In the eternal quest for the fountain of youth more and more people are turning toward cosmetic enhancements that promise less recovery time, lower cost, decreased incidence of complications and instant results.

Among this new armamentarium of “minimally invasive or non- surgical” procedures comes the newly touted thread lift — also known as the feather lift, lunch time lift, Russian lift or suspension lift. The”thread lift” is promoted as an inexpensive, easy to do, “lunch time procedure” with little down time that subtly “refreshes” a sagging middle-aged face.

And the marketing has been amazing, to say the least. Like Thermage, Oprah Winfrey promoted the new barbed-suture face-lift as a “one-hour lunch-break lift” and a “cutting-edge procedure with no cutting edges.” On “Today” Matt Lauer described it as a “new alternative to a face-lift.” And “Good Morning America” called it “one of the hottest new beauty fixes.” The NY Times then reported “Mixed Results on a New Beauty Fix” just before The Washington Post posed the question “A Lift at Lunchtime?” More recently on another TV show, one cosmetic surgeon described how these sutures work to lift the brow to a better position and are the newest thing going today. The not so subtle message was that these threads can deliver the results of a traditional brow lift or face lift without any of the inherent consequences of the latter.

You may be thinking that this sounds too good to be true, right?

Do thread-based brow lifts and face lifts really work?

First a little background: Since September 2004, when the FDA cleared Contour Threads, one of two brands of barbed sutures, for use in the United States, at least 1,400 doctors have taken courses in how to use them, according to the manufacturer, Surgical Specialties Corporation. Reportedly, these doctors have now done more than 9,000 thread lifts. Perhaps thousands more have been done with Aptos brand sutures, which are made abroad.

The thread lift procedure uses a barbed suture to grasp the tissues and elevate them. Theoretically, because tissues are not being separated from each other and there is much less lifting of the skin, postoperative swelling and bruising are reduced.

First the positives; non-surgical face lift procedures are generally:

1. Less invasive- a few small incisions are made
2. Do not require an extended recovery period- recovery takes a few days to a week in general, though it may take longer
3. Less costly- typical costs are $3,000 to $7,000, depending on the number of sutures used
4. No general anesthesia is required

Unfortunately, based on the results so far, the hype seems to overstate the real results. And so, the thread lift has come under fire from many facial plastic surgeons and general plastic surgeons, the kind of doctors who perform most real face-lifts. We believe that the thread lift has not yet been subjected to the kind of peer-reviewed clinical studies that are needed to demonstrate that it is safe and effective and to indicate which patients it is right for.

Do the results last?

One study found that the initial results with suspension sutures were relatively good, if not impressive. However, by 6 months, the corrections started to fade and by 12 months, between 80-100% of the initial corrections were lost. So, although some patients are told that the results generally last 3-5 years, in reality, it is impossible to know how long these corrections really last since the procedure is so new.

Are these procedures safe?

It is true that because these procedures are done under local anesthesia, rather than general anesthesia, the patient can expect less anesthesia risk. However, based on anecdotal reports, it appears at this time that these procedures are fraught with a host of potential complications including:

1. Infection
2. Potential Nerve Injury
3. Threads that cause bunching of the skin
4. Threads that break and recoil causing a visible knuckle of suture
5. Threads that protrude through the skin
6. Threads that can be seen or felt under the skin

Other patients have reported poor cosmetic results, swelling that took much longer than a week to subside and irregular or painful sensations in their face after the procedure.

Who should consider a threadlift and what results can be expected?

According to the American Academy of Dermatology, threadlifts are “for patients with moderate signs of aging who are looking for a little ‘lift’ without resorting to a facelift…”

Patients who want a subtle change in the mid face and lower face and who also need minimal downtime may be candidates for a threadlift, if they understand and are willing to accept all these possible complications. Patients who have sagging of the skin or deep folds in the tissues, who are really candidates for a face- lift, will likely be disappointed if they expect a big improvement.

Moreover, it should be noted that while these procedures take less time than a real face lift, “the view that a thread lift can be done during a lunch hour is not endorsed by the company…The downtime is not a lunch…It can be a day or a week, depending on the area that is being done.” And this statement comes from the mouths of the actual manufacturer.

A Final Note

Plastic Surgery periodically experiences periods when a new procedure is pushed hard by the media and some physicians and surgeons adopt it enthusiastically. Potential troubles or shortcomings show up later and the procedure falls into disfavor or is used much less frequently than at first.

At Profiles, we tell patients to wait a couple more years. We want to be sure that these “quick fix” procedures work, are safe and do what they claim to do. While they hold promise, we do not want our patients to be beta testers for new procedures that are all the rage.

