What are the best alternatives to a face lift?

In my opinion, to be a viable alternative to a facelift, another option should approximate the degree of improvement in appearance achieved through a facelift. While fillers and Botox do provide real improvement, I do not believe most patients would see an improvement similar to a facelift- so in fact they are a reasonable compromise, but a compromise, nonetheless.
This is not to say, however, that good alternatives do not exist- only that to achieve facelift like results you need to be very thoughtful and creative. In my practice, we have achieved great success for our patients who perhaps would do best with a facelift, but would rather avoid the procedure for one reason or another through a combination of a mini-facelift procedure, Mixo SX laser resurfacing, and filler injections. This is very appealing to many people because the procedure can be done in the comfort of my office, with oral and local analgesia, without a trip to an OR or general anesthesia, with a shorter, easier recovery, and it very closely approximates the result of a facelift operation. In fact, I think many patients would look more naturally restored through this combination of lesser procedures than through the larger facelift operation.

In my practice, I call this "the holding pattern," where all efforts are made to keep the skin up and tight against the bony contours of the face and neck, using non-surgical technologies to encourage the skin to stay in a position in which the face, jawline and neck contours are "held" up and preserved.  This can be done by stimulating collagen or filling in areas of  volume loss of the face, as well as polishing the surface of the skin to make it look reflective and radiant. 

The best alternatives to a facelift, in general, are combinations of nonsurgical treatments.  These include, but are not limited to:

• Religious use of high quality and effective medical skin care products
• Botox (given in a way to maintain a natural, non-frozen appearance to the face)
• Dermal fillers to augment regions of volume loss in the cheeks, sub-brow, folds around the mouth and plumping of the lips to a natural and pleasing volume-rich contour
• Use of collagen-boosting techniques, such as Titan procedure, skin resurfacing with lasers and other techniques
• Smartlipo of the neck and face and in instancees where skin laxity is significant enough to warrant some skin removal-minimal surgical techniques that are modified to minimize the incision and subsequent scar and maximize the use of ancillary supportive non-surgical technologies to tighten the skin. 
• Maintenance treatments with light peels using a combination of AHA and anti-oxidants to promote the long term health of the skin are also imperative to restore radiant skin. 
• Of course, lifestyle and genetics are important factors, and by following the kiss principle of keeping things simple and basic, one can have youthful skin with the proper diet, exercise, water/vitamin intake/and avoidance of the elements and vices that harm the skin (sun, smoke, lack of sleep). 

Many patients do not like the fact that it takes so much work to look good without surgery, but it is possible and quite rewarding, if the correct plan is made at the correct time --and earlier rather than later. 

The costs are known -- so a true budget can be make for this annual maintenance, which can definitely be the right path for many patients who want to avoid surgery or do not need surgery at this time.  

In the right hands, these procedures can be safely administered and the patients are ecstatic with the quick results.  It only takes one finding a picture of themselves-- a picture  5 years earlier before waging the "battle"-- to demonstrate to the patient how much improvement there is over time with these powerful nonsurgical techniques of facial/neck rejuvenation. 

Proper patient selection is key and that is what I take pride in, that I can do all-both surgical and non-surgical procedure for the  preservation of youthful and natural facial contours.

The panel members have provided quite an extensive review of options and are a wealth of information.  

Before considering whether or not you are a candidate for a face lift, you may want to consider how newer techniques and concepts with Botox Cosmetic and fillers (ex: Juvederm, Perlane, Restylane) may address your goals.  At the very least, using injectables may delay a future face lift. 

In many situations, the aging face is better addressed by replacing volume and reshaping the face.  Merely pulling one's skin tighter without addressing the lack of volume and shape will not achieve the same appealing, natural look.

The face can be divided into different components that are treated uniquely, age at different rates and require different amounts of intervention.

Imagine the face being a pair of slacks that needs to be brought to the tailor. The wrinkled mess that you deliver to the tailor is similar to your skin. As aging sets in, your skin shows fine lines and wrinkles. But you go to the tailor to take in the excess material that makes them too wide in the crotch or too long. Similarly, the face has excess skin as you age. But to carry the analogy to the next level, if you take in the material in the crotch but ignore the lining, the slacks won't sit well. In order to make the slacks fit well, you need to correct the excess material, reshape the lining and press the slacks. Finally, to insure that the slacks hold there shape you can care for them by hanging them up in between uses and take good care of them.

How does this relate to the question at hand?

