T Minus 10 Years: Mini-Treatments Leading up to the Facelift

Doreen Wu (00:02):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your cohost Doreen Wu. I'm excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "T minus 10 Years: Mini Treatments Leading Up to the Facelift." I'm going to start off with a story. I'm sure you've heard before Dr. Bass. And I think some of our listeners will be able to relate to what I'm about to describe. I'm not looking young anymore. I look in the mirror and I'm seeing more and more aging changes that I don't like. And don't really want, I've thought about a facelift, but I'm not quite ready to go there yet. Maybe in 10 years or so. Does this sound like you? If so you're in luck because this is the episode for you, Dr. Bass, how do our listeners know if they fit this example?

Dr. Lawrence Bass (00:57):
It's likely by age, uh, that they can get a pretty good indication of if this is where they are. Uh, they, they don't have really obvious hanging skin, but they're seeing more and more little things accumulate. And they're seeing that that hanging skin is somewhere in their future. Uh, it may also be by what they've done previously in the way of aesthetic surgery or aesthetic medicine treatments. And, you know, but it's likely that beginning of a little bit of, jowling a little bit of irregularity to the jawline, a little bit of hangs under the chin and lower down in the neck. And these are signs that, that facelift is going to be on the program at some point in the future. If you want to look your best, but not quite yet,

Doreen Wu (01:56):
How solid is this age? Is that early or late in the game,

Dr. Lawrence Bass (02:01):
We call this episode T minus 10 years, but by the same token, it may be T minus 20 years. If you're not planning a facelift until, until your sixties the options will play out a little differently in the earlier time period with smaller treatments and a little more invasively in the T minus 10 period. But that whole lead up to the facelift is when we're pursuing definitively more minimal options.

Doreen Wu (02:33):
Okay, I hear you. I've worked hard at taking care of my skin, but it's not enough anymore. Can you break it down for me? What are my options?

Dr. Lawrence Bass (02:42):
So, as you said, we have to break it down and take it by category. The first thing which should have been part of your beauty project for a couple of decades is the skincare. This is for maintenance, and then increasingly a little bit more medical treatments for restoration, deeper peels and more recovery based energy treatments. These are chasing the surface, changes in the skin, redness, pigment, like age spots and, and rough texture and early wrinkles.

Doreen Wu (03:19):
That's definitely reassuring to hear having a good skincare regimen is something I've consistently been working on since I was younger. Is this a small step forward in the magnitude of all these treatments? Or is it a big one?

Dr. Lawrence Bass (03:32):
It really depends on how you want to approach it. There's a very broad range of options in this category from many different manufacturers and all different kinds of modalities. So you can do this in a multi-step fashion, kind of like a maintenance program where you're periodically doing light or no recovery treatments, or you can aim for a big cleanup with a recovery based treatment that will hold you for a while.

Doreen Wu (04:04):
What is another category of aging that plastic surgery can help address?

Dr. Lawrence Bass (04:08):
Well, as you get into this T minus 10 years period, before a facelift, you're at the age where you start to see volume loss in the face is accelerating. It's not just the nasolabial folds being a little deeper, but the accumulated fat loss, which has really been going on since the late twenties is starting to add up. And in addition, you're at the point where we're seeing the beginning of bone and muscle loss in the face to an extent that it's actually starting to show. So this means not just, you know, a little touch of filler, half a syringe or a syringe in a, in a fold. This is a revolumizing of the face, uh, or occasionally a round of surgical fat grafting and not the small features, but the big features, the jawline, the cheeks, the temples, if they need it.

Doreen Wu (05:11):
I don't know. That sounds like a lot of filler. Will I still look natural with all that filler?

Dr. Lawrence Bass (05:17):
Well, this is a critical point. And we, and we talk about this all the time on, on the Park Avenue Plastic Surgery Class, that always every intervention we want to do in a fashion that preserves a perfectly natural look. So the idea is this, if I put back volume that you lost with aging, and I put it back where you lost it, I'm not distorting you. I'm putting you back where you were. So adding back volume, you lost is a good thing that brings you the shape that your face had in youth. If I add more volume modestly, I can accent your features and enhance them a little, or maybe harmonize them a little, but I don't want to, for the sake of dealing with something, that's not volume loss, I don't wanna just pump you up because that will be distorting. And that's a big mistake. So there's no reason you can't look perfectly natural, but it has to be artistically applied. And it has to be applied improper measure. And that's true with everything we do in plastic surgery.

Doreen Wu (06:29):
That all makes sense, but aren't these things that I will eventually address when I get my facelift.

