see 'em a day after surgery and they have a little yellow blue and some people can be really bruised. So it varies from person to person, just like most aesthetic procedures.

Doreen Wu (08:01):
What about results? How much improvement can I expect and how long does it take to see the results? Exactly what features are being targeted? You touched on this briefly before.

Dr. Sherrell Aston (08:11):
Sure. Well, the results with a FaceTite procedure, you can see before you put the bandage on, you can change the jawline, the neck immediately you see it happening on the table. As a matter of fact, just a couple hours ago I posted on Instagram an AccuTite that I did today in a minute and 13 seconds, you see the jowl, not, excuse me, not the jowl, the nasal labial fo on the patient's left side go from protruding forward to flattening out and it had some injection in it. So when the swelling's all gone, it'll be better than the result that's right now on Instagram. So you see the result depending on most procedures that we do and Dr. Bass would and certainly agree, the more you need to do for a patient, the more change they need, the more results you're going to see as you're doing. But people certainly change.

Doreen Wu (09:20):
Now, can you tell me who is an ideal candidate for the treatment?

Dr. Sherrell Aston (09:24):
Well, if we're talking about FaceTite, and this is where we have to lump in AccuTite, if you see someone whose primary concern is the jowls or the nasolabial folds, then you can just put the AccuTite electrode, the difference. Let me tell you the difference. A FaceTite cannula, the probe that goes under the skin's 10 centimeters long and the head of it, the tip where the energy is generated is 1.3 millimeters. Stop and think about it, that's pretty small. 1.3 millimeters in diameter and the AccuTite is six centimeters long and the little tip that it generates energy is, is 0.9 millimeters. Okay. So we can pass that at either of these instruments through a small puncture incision under the skin and do the procedure we want to do. You can take away the jowl, melt the nasolabial fold because see that energy is producing what we call thermal lipolysis or heat breakdown of fat.

(10:35):
And you can contour that jowl. Now what's the difference between that and say liposuction because you're doing some breaking down of fat, remove some fat as Dr. Bass said at the outset, we're applying energy to the underlying foundation. What we're doing with that energy is getting what we call contraction of the fibroseptal network. That means we're targeting the tissue with the AccuTite, FaceTite, so that the fibroseptal that attaches the skin to the underlying foundation are shrinking, you're tightening them. So you're tightening the skin. You'll see that contour change on the table. The other thing that's interesting is when you see the patient a year after surgery, they'll tell you that they're better a year after surgery than there were three months after surgery. Why is that? Because they're building collagen. They're tightening as the skin has an opportunity to build new collagen. In other words, you're getting what I call an architectural biological rejuvenation of the skin because you're making that skin more like younger skin.

Dr. Lawrence Bass (11:47):
I think that's a really important point. And not only the skin, but that fibroseptal tissue that gets heated up adjacent to the fat, that tissue as it remodels and adds collagen is going to densify and lock down the skin. When we're young, we're not loose. Our connective tissue fibers hold our skin close against are underneath. And by firming up that connective tissue component under the skin, it locks us in better and in a progressive way as you build that collagen in the months following the treatment.

Dr. Sherrell Aston (12:28):
I totally agree. Dr. Bass, excellent points.

Dr. Lawrence Bass (12:31):
So I'm curious to hear your opinion, Dr. Aston. We talked about loose skin, but are these under the skin treatments helping with wrinkles as well? Or is that where you really flip over to Morpheus8?

Dr. Sherrell Aston (12:45):
Well, obviously that varies somewhat from person to person because the quality of the skin is extremely important. And by the way, we should point out that when people get to a certain age in life and they have super thin skin and they've been smoking all their life and they've been in the sun, that sort of stuff, they're very, very difficult to stimulate collagen production with any technology known to man. But you can get some contraction of the fibroseptal network that Dr. Bass was just talking about. So you are getting some changes in the underlying foundation and before this technology came along, we just didn't have that wrinkles in the skin. I treat with the Morpheus, the fractionated bipolar radio frequency needles and we find that that helps a great deal, but you need multiple sessions with that.

Dr. Lawrence Bass (13:50):
Sure, that makes sense. Now, this technology grew out of the body type devices, the sort of bigger version that was used for body contouring in conjunction with liposuction. So we worry a lot more about loose skin in the face and neck, but sometimes there still are issues with fat that we need to contour. So what's the role of this technology for contouring or for fat reduction in the face and neck area?

Dr. Sherrell Aston (14:23):
Well, I think it can compliment if you have large amounts of fat removed, you still do the FaceTite because that will give you the fibroseptal network contraction that you don't get with liposuction alone. And if you have a great deal of loose skin, obviously you've got to take away that extra skin. Today I blend FaceTite or AccuTite into my facelift procedure. I think, as I said a few minutes ago on a majority of patients. So I use this as a complimentary technology to get changes in the skin we couldn't get before. If you have a lot of loose skin, you got to tighten the skin, take it away, and then you make the skin quality better by using the technology. If you have someone, Dr. Bass is alluding to just isolated locations of fat pockets under the chin or the jowl area, you add a little technology to that. If there's large amount of fat, you can liposuction it after you apply the technology and it helps the skin contract.