Perhaps, with time, experience and adjustments the threadlift may have an impact much like liposuction, which also was initially shunned. However, for now at Profiles, we recommend patients undergo time proven procedures that we know are safe and effective.

One thing that is important to do as much as possible is to limit ongoing acne before you tackle the scar concerns. It’s not much use having a great scar revision result only to later suffer from ongoing scarring in the same areas.Peels and microdermabrasion are good for overall skin texture and coloration but may not always be the best solution for ongoing acne. Some medical grade topicals are excellent and your doctor can make some recommendations in this area.

The most promising treatments to come out in recent times are photodynamic therapies (PDT) using chemical sensitizers such as levulan (ALA) and blue light (such as BLU-U) or intense pulsed light (IPL). These kill the bacteria responsible for acne and can shrink up sebaceous glands to reduce future breakouts.

For scarring, there are a number of treatments available, depending on the depth and extent of scarring.Subcision, a technique that releases the scarred skin from underlying tissue, followed by filler injection, is a great alternative for fairly limited areas of scarring such as a focal deep scar. See the attached photo for a real Profiles patient example of this technique

Sometimes, removing or altering the scar is the best approach, often called a scar revision. Other times, we simply ‘lift’ the scarred skin.

When larger areas are involved, a resurfacing procedure using various lasers, deeper peels, or dermabrasion works best.

The strikingly unnatural lip enhancement you’re talking about is everywhere these days and is an unfortunate result of the thinking “If a little of something is good, then a lot of it must be really good”. In many cases, this couldn’t be further from the truth.

The final result depends on the volume of injectable used and the exact placement. This location can be varied to give different looks. Options for enhancement are non-permanent fillers such Restylane and Juvederm, longer-lasting fillers such as Radiesse and Artefill, and permanent implants or procedures.

Hand in hand with lip enhancement goes rejuvenation of the entire surrounding area, including the cheek-lip (nasolabial) folds and lip-chin folds. In the attached photo of a real Profiles patient, you can see how these areas are also enhanced giving the lip a more youthful look by elongating it and restoring an upturned curvature to the corners

Here at Profiles, we tend to encourage and lean towards a very natural lip enhancement that increases volume and definition without looking out of balance with other facial features. Feel free to give us a call to schedule an appointment to discuss your concerns in more detail.

As you probably know, all of the products you asked about are dermal fillers. These are designed to restore volume to sagging skin in areas of creases or folds, such as the nasolabial folds between the cheek and lips.

These are 3 of the most popular hyaluronic acid products which, along with collagen, make up the main ‘building blocks’ of your skin. Unlike most collagen products, they are not animal-derived but, rather, are ‘grown’ in the lab, so the risk of an allergic reaction is minimized.

Injectable Collagen causes improvement in creases that lasts about 3 to 4 months. Because of the allergy risks and other factors, its use has largely been replaced by the hyaluronic acid products. Restylane, Perlane and Juvederm restore and replace hyaluronic acid that the skin has ‘lost’ and add volume by absorbing up to 1000 times their weight in water. The cosmetic benefits usually last from 6 to 9 months depending on the area injected, the volume used, and other factors. ‘Touch-ups” will cause the effects to last even longer.

Restylane and Perlane are from the same family made by the same manufacturer. They differ only in particle size, with Perlane having larger particles. This means that Perlane is more appropriate for deeper creases in thicker skin. In these situations, it will likely last longer than Restylane.

Juvederm is also a hyaluronic acid with a slightly different formulation or cross-linking. Its use in the United States is more recent with some claiming that it is perhaps slightly smoother and longer-lasting.

Because these products have been approved for use in Canada for many years, we at Profiles have had extensive experience with them. Please browse our web page on injectables and wrinkle reduction to get a sense of what these fillers can do for you.

That is a great question and one that is hard to answer without seeing you in consultation to personally examine you.

Aging tends to be noticed in stops and starts rather than as a gradual process. With age, most of us get some drooping of the brows AND some redundancy of the skin and fat of the upper and lower eyelids. But, in many patients, we often find that one of these problems, more than the other, is responsible for their concerns.

In the early stages, use of Botox and injectable fillers may be enough to relax the area and add volume to the brow region.

When more advanced aging is present, we may recommend an upper eyelid lift or a browlift depending on your particular area of concern. Many people think that these procedures are mutually exclusive when, in fact, they can achieve a remarkable result when done together.