Dr. Lawrence Bass (06:35):
So that's a great question. And, you know, we'd like life to be simple. We'd like one thing to go wrong. And we do one treatment and it fixes everything, but this is just not how life works. Everything is multifactorial. And the things we've been talking about for the last couple of minutes are really other aging features that are showing. And they tend to show earlier than major laxity starts to trickle into the face. So they're really separate issues from facelift. Now, if I put volume back, that will take up, you know, a minimal amount of laxity or slack in the face, and that's a good thing, but that only really helps me when it's very minimal. And once it becomes more significant, then we have to start looking at other options.

Doreen Wu (07:26):
Here's another scenario. What can I do about skin laxity, short of a facelift?

Dr. Lawrence Bass (07:31):
So this is, this is what I'm saying, you know, early on, almost anything we do has, you know, there's a, just a teeny drop of overlap between all these different major categories, the volume loss, the skin surface changes and skin laxity are the three big categories. And, you know, almost any treatment we do, we do has a drop of effect on all of them, but it predominantly affects only one of the categories. So when we're starting to see more than very minimal skin and laxity, we have to start doing treatments that are expressly designed to address skin laxity. So major laxity, this is the most obvious sign of age. Major laxity is still treated with the facelift. There's no replacement in, in any fashion that measures up to what a facelift can accomplish in dealing with major laxity. But this podcast is about T minus 10 for the facelift you're years away from when you have to go to the facelift. And so there are all sorts of mini options that are designed to address laxity, not work on laxity in a backhanded way that are worth chasing down in this, in this T minus 10 stage.

Doreen Wu (09:05):
What are some of these options?

Dr. Lawrence Bass (09:08):
So, you know, there are a range of options. Some have a bigger effect, some have a smaller effect. The ones with the smaller effect are things you're gonna work on. If you're thinking of a facelift earlier in the game, and if you're really gonna hold off the facelift until very late in the game, when you really, really have no other option, then you're going to pick some of the bigger options. The lighter options are things that apply energy externally to the skin to create new collagen and a tightening effect. These are things like Ulthera, which uses sound energy or wanding techniques with radiofrequency energy. And, and there are a number of of different brand names for these kind of treatments. The radio frequency wing is typically a repetitive treatment. You may do three to five treatments where something like Ulthera is typically done as a single treatment, or occasionally with a second follow up treatment a few months later, if that's not likely to be enough, then you have to resort to some of the treatments which are called microinvasive.

Dr. Lawrence Bass (10:20):
And the big category for that today is radio frequency microneedling. So little needles, little arrays of needles go into the skin to a defined depth. And most of the needle is insulated, but the tip is not an energy is applied there, which creates a little thermal injury as the body heals. You add collagen and you get a little tighten up again, typically done as a series of treatments, very often five, or sometimes more occasionally only three and often a little bit of recovery because there are multiple punctures in the skin. Now it's important to point out that it takes a few months to really see the full effect of these treatments as the body responds to the injury. And does the work of tightening up the skin. It's also important to point out that these treatments have a wide variation in response based on how old you are and how much remodeling ability your skin has because we're pushing the skin and we're counting on the skin to respond. The final set of options are internal energy options. Things like laser liposuction or face tight, which uses radio frequency in an attempt to put more energy under the skin in a minimally invasive fashion, through small incisions of a couple of millimeters, or just needle punctures and push the skin hard to tighten up.

Doreen Wu (12:03):
Let's say, I've waited and I'm still not ready for a facelift, but there's more laxity showing what can I do short of a facelift to address my concerns.

Dr. Lawrence Bass (12:12):
So now you're getting to a set of treatments that are minimally invasive to actually surgical treatments that are smaller than a facelift in an effort to actually pull and lift the skin. And in some cases to actually remove excess skin just in a smaller zone than a full face lift does. And these are things like thread lifts, which are sutures that have either barbs or cones that can slide in one direction. And one pulled in the other direction, exert a lifting or traction effect on the skin. There are pinch lifts and mini lifts, and there are all kinds of variations of these, but these are small surgeries that actually make incisions to remove skin in small focused areas where it's most prominent. I'm not a huge fan of these procedures. They're useful for very specific individuals, but the recovery from those procedures is often very close to the recovery that you get in a full facelift, just in a smaller part of the face because you focused your surgery there.

Dr. Lawrence Bass (13:30):
And so for a lot of folks, by the time they need that, if they did the full face lift, they would get the much more complete correction and the much longer durability. But those are options in some cases where there's just a particular part of the face that really gave out.