The wrinkled pants are like the wrinkled skin. Instead of pressing the pants you can have the fine lines and wrinkles removed. Medical treatments include; fillers (juvederm, restylane, radiesse, fat), Botox, chemical peels, dermabrasion and Laser skin resurfacing.

The excess skin and underlying material can be removed by a chinese menu of surgical procedures that address specific needs relating to each patient. midface lifts, mini-lifts, facelifts, necklifts, eyelifts and browlifts, to name a few.

Finally to insure that all the hard work doesn't go for naught, you should take care of your skin as well. This includes preventative measures that include;
Retin-A, antioxidants (oral and topical), hydroquinone, alpha-hydroxy acids, zinc oxide sunblock, adequate sleep, limited exposure to severe pollution, no smoking and limited alcoholic consumption.

So to answer the question, the treatments named above are not used instead of a facelift, they are used as part of the different tools to keep you looking young.

The Liquid Face Lift is a painless, 30 minute, in-office procedure usually performed by a physician very experienced in filler and BOTOX injections. Utilizing various fillers and Botox Cosmetic, a Liquid Face Lift (LFL) can rejuvenate and lift your face to create a naturally younger look.

A LFL can:
Fill in wrinkles and folds, such as smile lines and marionette lines.
Smooth out frown lines, crows feet and forehead lines
Enhance and lift cheeks.
Restore volume to flattening and sagging areas.
Lift eyebrows up to their youthful position.
Hide bags under eyes.
Reduce jowls and create a straighter jawline.
Plump lips and smooth out lip wrinkles.
Lift up sagging corners of the mouth.

I recommend you have a consult with an experienced dermatologist or plastic surgeon who performs this technique to see if you are a candidiate.

Easy things you can do:

1. Don't smoke. Smokers appear years older than their non-smoking piers.
2. Avoid sun. Sunscreen applied once to twice daily reduces sun exposure, but probably only 80%. Golfers, horse riders, swimmers, tennis players especially beware: cover up as much as possible with hats and long sleeves in addition to using sunscreen.
3. Use a good and regular skin care regimen daily to exfoliate
4. Exfoliate monthly with a facial or microdermabrasion
5. Ask your doctor if you are a candidate for Retin-A or a related topical compound, tailored for your skin type
6. Watch your weight and exercise regularly. Yo-yo diets and weight gain/loss stretches the skin
7. Eat foods high in antioxidants and fresh vegetables and fruits. Avoid procedded foods, fast foods, high sodium foods
8. Avoid excessive drinking and drugs. In addition to the obvious effects, these vices can cause great fluid shifts within the body-- every heard of the bloated drunk?

Now for some of the more involved treatments:

1. Botox and filler at a young age when wrinkles start to appear. Try to stick to hyaluronic acid products; much less tendency to lumpiness that can be permanent (in my humble opinion)
2. Small surgeries when problem start to arise that aren't correctable with filler and Botox, i.e. eyelids, lateral browlifts, LiveFill, subtle minimal incision cheeklifts
3. PhotoFacial treatments. Some patients like Thermage/ReFirme, fractional lasers as less invasive methods which give more subtle results.
4. Beware of gimickry such as lasers that do everything, no incision weekend techniques. Almost every treatment looks better for a few months, then the swelling goes away (and so does your money). Threadlifts also in this category, in my opinion. We routinely remove threadlift materials when patients come in for their minilifts or facelifts.

Surgical or even non-surgical treatment of facial aging changes must be carefully individualized to match each patient's aesthetic needs and desires. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized plan is then developed which addresses each patient's specific concerns and needs.

A "liquid facelift" is a procedure that is performed using temporary dermal fillers like Juvederm Restylane or Perlane. There is little to no downtime with a liquid facelift. This might be an ideal treatment for some, but the results are temporary and it does not address excess skin.

Structural fat grafting, sometimes referred to as microfat grafting can provide fullness to lips, cheeks, hollowed upper or lower eyelids and can fill lines and wrinkles on the face. Unlike the liquid facelift, the results from structural fat grafting can be permanent

Laser Skin tightening is a non-invasive treatment with little to no downtime. For individuals with early signs of aging, uneven skin tone, scarring or large pores a laser skin tightening procedure can provide dramatic results.

Full Facial rejuvenation or a full facelift may be the answer for some. Some people looking for facial rejuvenation are interested in the lower face, midface and eyes, others are interested in one area only. Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.

Consult with a plastic surgeon who has experience and expertise in both surgical and non-surgical facial rejuvenation to determine the treatment plan that is best for you.