You should also consider that people tend to see the eye area as a whole when looking at you. So, improving the appearance of the upper eye/brow area while leaving the lower eyelid area alone can sometimes attract unwanted attention to aging changes affecting the lower eyelids. That’s why many of our patients at Profiles choose to have the whole eyelid region rejuvenated at once to achieve an overall more youthful look.

Feel free to contact one of the Profiles doctors for more information specific to you.

In order to explain all the differences we need to first differentiate between those procedures which are “non surgical” and the others which are “minimally invasive.” The “non surgical” options include Botox, Thermage, and the various lasers. For the purposes of this blog we will avoid lasers which are can serve as facial rejuvenation tools but are not really intended to give the effects of a facelift. (We will of course blog on all the various lasers in the near future.)  The minimally invasive options will be discussed over the rest of the week.

“Non surgical” facelift options are intended for those patients who wish to improve the appearance of their facial features without undergoing any downtime whatsoever. Some of these non surgical options are more invasive than others, each have there own risks and benefits, and all require different fees.

Perhaps the most popular “non surgical” facelift procedure is Botox. More than two million people underwent a Botox “non surgical” facelift procedure in 2003 alone. Botox can be used on all skin types and colors, has really no downtime, and has minimal associated pain and complications. However, in point of fact, while Botox works great at doing its job when used by appropriately trained physicians, it really has very little correlation with a true facelift. The results are far less dramatic than a surgical facelift and generally last three to four months. (Please link to our Botox page to read much more about the appropriate uses for Botox)

Perhaps the next step in “non surgical facelift” is Thermage.

Thermage is a patented radiofrequency device that uses deep heating to tighten skin and renew facial contours. In conjunction with deep heating, the Thermage device also cools the skin. This combination of deep heating and contact cooling in theory protects the outer skin while breaking down the underlying collagen. The theory is that as the collagen rebuilds the skin tightens and renews facial contours. Unlike lasers, Thermage works on all skin types and colors, is touted as requiring only one treatment, and has no downtime.

For those of you who have heard of Thermage, it has undergone a number of changes since first being touted by Oprah in 2003in a segment entitled, THE AGE DEFYING WOMAN: HOW TO STOP THE CLOCK ON AGING. At that time millions of Oprah Winfrey fans came face-to-face with the Thermage procedure.

http://www.thermage.com/vids/page45_Stretching.html
In fact, Oprah was key to introducing Thermage to the general population. After this non-surgical “facelift” was touted on her show, sales of the machine and treatments skyrocketed. Unfortunately, in the years since that initial segment was aired, there have been numerous reports of patients who have had what appears to be significant damage from the Thermage treatments, especially when the machine was used at its higher settings. Patients have exhibited a progressive gauntness of the face, in addition to dents and stripe-like linear depressions. Some have speculated that the fat underneath the skin can become affected and even cause scar tissue to develop. Not many people know about the possible risks of this popular treatment, and it is operated by many people who are not board-certified plastic surgeons or dermatologists. Moreover, and perhaps just as importantly, the benefits of Thermage are often difficult to see.

On the positive end, Thermage has undergone a number of changes in the way it is performed. Using the original treatment algorithm, 45% found the procedure too painful, and 68% of patients found the treatment results met their expectations. With the newest algorithm and with better explanations of what you can truly expect with these treatments, only 5% found the procedure too painful, while 94% found the treatment results met their expectations. How long these treatment results last is still not clearly understood with at least one study showing that the demonstrated improvements diminished with time.

At PROFILES, our conclusion is that Thermage currently should not be intended to replace the more dramatic effects of surgical techniques. Results are always subtle and are not remotely as dramatic or reliably produced as those obtained from surgery. The skin contraction achieved is in the order of 3 mm at best in the face. Radiofrequency can impart mild tightening in patients with minimal facial laxity. In addition, it may help acne scars and acne. With further refinement of the technology and treatment algorithms, Thermage may represent a tool of growing importance to the future of facial rejuvenation procedures. There is, however, a need for more studies.

I was reading the Times when I came across an article about a duo of doctors who were planning on opening a “Botox- only” store front office on a busy corner of 59^th Street in NY, when I began to think

“Is a Botox convenience store appropriate?”

The idea behind the store is:  “It will appeal to people who took a few hours to shop at Bloomingdale’s, to secretaries on their lunch hours, to people who live and work in the neighborhood, and we will be getting visitors who think on a whim, “I wouldn’t normally do this at home, but we’re in New York, so let’s try it.”