Dr. Lawrence Bass (13:51):
And another example of that is a surgical platysmaplasty where a small incision is made under the skin. And there's an attempt to correct the vertical banding in the neck by rejoining the platisma muscle edges that have separated with aging and trim sometimes trim extra muscle tailor off excess fat, if there's a blanket of fat in the neck. So again, if that's the focused area of trouble, sometimes that smaller procedure with a somewhat smaller recovery than facelift will, will hold you for a few years.

Dr. Lawrence Bass (14:30):
And a more recent development is something called the trampoline platysmoplasty.

Dr. Lawrence Bass (14:37):
So this is a procedure that does not make incisions. It's done through needle punctures, using a suture to divide the muscle banding and to suspend and support the tissues along the jaw line and under the chin in the, in the neck to sharpen the contour in the neck and to sharpen the contour in the jaw line. And so if there's some sagging, not a facelift level of sagging, that procedure can work well. And compared to things like thread lifts, it has much more durability, typically five years, or maybe several years beyond that. Uh, and it's got a little recovery bruising and swelling as all of these treatments do, but again, substantially less than a facelift. So that's a good procedure. If you have the specific findings in your neck and jawline that make you suitable for it, once you have a substantial amount of hanging skin in the neck, that procedure is not going to tailor out that significant amount of excess skin. And so it's not a good option, but if you're short of that, if you can pull a trigger on going forward with a small recovery needle, puncture local anesthesia procedure, uh, that's done in about 30, 40 minutes, uh, that can be a, a great help to the appearance of the neck and jawline in, in this T minus 10 stage of, uh, before the facelift,

Doreen Wu (16:21):
Our discussion today has shown me that I have a plethora of options, but how should I pick, what are the key takeaways Dr. Bass, so that I don't end up disappointed?

Dr. Lawrence Bass (16:31):
Yeah, that's a great question because you know, like everything in plastic surgery, we have to be real mother nature, doesn't blank, and we have to understand the biology and understand what the treatments can do and not hope that against every, every understanding it's going to do more than it's designed to do. So, the first takeaway is if you really need a facelift, whether you're ready for it or not, there's really no meaningful substitute in 2022. And I do a lot of technology development research, and I don't see anything on the horizon right now that I think is gonna come online in the next five, or maybe even 10 years, that's going to put facelift into an obsolete category. So you may not want to do it, but if you really need a facelift doing something, that's not a facelift is probably going to be disappointment.

Dr. Lawrence Bass (17:34):
As I said earlier, the small surgery procedures, the mini lifts and other things that actually make incisions have three quarters of the recovery of a facelift or some something that ballpark is the same recovery. And so I think only for certain selected cases where that's really the, the trouble area, are those procedures very useful, uh, the short durability treatments. I mean, sometimes that's the right choice, cuz they're so quick and easy to do. You need to look good now and you'll deal with looking good later later. But recognize that's a big compromise. And often the cost of those procedures is the same as things that would give you much more durability. So everybody loves minimal options because they're less cost less recovery and less or no scars or incisions, but the, what you're buying at the same time with those options is less degree of improvement, less durability of improvement and less predictability or consistency, how much improvement you're going to get.

Dr. Lawrence Bass (18:52):
So everyone likes those first advantages, but you have to live with the second half as well when you pick a smaller option. So it's okay to compromise. As long as you're being real about the trade offs, your plastic surgeon should explain the pluses and minuses of all these options. And if you accept the trade offs, then you know, it can be a good choice for you. It's just a good fit for your individual circumstances, but don't hope you're not going to get the, the negative tradeoffs you're gonna get the whole package. So, you know, my father used to have a saying, you know, don't expect a gourmet eight course meal for a dollar 50 and the same is true when you're picking these kind of treatments.

Doreen Wu (19:39):
That's a great point. And something very important that we shall all keep in mind. Thank you, Dr. Bass for sharing your expertise regarding the options and planning I should consider in the decade leading up to the facelift and thank you to our listeners for joining us today. It was definitely encouraging to hear that there are so many options to keep us looking good before it's time for a facelift, especially with new innovations, like the, my elevate procedure.

Doreen Wu (20:01):
As always, if you think of other exciting developments or trends in plastic surgery that you would like us to discuss in an upcoming episode, please reach out by email or Instagram. We'll see you next time.

Doreen Wu (20:13):
This is Doreen Wu, thanking you for joining Dr. Bass on me for this discussion of treatments and procedures T minus 10 years until the facelift. Be sure to tune in next time. And don't forget to subscribe to our podcast, to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (20:31):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor-patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.