Many patients wonder what alternatives there are to a facelift because while they want the result of a beautifully performed facelift, they are afraid of the potential downsides when the surgery is not done as well. While there are numerous minimalistic treatments that can be done instead of a facelift, none will approach the result of well done surgery.

So, perhaps rather than asking about alternatives to a facelift, ask whether the result you really want is only going to come from surgery. In other words, what exactly are your expectations? Then find the right doctor to help you get the result you desire. This can be challenging, but I would be certain they are a Board Certified Plastic Surgeon and that they do many facelifts and that they show you numerous before and after photos of their patients so that the changes you see reflect what you would like for yourself.

Dear Anon,

I am often asked this very question by my patients; giving the "right" answer is not that easy. In general terms my answer will relate to what the chief concern (or change) that the patient is expecting to correct.  Essentially facial aging is best evaluated by isolating the the many components that contribute to an older looking appearance. 

That is, looking at the skin quality, the bone structure, and the presence tissue laxity.  In cases when I see that the patient has significant jowling, neck skin/muscle laxity, the loss of cheek area fullness, and overall facial skin laxity the treatment will likely involve a combination of a face/neck lift, and other complimentary treatments. 

Some of these additional treatments may involve a combination of skin resurfacing (eg., laser treatment.) to tighten the skin, and the restoration of cheek, or other area, fullness with either a facial implant, or injecting a "Filler".  Sometimes these additional steps can be performed at the same time, or may be done in a staged approach at a later time after the initial surgical healing. 

Using a filler as an adjunct has been particularily beneficial to treating the deep naso-labial folds that the face-lift in itself often does not treat as well.

In the less advanced cases however, much can be accomplished with facial skin resurfacing, and the application of  the wonderful longer-lasting fillers now available.  Many times these less invasive procedures can really help to post-pone the need to get the classic surgical facelift.

Best wishes,

S.P. Maggi, M.D., FACS

Nonsurgical rejuvenation in most cases is not as powerful for improving the signs of aging as a well-performed facelift would be. That being said, it is important to know that there are four areas of the face that need to be addressed to actually fully rejuvenate the face. I will list each area individually and then give you an idea of options, both surgical and non-surgical, than can be attempted to provide the results you seek. Please note that this is my simple take on a complex issue, and that others may have a different viewpoint:

1. The Skin - this outer covering is routinely abused by the environment and our behaviors (sun, smoke, smog, etc.). As we get older the content of collagen and elastin diminishes creating a thinner, more saggy covering. From the list below, it is common to utilize most of the therapies to help rejuvenate the skin and slow down aging: Sun screen, Moisturizer, Stop smoking, Drink alot of water, Microdermabrasion, Chemical peels, Laser resurfacing, Medical grade skin care
2. The Muscle (SMAS) - routine use of facial musculature over time + gravity creates laxity, especially at the neck. There is no way to rehab the muscle as it ages. Most muscle tightening comes in the form of muscle plication or muscle resection and shortening. SMAS-type facelifts
3. The Fat - Until the last few years there was little emphasis paid to the way the facial fat layers changed with age. Now most forward thinking plastic surgeons realize that re-inflation of the face with fat and fat repositioning procedures are better are restoring those pleasing youthful contours Autologous fat grafting - restore volume Facial injectibles - hide the signs of lost facial volume
4. The Bone - with age there are changes in volume and projection of facial bones, and this creates less support for the overlying soft-tissues letting them sag more and give the face a more flattened look. The name of the game here is volume restoration.

• Facial implants - more reliable and powerful
• Autologous fat grafting - easier on the body

Except for number 2, everything I have mentioned are considered non-surgical or minimally-invasive. I hope that this will make your decisions easier.

The primary purpose of a facelift is to remove excess skin and repostion soft tissues that through aging and gravity have migrated down on the face. It is difficult to accomplish these goals through other methods; however, there are options for individuals looking to look younger and more rejuventated which do not necessarily involve surgical procedures.

One of the primary 'tell tales' of aging is the appearance of the skin. Aging, sun damage, smoking, excessive alcohol consumption and a history of acne can all decrease the aesthetic appearance of the skin. 

In facial rejuvenation, the skin plays the most important role. Just as wrinkles and sagging skin can make us appear aged, healthy and vibrant skin can give us a younger healthier look. Although aging affects every part of our body, it is most noticeable in our skin. Daily skin care combined with a well-balanced diet, plenty of rest, abstinence from smoking, and protection from ultraviolet radiation are the keys to maintaining healthy skin.