Dr. Lawrence Bass (15:34):
That makes perfect sense. So you spoke a little bit about the difference between FaceTite and AccuTite, and I'm just curious to hear you catalog when you use each as a standalone and when you use it at the same time as a surgical facelift, what spots on the face do you usually chase with these technologies when you're doing a facelift at the same time?

Dr. Sherrell Aston (16:00):
Most time Dr. Bass, if I'm using the AccuTite to complement the facelift, it's reducing the nasolabial fold. And if the skin is particularly not so good quality along the jowl area, I'll also use the AccuTite and I use the AccuTite for nasolabial fold and jowl just because it's a smaller tool and that's it easier to manage as a surgical instrument if you will. In this case, a minimally invasive procedure complementing surgery. So the jowl is very good for AccuTite, jowl is very good for AccuTite. And in patients who have a lot of laxity in the skin and the anterior face, I'll do AccuTite or FaceTite more often AccuTite because I'll be dealing with the anterior lower portion of the face where the wrinkles are extremely bad. I'll do the AccuTite. I get a fibroceptal nerve contracture, I'll undermine the skin, often go under the same area where I just did the fibroceptal network contracture technology and finish that up with the Morpheus8 over the same area. So that skin has had the the undermining of the surgery and the Morpheus right over top of it. And that has helped me with the patients who have really poor quality skin, a lot of wrinkles out very far on the face. I guess I new degree a hundred percent. The patients have a lot of laxity and wrinkles very far, almost to the corner of the mouth. They're very difficult to just get out with a facelift.

Dr. Lawrence Bass (17:48):
Yeah, I do agree a hundred percent. And I think an area that I find particularly troublesome is that area right by the corner of the mouth. It's north of where the jowl is and there's often a bulge there. There's often lax skin or wrinkled skin there. And facelifting alone doesn't a hundred percent address that area. And a lot of patients come back and point to it and want to know what can be done. So this is a good way to chase it, it sounds like.

Dr. Sherrell Aston (18:21):
Well, it certainly can be a complementary, can make some people better. And as you know from having done hundreds of these yourself, that little bulge sometimes at the corner of the mouth is more muscle than fat. And you can't get 'em exactly where the patient would like to go or where we want to make it go away for 'em. But we make 'em as good as we can. Right?

Dr. Lawrence Bass (18:48):
At least we get it better. It's a way of amplifying the response that's right. Now another spot that's often troublesome is getting that last little drop of skin out right at the cervicomental angle, right at the part of the neck between the horizontal and the vertical. We get 95%, but sometimes it's hard to get a hundred percent. Is a little energy at the same time as the facelift or maybe at a later sitting just with a little drop a local anesthesia in the office. Would that be a good way to chase that feature?

Dr. Sherrell Aston (19:25):
Both times would be correct, if they have that little bit of laxity wrinkle skin low in the neck, I agree with you, that's a very difficult area. I'll do the facelift, tighten the neck, do Morpheus at the same time. And having told most of 'em, depending on how much loose skin they have, they we're going to do this another three times and you're going to come to the office, we're going to put a topical anesthesia on. You sit in the chair and do your emails for about 40 minutes and we'll do it with the Morpheus. You go home, you may be a little bit pink on your neck that day the next day. But really when we have downtime, most people agree with that. They're happy to do it.

Doreen Wu (20:09):
Lastly, as we come to a close, Dr. Aston, what takeaways would you leave our listeners with when it comes to FaceTite and AccuTite?

Dr. Sherrell Aston (20:16):
Well, I think they would have to say that FaceTite and AccuTite add to the armamentarium of the plastic surgeon for facial rejuvenation procedures. It gives us something that we can do that's minimally invasive to help rejuvenate the appearance of the skin. And it's also a tool that we can use to complement the results of our surgical procedures. So it has become sort of an everyday tool to use in trying to make people better. So I really think it's been a great step in the right direction for facial rejuvenation, particularly minimally invasive procedures.

Doreen Wu (21:01):
And Dr. Bass, your takeaways?

Dr. Lawrence Bass (21:03):
So I'll start with what Dr. Aston just said. It is a minimally invasive treatment and by putting the skin in, putting the energy in under the skin, we can get much more energy in than with the wholly noninvasive treatments. So that allows an amplification of the effect that we're going for. So this kind of treatment is good as a standalone for earlier stages of skin laxity that don't have major amounts of hanging skin. And it's also grade in conjunction with a facelift and neck lift for features that are not well addressed by the surgery alone. And to amplify the overall quality and completeness of the result of the facelift. Facelift is A, and we want to get it as close to A+, as close to a hundred percent as we can. And by using a multimodality approach instead of just one tool, it's possible to really come a little closer to complete rejuvenation. It also has a role in early rejuvenation, as I said, and for an aging facelift that's not ready to be redone yet as a post-surgical maintenance treatment in the years following a facelift. So Dr. Aston, I'd like to thank you. It's been a pleasure having you on the podcast and you continue to innovate and look at new options, and that's why everyone listens to you when you get up on the lecture podium because you always have something important to say.

Dr. Sherrell Aston (22:50):
You're very kind, Dr. Bass, and thank you for the opportunity to be on your podcast.

Doreen Wu (22:55):
Thank you Dr. Aston, for sharing your expertise with our listeners. I really enjoyed hearing your fascinating perspective on the current state of affairs in nonsurgical options with and without surgery. 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.