They reason in an age-conscious society that has already accustomed itself to Botox parties, Botox house calls, Botox in spas and Botox at malls, the idea of a Botox specialty retailer akin to Starbucks seems inevitable.  One of the doctors was quoted as saying, “Botox is the female yuppie heroin. It’s like electricity: If you want to keep it on, you have to keep paying.”

To this effect the owners of this new enterprise have hired family practitioners whose experience with cosmetic injections and facial aesthetics amounts to courses on Botox injection they have taken at weekend seminars and training by the doctor- owners of the store.

After reading the article I was left confused and troubled. For us at Profiles, it seems that the idea of Botox or any other injectable as an impulse buy is, too say the least, problematic. The owners of the Botox-only store believe that general practitioners who have basic training and experience using Botox could be good injectors, saying “Botox is not very user dependent…As long as you inject it in roughly the right spot, it works. It’s like a flu shot. You can have it in your deltoid or your buttocks and it spreads out. It doesn’t have to be to the millimeter.”

We wonder if consumers would go to a place like this if they knew that the owners felt this way about their Botox treatments.

In our experience and in our practice, each patient is viewed individually both in terms of their concerns and with respect to their anatomy. Some patients have stronger muscles or thicker skin and require more Botox, other patients are very clear in knowing that they don’t want to be frozen and require less Botox. But only by listening to their concerns and understanding their anatomy can we discern these issues. Moreover, and perhaps even more importantly, some patients present thinking they need Botox when really they would do much better if they had a filler, a combination of Botox and a filler, or something totally different, like a peel. So what happens in a “Botox- only” store? We fear the answer is akin to the man with a hammer, who thinks everything he sees is a nail.

I thought it was interesting that another doctor who was questioned about this Botox-only store compared the new enterprise to car painting, saying there are places that also paint cars for $99 but that doesn’t mean you’re going to take your Porsche there.

First let us start by saying Congratulations! Your daughter’s wedding will be an awe inspiring event for sure.

As for your question, when it comes to a facelift, the simple answer is one month to six weeks before the wedding would be good. Unlike, some of the advertisements you may have seen for the so called “lunch time” or “threadlift” facelifts, we believe that patients get the best and most permanent results by having time tested proven procedures. A real face lift can be done in multiple ways and at multiple levels and the only way to know which procedure will be best for you would be to see you in consultation. While our patients are up and walking the day after surgery, we tell our patients that it will take about two weeks for the swelling and any bruising to really be gone. We then tell patients to take another two weeks before any big events like weddings and anniversaries.

Since your daughters wedding is in July, while the sooner the better, you should plan to see us a few months in advance so that we can properly meet with you, discuss your goals, and have the time to schedule your surgery. We genuinely look forward to meeting you and helping you in achieving your goals for this once in a lifetime event. Please call our office and speak to our patient coordinator so that our team can prepare you for this wonderful experience.

We came across a recent article in the NY Times that quoted research which shows that women are more likely to keep using a product that was not effective.

After interviewing nearly 300 women, ages 27 to 65, who were trying to achieve a more youthful appearance by using creams, vitamins and other beauty treatments, researchers were surprised to find that women were more loyal to products and treatments when they didn’t work than when they did.

The research studied women who had used various beauty treatments in the past year including salon level anti-aging skin care, moisturizing products, vitamins, special diets, as well as medical treatments such as Botox or chemical peels.

They found that among women who felt that the treatments were not working, only 27 percent had stopped using the products; the rest said they wanted to continue using them. But among women who felt the treatments were successful, 55 percent had stopped using them.

So why would a successful beauty treatment spur more quitters than one that failed?

The researchers reason that maybe when people don’t feel good about themselves, fear is a more powerful motivator than success. In other words, when women fear looking older they are spurred to continue trying products even when they don’t work.

Because success, in this case younger-looking skin, dissipates anxiety, women stop worrying about it. Of course, similar-type research in men has shown similar results- the fear of looking bad was a more powerful motivator than the hope of looking good.

As you can see above with Angelina Jolie, not all moles need to be removed. However, the next time you or a loved one are thinking of having your mole evaluated by a dermatologist you should note that recent studies by the American Academy of Dermatology found that patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkle treatment.

Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared with a typical wait of 26 days for a patient requesting evaluation of a changing mole.

“The difference in wait times between medical dermatology and cosmetic dermatology patients is clearly real,” said the lead author of the study and an assistant professor of dermatology.

In Boston, the median Botox wait was 13 days, versus 68 days for a mole examination. In Seattle, the median Botox wait was seven and a half days, compared with 35 days for a changing mole.

So maybe the next time you’re worried about your mole, you should consider calling your facial plastic surgeon rather than waiting.