With age your skin starts sagging because of collagen and hyaluronic acid loss. The reason: hornone levels decline. Therefore, to lift your sagging skin you have 4 nonsurgical options:

1. Improve your hormone balance with bioidentical hormone replacement therapy.
2. Restore lost volume with fillers like Restylane or Juvederm.
3. Improve your skin tone with skin tightening treatments or resurfacing procedures e.g. Thermage, IPL etc.
4. Pull up your skin with Thread lift.

The choice depends on the main reason of skin sagging: hormonal loss, volume loss or loose skin. Combination of treatment works very well.

There are some reasonable alternatives to face lifts these days. The desire for a non-invasive face lift, however, does not exist.

For a patient willing to settle for less in order to avoid a face lift they should consider using combinations of the following minimal down time options in order to maximze results:

• Thermage radiofrequency tightening procedure
• Fractional resurfacing procedures
• Dermal fillers or fat transfer to restore volume to the cheeks or lines
• Botulinum toxin

The idea is to lift, fill and resurface / rejuvenate the skin. The rationale for this approach is described below.

Patients who inquire about face lifts usually do so because they see visible changes that collectively create an aging appearance. These changes may include wrinkles, sagging cheeks, deepening nasolabial folds (smile lines around the mouth), a loss of definition along the jawline or jowl formation, a drooping neck line. The reasons for these changes can be due to combinations of aging and or environmental factors.

Aging causes a loss of fat in the face leading to drooping cheeks and the appearance of excess skin. The skin itself relaxes and leads to wrinkles and loose skin. Motion of muscles oover time can lead to frown lines, squint lines around the eyes (crow's feet), forehead lines or lines around the mouth.

Ultraviolet light intensifies the loosening of the skin and leads to discoloration and pigment changes. Nutrition and smoking are other causes of advanced skin aging.

A personal consultation with a physician who provides a wide range of procedures is always best in order to determine which procedure or combinations of procedures are best for an individual.

For some patients there is no best alternative. To get what they want they need a face lift. For others there are a range of non surgical treatments that can rejuvenate the face very effectively and very safely. Often the face lift is combined with these non surgical treatments.

As we age we accumulate a set of visual clues to how old we are. These clues have multiple causes and have a very gradual onset.

Some of these visual clues are the result of environmental injury to the skin. This is mostly the consequence of sun exposure, but cigarette smoking and air pollution hurt too.

Environmental (UV light) injury causes the skin to become irregularly discolored with red and brown dyschromias. These color changes can add up to 20 years to the aged appearance of the face.

Another effect of sun injury is that the skin becomes loose and wrinkle prone due to disorganization of elastic fibers and loss of collagen. This is called solar elastosis. Facial muscles that continually compress this damaged skin cause permanent wrinkles to form.

As we age we loose volume in the face; there is atrophy of bone fat and muscle. This, combined with gravity and loose wrinkle prone skin, creates deep folds and furrows in the skin.

There is probably no single treatment that attacks all of these accumulated visual clues of age so a combination is needed.

Tailoring the combination to the needs and desires of the patient is the job of the treating physician.

Some of the combinations are the use of a neuromodulator like Botox to weaken or relax the wrinkle producing muscles, along with a volume replacing filler like hyaluronic acid to re-inflate the atrophied tissues.

The skin itself can be improved as well. IPL or Intense Pulsed Light will smooth out the irregular discolorations and brighten the skin to restore the youthful glow. Laser resurfacing with a fractionated CO2 laser like Active FX restores texture and tightens the skin by stimulating collagen production.

It is by the judicious of multiple non surgical treatments that we can frequently for stall or avoid a face lift.

Once again, the treatment must be tailored to the individual patient's circumstances.

While nothing can replace facelift is someone who really needs it, there are finally viable alternatives for those that are not yet ready for the surgery.  The best results are achieved by combining the incredible Titan laser with other lasers and adding Botox and fillers as needed.  These Titan combination procedures are commonly called "3D" and "5D".  In our Rejuvenation Center, we first do a Visia skin analysis and do a pre-rejuvenation skin treatment, which includes a deep cleaning facial and microdermabrasion.  A plan is designed for each patient which includes home care with products selected for each individual.  We have come a long way in the field of non-surgical rejuvenation and this is only good news for patients.

