Non-Surgical vs. Surgical Facial Rejuvenation: Which is Right for Me?

Facial Rejuvenation OptionsOver the past several years there has been an explosion of options to help your face look better and younger. Fillers, toxins (e.g. Botox®), stem cells, facelifts, fat grafts, skin tightening, and the list goes on and on. With so many options, how can you know what is right for you? Is surgery better, or will non-surgical treatments help you achieve your goals? Do the treatments even work? As you consider your options, understanding a few general principals can help simplify the decision.

First, it’s important to understand that surgery and non-surgical procedures sometimes do different things, but sometimes they do the same thing in different ways. For instance, deepening of the nasolabial folds (the creases from the side of the nose toward the corners of the mouth) can be softened by dermal fillers such as hyaluronic acid (e.g. Juviderm®, Restylane®). This type of injection is performed during an office visit and only takes a few minutes. Surgery, however, can also diminish the folds. Fat grafts can be utilized to soften the folds much like fillers, and often the most dramatic improvement to the folds is when a face lift is combined with fat grafting.

Second, while non-surgical or minimally-invasive treatments are easy to undergo and recover from, they are typically temporary and will need to be repeated to maintain the effect. Neurotoxins (e.g. Botox®, Dysport®, Xeomin®) do a great job of softening wrinkles between the brows, in the forehead, and by the side of the eyes, e.g. ‘crow’s feet’. These injections take only a few minutes to complete, but they typically last about 3 or 4 months and then need to be repeated to maintain the effect. On the other hand, surgical procedures tend to be more long lasting and may never need to be repeated. A brow lift can treat the wrinkles between the eyebrows extremely well, and this improvement is generally permanent.

Third, there are some aging changes that simply can’t be adequately corrected by non-surgical treatments, at least at this point in time. If you have developed significant jowling, only surgery can reliably address this issue. If the brow position is quite low or there is a significant amount of loose skin of the upper eyelids, only eyelid and brow surgery can reliably reposition the brow or eliminate the loose skin of the upper lid. If there is significant skin laxity in the neck, minimally-invasive treatments will not fully correct the looseness, and a neck lift will be required for full correction.

It is also very important to understand that often non-surgical and surgical treatments represent a continuum of effectiveness. Office chemical peels, mechanical treatments, or facial lasers can do a great job if the degree of skin changes and wrinkling is relatively limited. More aggressive lasers or surgical chemical peels, however, can produce more dramatic results when the skin has more established aging. Very often, minimally-invasive treatments are a great option for less severe changes, while surgical treatments are the best for more severe changes. If you are older and have more advanced aging concerns, surgery is more than likely the answer for you, but if you are in your thirties or forties, very often the non-invasive treatments such as fillers, Botox®, and good skin care is the best strategy.

Finally, and most importantly, marketing and hype doesn’t mean that something works. As much as we are always hoping for great, new options, some of the marketed treatments have little or no proven effect. For example, although the potential of stem cells to treat many conditions – including facial aging – is significant, at this time there are not sufficient studies to show that the currently marketed treatments are either safe or effective. Also, just because a treatment is approved by the FDA doesn’t mean that it is better than the older, simpler, or less expensive procedures. The old adage is upheld: If it seems too good to be true, it probably is.

As you work to figure out your best combination of options, remember that the doctors at the Emory Aesthetic Center are trained in both non-surgical and facial surgical solutions to address your aging concerns, and can help you figure out what strategy is best for you. In addition, we can help you develop a long-term, integrated plan to keep your face looking its best, incorporating good skin care along with non-invasive and surgical treatments when the time is right.

Join us for a live chat on Facial Rejuvenation –Surgical and Nonsurgical Solutions on Tuesday, November 11th at Noon to hear more about this topic. Dr. Foad Nahai, cosmetic surgeon, will be available to answer all of your questions. To register for the live chat, click here.

