Friday, September 29, 2017

All You Need To Know About Facial Skin Tightening

Dermatologist Dr. Kenneth Mark:  “Prior to Ultherapy, we dermatologists had no way to lift the skin other than with Botox (results very short lasting, typically 4 months) or fillers.  With fillers, unless you go for the chipmunk look, we are somewhat limited with how much lifting we can get and again results do not last nearly as long as with Ultherapy.  It is by far the best non-surgical treatment to lift the skin of the neck and around the jawline/jowl area.”
by Delia von Neuschatz

Are you looking for some subtle facial tightening but are not yet ready for a facelift? 
Perhaps your cheeks fall a little flat and your jawline is not as sharp as it once was?  You understand that injecting fillers in the cheekbone area will give you some volume and lift, but are hesitant to go down that road as it’s easy to go overboard and end up with a puffy face?  Plus, it’s something you have to repeat with some frequency.  So, what are some effective non-invasive and minimally invasive skin tightening options?  I explore a few choices below and look into a less invasive facelift procedure too.

My first port of call was the Southampton office of dermatologist, Kenneth Mark, MD for an Ultherapy treatment on my face and neck.  There, I was ministered to by an experienced nurse following the doctor’s customized protocol.  The hour-long procedure delivers ultrasound technology to the deepest layer of the dermis, heating this foundational layer of facial tissue to a temperature that is optimal for collagen stimulation. “Ultherapy is the only non-surgical device cleared by the FDA to actually lift the skin.  No other company, machine, laser, can claim to lift the skin,” informs Dr. Mark. 
Ultherapy uses ultrasound to heat the foundational layer of skin to the temperature that is optimal for collagen stimulation.
Because Ultherapy bypasses the surface of the skin, there is no damage to the epidermis and so, there is no downtime.  The treatment is not painless however and I made vigorous use of the squeezy ball that was on hand.  Thankfully, one session is all that’s required.  In Dr. Mark’s 5+ years of experience with Ultherapy, almost all of his patients had just one session.  “This is one of the advantages of Ultherapy compared to other procedures that take multiple sessions and do not even deliver near the results,” says the dermatologist. 
“The results absolutely do last 5 years!” exclaims Dr. Mark.  “I have seen patients repeat it 5 years later, and despite being 5 years older, they still look better than they did before their first treatment.  Having said that, this is an individual decision.  I have some patients repeat it every year on their birthday to push back on the aging process. Most patients do repeat it every 2-3 years, but it is not because they reverted back to baseline.  They still look better, but it is each patient’s personal preference depending on their motivation, budget, etc ... As one patient said to me, ‘any time you form collagen, it is a good thing!’”
Month by month, there is visible improvement with collagen production peaking approximately 3 to 6 months after treatment.  Collagen production continues from month 6 to 12 with some patients seeing significant improvement during this time as well.  “Having treated patients for over 5 years, I have witnessed the results last that long,” says Dr. Mark.  “It is not meant to replace a surgical facelift, but statistics show 90% of patients obtained about a 2 mm brow lift at the 3-month mark.” 

It may take several months to see optimal results, but some facial tightening is visible right away because there is some immediate skin contraction. Indeed, the day after my treatment, I met a friend for dinner and she asked me, unprompted, if I had had anything done as my skin looked so good.  Today, four months later, I notice a slight, but distinct lifting of my brows, a less crepey under-eye area and a smoother neck.  To be sure, the results are subtle but I feel that I’ve delayed going under the knife for the time being.  As for the cost, In New York, you can expect to pay around $4,500.

Ultherapy utilizes ultrasound to achieve results.  What about radiofrequency, another technology in dermatologists’ arsenal?  I was particularly curious about a minimally-invasive, FDA-approved treatment called EndyMed.  To find out more, I called upon dermatologist, Dr. Doris DayEndymed Intensif Microneedling with RF, explains Dr. Day, utilizes radiofrequency to stimulate collagen production deep within the skin.  The energy is delivered to the dermis via gold-plated non-insulated needles, triggering a natural healing and contracting process.
Dermatologist, Dr. Doris Day:  “I like EndyMed Intensif because it has non-insulated gold-plated needles that provides accurate and precise combination microneedling and radiofrequency energy delivery with minimal bleeding or collateral trauma to the skin.  I have found the results to be consistently impressive and reliable.”
The non-insulated needles serve to cauterize blood vessels which means there is less bleeding. “You have a couple of days of redness at the most,” says Dr. Day who adds that for superior results, this treatment can be combined with PRP.  PRP or “platelet rich plasma” involves the extraction of growth-factor-rich plasma and platelets from the patient’s own blood.  The resulting protein-rich concentration is then re-administered onto the skin through the process of microneedling. 