Botox/Fillers along with the Total FX laser resurfacing which includes Active /  Deep  FX fractional.  Fractional CO2 seems to offer the option to safely improve texture, tighten skin, and improve dsychromia.  In my opinion, this is the best alternative to a face lift however, may complement it.  In terms of wavelength CO2 is still the GOLD standard fractional or not.

Patients should first identify (and prioritize) their facial aesthetic goals. Facial rejuvenation techniques need to be individualized for every patient. “Cookie cutter” approaches applied to every patient will not only not improve the aesthetic goals, but often lead to facial disharmony.

Patients who accept smaller incisions and less invasive techniques in favor of the correct surgical approach are simply cheating themselves. In the short-term, they will be faced with a less than ideal and short lasting result. In the long-term, secondary procedures to correct the initial procedure can often become significantly more expensive, can lead to a more prolonged recovery, and are invariably associated with a higher complication rate.

If the primary goal is to correct global facial skin laxity, or to correct neck laxity, jowling, or midface descent, then a full facelift should be performed. This can correct loose or sagging skin through appropriate repositioning and elevation of soft tissues.

However, if volume restoration is the primary goal, then temporary filling agents (autologous fat, Restylane, Juvederm, Radiesse, Artefill, or Evolence) can often provide excellent, albeit temporary solutions. These can often be performed in combination with laser skin resurfacing procedures to further rejuvenate the facial appearance through technologies than improve skin tone, superior and deep skin tightening and superficial skin ablation. Facial implants are also volume corrective and can offer great improvements.

Obviously there is no simple answer to this question. A surgical face lift remains the gold standard by which every other non-face lift procedure is measured against. You have to keep in mind that everything else is just a substitute and a temporary one at best!

Having said that, there are many alternatives to a surgical face lift for facial rejuvenation. In order to select the best procedure for you, you must consult with someone who is competent and performs face lift along with many other non-surgical methods. In other words, if you consult with a one trick pony, that pony will only show you the only trick he knows!

Botox and fillers (Juvederm, Restylane, Radiesse) are good, simple options in most cases. Next to this comes laser resurfacing (CO2, Erbium, Fractional, etc). Thermage is also an option but in my opinion, for what you pay, it probably does not give you enough improvement.

Among minimally invasive procedures, thread lifting comes to mind but the longevity of this has not been proven. Autologous fat injection to hollowing areas of your face (under eyes, cheeks, etc) can often produce very nice results.

Honestly, to find the best answer to your specific needs, you should consult with a facial plastic surgeon or a plastic surgeon who specializes in facial surgery.

While there are a number of procedures (e.g. Lifestyle Lift, Thermage, and Contour Thread Lift) that have  received considerable publicity, they all have variable success.

If you have already had (and want a refresher) or if you are not ready for a full facelift, SmartLift and segmental facelift are two viable options.

Botox and injectables (Restylane, Juvederm, Artefill, Radiesse, Perlane, etc.) prove to be excellent value in an experienced injector's hands.

Many patients get excellent improvement by focusing on one part of the face, especially eyes and nose. With the eyes, blepharoplasty and the nonsurgical periorbital revitalizer provide excellent improvement. Revitalization of the eyes gives the face a refreshened look.

Rhinoplasty and nonsurgical Rhinoplasty can balance the face and create a strong focal point for both men and women.

Visit your local board certified surgeon to explore what options that they can provide.

Occasionally the neck is the presenting problem with excess fat and platysmal cords. These can be addressed through only a neck lift.

For individuals in their early 40s with a small amount of jowls, a mini lift can help with early signs of aging. Cheek implants can rejuvenate the mid-face if the cheeks have a flat appearance.

If an individual has truly sagging cheeks and jowls and a similar hanging, sagging “turkey gobbler” neck, then a well done face and neck lift is the most effective treatment.  One that will last six to ten years.

Peoples' faces change with age for three different reasons.

1. There is atrophy and loss of volume in the upper face so that you develop hollows.
2. There is sagging of the cheeks and jaw line.
3. Lines and wrinkles develop around the eyes and around the mouth.

The treatment for each of these three different aging problems is different.

When correcting hollows in the upper face and in the cheeks without a facelift, deep fillers are most effective, and we have had very good results both with Juvederm Ultra Plus and with Radiesse.

When the main problem is looseness in the jaw line, the most effective treatment is tightening the skin with Thermage, which uses radiowaves to contract the collagen in the deep layers of the skin and produce a cleaner jaw line.

For the lines and wrinkles around the eyes and around the mouth, a combination of Botox to relax the muscles and fillers to clean up the lines and wrinkles is quite effective.

The non-surgical alternatives to a facelift are most effective in younger patients. We look not at chronological age but at the actual biological age of the skin of the individual.

In general, patients over the age of 60 may well need surgery.

As a person ages, he/she loses facial volume.  To restore this volume, one may consider injectable filler materials such as Restylane, Juvederm, Radiesse, or Sculptra.  One may also consider transferring fat from the lower body to the face. 

In addition, there are many different devices that use heat energy, light energy, and/or ultrasound to rejuvenate the face.  However, the effects are often subtle and short-lived.

Addressing the quality of the skin can help improve one's facial appearance.  If indicated, this may be done through skin resurfacing (e.g., chemical peel, laser, dermabrasion).

ThreadLifts, in which threads are inserted through the skin to lift the tissue, may be considered.  However, the success rate is variable.  The threads can extrude or become infected.

In summary, nothing can take the place of a facelift.  However, options are available to help improve one's facial appearance without undergoing a facelift.  It is important to have realistic expectations.  Check your doctor's credentials and experience.  Be sure to clearly communicate your expectations so your doctor can meet and hopefully exceed your expectations.

As a plastic surgeon, I offer my patients numerous alternatives. It's not just a facelift or its not just injectable products or lasers. I can do both, one or none.  I offer my patients the procedures that I think can best treat their concerns.  Many patients, that are not ready or are not good candidates for facelifts, I place on skin care regimens and incorporate laser treatments or injectable fillers.  These products can help put off facelifts in those patients that are not quite ready for a facelift. 

 Obviously patients with severe sagging will be more satisfied with a traditional facelift.    Non surgical alternatives to face lift are suitable option for patients with mild to moderate sagging, fine and deep wrinkles and surface skin conditions such as poor texture, brown spots etc. While there are several resurfacing and tightening options availble, I have had tremendous success with Plasma Skin regeneration. I have treated dozens of patients with mild to moderate facial aging (wrinkles, sagging, jowls, saggy eyelids, poor texture, brown spots)

There are several advantages of Rghtec Plasma Portrait skin regeneration.

• It is minimally invasive and non surgical .
• No general Anesthesia
• Done in Physician's office under local anesthesia with or without a sedative
• rapid recovery (8 to 10 days) compared to some traditional ablative lasers (6 to 8 weeks with CO2 laser)
• Safe and effective for use on non facial areas such as neck, chest, hands.
• Due to its unique thermal profile, plasma energy produces consistant results in improving skin tone, elasticilty and deep wrinkles along with treating superficail skin lesions such as Actinic keratosis, solar brown spots etc.
• It is safe and effective on many skin types including darker skin.
• Can be done in specific areas only (e.g around eyes, or around mouth) in some patients who have good overall facial tone and elasticity.
• Several treatment protocols are available to treat different types of skin conditions.

In my practice, and talking to other physicians around the country with Plasma Portrait experience, patients have a very high degree of satisfaction for eyelid sagging, jowls, deep wrinkles, surface skin conditions with this procedure.

In my opinion, this treatment done as a single session for $4000 to $5000 for face and neck is the best option for anyone looking for NON SURGICAL facial tightening, deep wrinkle and surface lesion treatment.

Loose or sagging facial skin is best corrected with a facelift that involves tightening and redraping of the facial soft tissues and skin.

Less invasive procedures, such as the threadlift, radiofrequency tightening, and “lunctime” lifts, generally produce results that are less long-lasting and less satisfying than the traditional facelift.

For patients with advanced signs of facial aging who do not want to undergo a facelift, I would recommend use of soft tissue fillers (autologous fat, Restylane, Juvederm, Radiesse, Artefill, etc.) and skin resurfacing treatments (laser resurfacing, chemical peel, dermabrasion).

Noninvasive tightening procedures are an additional option, although their effectiveness may be limited.

There are several options for people who want to improve the lower 1/3 to 1/2 of the face without full rhytidectomy (facelift).

Z-PLASTY: In a male with loose neck skin without much fat, a z-plasty is a possibility that has excellent results. The excess skin and muscle is removed with an incision shaped like a "Z", and this avoids the scars around the ears associated with facelifts.

FAT TRANSFER: In patients with a significant loss of facial fat and resultant sagging skin, facial fat transfer is an excellent option due to its longevity and ease of harvesting. These patients must have available fat to donate and must be willing to accept repeat treatments and swelling and bruising associated with the procedure. This can often simulate a facelift with very natural results. Other fillers are acceptable options, but require more maintenance.