In addition to skin tightening, EndyMed Intensif is also effective at skin resurfacing.  It has been used to treat fine lines, wrinkles and stretch marks. “It’s great for rejuvenating the area around the eyes and lips and for treating acne scars,” says Dr. Day.  “I also like the tightening and body contouring and submental fat contouring aspects using the radiofrequency energy.” Three sessions at 1-month intervals are recommended followed by 3 more sessions at 3-month intervals — so 6 sessions spread out over the course of a year.  Results last up to a year after the last treatment.
EndyMed Intensif RF uses microneedles to deliver fractional radio-frequency energy to specific locations into the deeper skin layer known as the dermis. This energy promotes the body’s natural production of collagen and elastin.  (An equivalent microneedling and RF technology is Infini.  One of the main differences between the two machines is the microneedles utilized in Infini are insulated, while EndyMed’s microneedles are non-insulated.  This means that with Infini, the energy is delivered through the tip of the microneedles, while the energy delivered through EndyMed travels through the entire length of the microneedles.   Consequently, Inifni has a more precise delivery of energy, but requires multiple passes.)
Before and after EndyMed Intensif:
Interested in the potential results of the next level of minimally invasive techniques, I went to speak with Dr. Paul Jarrod Frank, founder and director of The Fifth Avenue Dermatology Surgery and Laser Center.  I was especially interested in UltraTight, a neck and jowl-tightening procedure he developed and trademarked.  A modification of neck liposuction, UltraTight removes fat from the neck and jowl area while simultaneously and internally tightening the area with ultrasound technology. 

The main concern with traditional neck liposuction, explains Dr. Frank, was always “what happens to the skin after you remove the fat?”  With UltraTight, after an injection of local anesthesia, a Q tip-sized ultrasonic wand — a Vaser (which Dr. Frank helped develop) — is inserted through two very small slits that close without sutures.  The Vaser melts the fat and heats up the dermis from the inside to help tighten it.  The fat is then removed under suction with a micro cannula. 
Dr. Paul Jarrod Frank:  The key thing to remember with any kind of treatment and particularly so with skin tightening is there’s no best.  It depends on the patient – their skin color, their age, their laxity, their tolerance for downtime, their pocketbook.  You get the best results by playing jazz with different instruments.  So with the 25-30 different technologies I have, I get optimal outcomes by combining several small procedures like ultrasound, radiofrequency and microneedling rather than doing one single procedure.  It’s my Tighten, Lift and Tone (TLT) protocol. 
Dr. Frank equates the experience to going to the dentist.  “I would say the recovery during the weekend is like getting a tooth pulled, having a root canal.  There’s really no bruising, just puffiness,” he says.  “It’s a weekend recovery.  I’ve never had a patient in the ten years I’ve been doing it who couldn’t go to work on Monday.”  So, how does this compare with competing non-invasive methods like Kybella, a fat-busting injectable and the fat freezing CoolSculpting? 

The problem with procedures like Kybella and CoolScultping is that they don’t treat the jowl area. “You can’t do CoolSculpting and you can’t inject Kybella in the jowls because there’s a very important nerve that is affected when you do something like that,” reveals Dr. Frank.  “With UltraTight, I can etch out the jawline all the way to the ear.”  Furthermore, Kybella causes a considerable amount of swelling, resulting in more downtime.  It also requires multiple visits while UltraTight is a one-time procedure.  “Most people end up paying less money and have less downtime with this one-time treatment,” reveals the dermatologist. “Unfortunately, a lot of people don’t get to me until after they spend time, money and downtime with things like Kybella or CoolSculpting.”

Not everyone is a candidate for UltraTight, however.  Those with waddling skin are better served by surgery.  But, if you are anywhere between 25-55 years old, have pinchable fat and are just looking for some definition in the neck and jowl area, UltraTight which has also enjoyed popularity among Dr. Frank’s male patients, may be the answer.  Costs range from $5,000-$6,000.    
UltraTight is a popular procedure among both male and female patients.
After exploring non-surgical face lifting techniques, I wondered if there is anything on the surgical front that is less invasive than a traditional facelift.  It turns out there is.  Facial plastic and reconstructive surgeon Dr. Thomas Romo III has developed a unique technique called the endoscopic composite facelift

With this procedure, small 3D scopes are inserted via strategically-placed limited incisions, allowing for better visualization of the underlying facial structure.  Tiny surgical instruments (which Dr. Romo helped develop) are then introduced and used to lift the muscles and remove excess tissue.  Because they are so small, the incisions made during an endoscopic face lift allow much greater flexibility regarding the placement of surgical instruments.  This makes it easier to aesthetically modify even traditionally hard-to-reach areas.  This approach, according to Dr. Romo, has numerous advantages over other facelift techniques, including more natural-looking and long-lasting results, smaller incisions, and a more rapid recovery after surgery.
Double Board-Certified facial plastic surgeon Dr. Romo III is Head of Facial Plastic and Reconstructive Surgery at both Lenox Hill Hospital and at Manhattan Eye, Eat and Throat Hospital (MEETH).
All areas of the face that show aging are evaluated, be it brow, forehead, temple, midface, lower face and/or neck.  “A person may need all of them treated or just specific areas depending on each individual face,” explains Dr. Romo, “but the evaluation and treatment of the face is done as a whole unit or composite grouping of the face.”  Candidates are typically 45 years and older and want to address drooping muscles and misplaced fat, but do not have a large amount of excess skin.  Fees range from $10,000 - $20,000.

Pre and post-op photos of a composite endoscopic facelift:
Expert tip:  Dr. Romo advises patients to delay surgery as long as possible because “women today live longer and they’re having procedures done earlier.  So you have to have a physician who understands your face and who will put a package together for you so that you can have something done 5, 10, 15 years later and 5, 10, 15 years after that and you haven’t burned all these bridges.”
For more beauty tips and information, follow Delia on Instagram: @chasingbeautywithdvn