TOTAL FX: The Lumenis UltraPulse Carbon Dioxide laser has the benefit of superficial tightening (ActiveFX/MaxFX) and deep tightening (DeepFX). This improves skin tone, texture, and fine lines with about 1 week of downtime. The Fraxel re:pair may be an equivalent technology.

Ultimately, there are going to be patients that require rhytidectomy (facelift) to acheive satisfactory rejuvenation of the lower face. These include patients with significant platysmal banding and severe jowls.

Not everyone needs a facelift. Not everyone wants one. But... everyone wants to look good. Here are some things you can do (without surgery!) that will improve your appearance:

1. Nasolabial folds and jowls - fillers can be used to smooth lines around the nose and mouth and mild to moderate jowls. This improvement can be natural and noticeable.
2. Fullness under the neck - lymphatic drainage procedures improve this for 3-7 days. A series of massages can provide longer lasting results; for long lasting results based on a one-time intervention, liposuction under the chin can help. If the skin and jowls are tight, but the neck skin is loose, a limited neck lift can be done. If this looseness is related to a weak chin on profile, a chin implant alone or added to another procedure, can provide a noticeable improvement as well.
3. Overall loose tone - a facial exercise regimen can definitely help, BUT commitment is key. ("facersize")

Happy choosing!

These days a lot of patients are opting for non-surgical facial rejuvenation instead of the traditional form of nip/tuck. I like to offer patients who are looking for a gentle yet effective time reversal, my Hydra-FaceLift.

As we well know, aging can lead to volume and collagen loss in the face. By using synthetic collagen/fillers one can actually add volume to areas of the face that have started to lose that fullness. I like to fill nasolabial lines, marionette lines, lips, hollow appearing eyes, cheeks… any area, with long lasting temporary fillers.

I prefer not to use permanent fillers to enhance soft tissue volume because of the unpredictability of aging. If a permanent filler is put in and the face changes dramatically, the patient is not doing themselves any favors. The face can look different and the filler can stand out from surrounding tissues, warranting surgical excision, the one thing that most patients are trying to avoid.

In this day and age where patients are wanting to enhance their appearance but do not fit the criteria for a surgical lift, we have great resources to offer them.

So what I prefer to use in my patients who want a longer lasting temporary filler, is Radiesse. It is a great longer lasting alternative to Restylane or Juvederm. Restylane can last up to 6 months and Juvederm I have seen last up to 9 months. Radiesse lasts up to a year, all the while building collagen! Those extra few months have been well worth it for my patients, in lengthening their return to my office for injections. Also the effect of Radiesse, of building collagen in the injection areas, is wonderful because the patient doesn't return down to baseline in a few months when the filler wears off. There is a greater fill to deeper nasolabial folds with Radiesse and I Iike to top off the superficial lines with Juvederm.

The results are great in combination with Thermage for a longer lasting smoothness and tightness to the skin, and thus rejuvenation. Thermage does not put a Band-aid on the situation, but addresses the cause of skin laxity by building back the lost collagen and tightening the skin over time, giving a soft, lifted appearance to sagging facial skin.

We are getting great non-surgical face-lifting just with these modalities, which combines Botox, Juvederm, Radiesse and Thermage (Skin Tightening and Collagen Building).

Fraxel Re: pair laser, manufactured by Reliant, is at the cutting edge of the future of facial plastic surgery.  It is a pre-emptive strike against a facelift, and in those patients who begin their treatment at the early signs of aging in the face and neck (jowling and lax skin with wrinkles), a facelift may never be necessary. 

Additionally, upper and lower eyelids are easily treated, resulting in rested, youthful eyes.  

It is safe, effective, and quick with a very short social downtime period.  The results are a natural younger version of you, without the "pulled” look of too many unfortunate surgical facelifts. There is no cutting, operating room fees, or anesthesiologist involved.  This is truly where the future of facial plastic rejuvenation surgery is heading. 

A deep plane face lift, skillfully performed, along with platysmaplasty, smooths sagging platysmal bands (the 'turkey gobble'), removes excess skin while tightening the deeper tissues of the neck and jowls, and lifts the malar fat pad.

While there is no substitute to a face lift, in terms of the degree and duration of correction, minimally invasive techniques are available to effectively 'renew' the face.

• Injectables such as Restylane, Juvederm, Radiesse, and Artefill can be used to fill in fine to deep lines and wrinkles. Sculptra can be used to thicken and revolumize the skin (imagine a shriveled balloon being blown back up), and various technologies can be used to remove discolorations, resurface, and renew the skin.

• The best of these technologies include compounded hydroquinone, tretinoin, and hydrocortisone creams, used along with IPL, the carbon dioxide laser, or trichloracetic acid peels.

• A chin implant can also work wonders in improving the jaw line, but does requires surgery.

• Radiesse injections can achieve the same effect, albeit temporarily.

Beware of technologies such as Thermage, Titan, barbed sutures, and fractionated laser technologies unless you have money to burn; they promise much more than they can deliver.

There are a number of non-surgical treatments that will help rejuvenate the face, although rarely in the same manner, to the same degree, and with the same longevity as a surgical face lift. In my opinion, the most effective non-surgical alternatives to a face lift are:

• Fat grafting
• Facial filler injections (such as Radiesse, Sculptra, etc.)

There are other non-surgical techniques, which can, to a much lesser degree, help tone and tighten the face. They include:

• Thermage
• Polaris (Elos)
• Laser resurfacing

A Facelift will resolve more advanced photo aging.

Alternatives for a facelift include the following laser treatments:

• Thermage
• ReFirme
• Titan
• Microablative Fraxel

There are many alternatives to a traditional surgical facelift. Many people do not want to have surgery, general anesthesia, the down time, or a certain "post-facelift" look that sometimes occurs.

Usually, the woman or man wants to lift sagging tissues, lessen large folds, lessen wrinkles, get rid of jowls, tighten the chin and neck skin, and open the eyes more. Several procedures offer nice results in these areas, and I have found (as have many doctors) that combination therapy of two or more treatment types works best.

One powerful combination therapy to lift sagging skin, restore elasticity, greatly reduce wrinkles and folds is: New Tip Face and Neck Thermage and Rhytec's Face and Neck Portrait Skin Regeneration.

The skin shows remarkable tightening, lifting, and smoothing with this combo, better than with either procedure alone. The smoothing of the skin, pore reduction, elimination of "crepe-paper" eyelids and under-eyes, and elimination or reduction of lines around the mouth cannot be achieved with a traditional surgical facelift. Surgical facelifting usually doesn't get rid of the folds called "nasolabial folds,"
leaving the patient bewildered and angry.

Barbed suture lifting can be added to Thermage and Portrait for additional lifting of sagging skin. Suture lifts on their own, as a single treatment do not produce satisfactory results.

Filler material is very useful for volume correction and restoration of youthful proportions in the face. As we age, we all lose subcutaneous fat from the face, leaving it more gaunt and in some, more "skeletal" looking. Many fillers can be used to correct this, including Sculptra, Radiesse, Juvederm, and others. This volume correction is wonderful for cheeks, "apples" of cheeks, temples, under the eyes, at the chin, and elsewhere. Filler therapy can be combined with all of the above procedures to result in a natural, restored, more youthful look.

In some instances, only surgery wil produce the desired look.  An individual may have profound laxity or a deformity that only surgery will correct. Some people want their skin pulled "very tight," and fortunately, only surgery can give you "drum tight" skin. Some people simply prefer surgery, for their own reasons.

Revolumizing the face with a filler is the best alternative. Only your dermatologic or cosmetic surgeon can advise you if surgery is necessary or if the use of filling substances, such as Sculptra, fat, Radiesse, Juvederm, or Restylane will be best for you. At times a variety of fillers are used in one session.

Laxity or sagging of the skin caused by aging or weight loss is best corrected with a standard facelift procedure that involves redraping and tightening of the facial tissues and excision of redundant, or extra, skin.

Lesser invasive procedures like threadlifts, radiofrequency tightening, or procedures to lift the face touted as “no downtime” or “lunchtime facelifts” generally do not produce as long-lasting or satisfying results as the traditional facelift.

Neck laxity, jowling, and midface descent are all signs of aging that are best addressed by a facelift, which many plastic surgeons believe to be the gold-standard for facial rejuvenation.

Beware of procedures that are branded, or advertised on TV infomercials, where it is difficult to discern from the information you are given who will be doing the procedure or the technique used.

• The LSL and minilifts in general, do not create an unnatural “pulled up” look.
• The more aggressive types of facelifts have far greater risk of creating a more pulled and unnatural result as a result of them being more invasive.
• The key to a great outcome is to communicate your goals and expectations.