About Dr. Eaves

Felmont Eaves, MDDr. Eaves recently returned to Atlanta, Georgia, to head the Emory Aesthetic Center as Medical Director, having previously completed his plastic surgery residency as well as a fellowship in endoscopic and minimally invasive plastic surgery at Emory University, The Emory Clinic, and associated hospitals. Before joining the Emory Aesthetic Center, Dr. Eaves was a partner in Charlotte Plastic Surgery for more than fifteen years and served as group president from 2010-2012.

His professional and institutional committee memberships and offices include an impressive list of national, international and local plastic surgery organizations, societies, boards, task forces, advisory councils, coalitions and foundations, including having served as President of the American Society for Aesthetic Plastic Surgery (ASAPS) from 2010-2011 and Trustee (2011-Present).

Dr. Eaves’ primary areas of academic inquiry have been in minimally-invasive and endoscopic aesthetic surgery, patient safety, system and process improvement in plastic surgery, evidence-based medicine applied to plastic surgery and recontouring surgery after massive weight loss. He has received several patents for new medical devices he developed, and has made major clinical service contributions to his field. Dr. Eaves has published more than 100 articles, book chapters and book reviews on plastic surgery in peer reviewed publications, as well as manuals, videos, computer programs and other teaching aids and has coauthored the first textbook on the topic of endoscopic plastic surgery.

What is A “Liquid Facelift”?

liquid-faceliftA “Liquid Facelift “is the non-surgical rejuvenation of the face through injections. These injectables include Botox© (sometimes referred to as “neuromodulators”) which relax the muscles, and fillers which restore volume. The “Liquid Facelift” should not to be confused with the mini or short scar facelift which are surgical procedures.

As our faces age we lose volume, develop lines and lose skin elasticity. Our facial muscles enable us to smile, frown and express our feelings, but over time, these muscles contract, leading to lines or wrinkles on the forehead (frown lines), eyes (crow’s feet) and around the mouth. Loss of facial volume with decreased skin elasticity leads to the development of folds, jowls and the appearance of a sagging face.

Botox©, and similar muscle relaxants such as Dysport©, Xeomin©, help to soften or eliminate the lines on the forehead, around the eyes, elevate and reshape the brow and the area around the mouth. The face appears less wrinkled, more relaxed and rested. The result of muscle relaxants last between four and six months.

Fillers replace lost volume by filling hollowed areas of the face and reducing skin laxity. The effect makes the face appear to be “lifted”. There are a variety of fillers, varying in composition, thickness, longevity and cost. Some are suited for deep injections, others for more superficial placement. Each has its role in facial volume replacement, and it is not unusual to inject two different types of fillers into the same face – deep placement with one type of filler and more superficial with another. Fillers can also be used to soften deep lines and wrinkles in conjunction with muscle relaxants.

Not everyone is a candidate for a “Liquid Facelift”. It is best reserved for patients with early stages of facial aging – those that when relaxing the muscles and adding volume will lead to a “lift”. For those in the later stages of aging with excess and inelastic skin, a surgical facelift may be better served where the excess skin is removed and the deeper tissues are rearranged. A cosmetic surgeon will be able to evaluate your face and make recommendations based on your individual need.

“Liquid Facelift” Frequently Asked Questions

How is the procedure performed? It is an office procedures which may take up to an hour depending on the number and extent of the injections. Some physicians may wish to stage the procedures and spread them over two sessions. A topical anesthetic (numbing cream) is typically applied prior to injection. Some fillers contain local anesthetics. Following the injections ice may be applied to minimize bruising. There is little, if any, down time associated with the procedure, although there is always the possibility of bruising.

Is this an expensive procedure? Costs will vary depending on the amount and type of materials injected. Typically one or two sessions are much less expensive than a surgical facelift. However, the cost of injectables does add up and over a number of months or years may surpass the cost of a surgical facelift.

How long do the results last? These treatments are not permanent nor do they last as long as a surgical facelift. In general, the relaxants last four to six months and the fillers last anywhere from two to four years. Some fillers last longer than others.

Related Resources

What is a Mini-Face Lift & How is it Different from a Traditional Face Lift?

Mini Face LiftIt seems that every cosmetic surgery practice out there is marketing a different trendy name for a mini face lift. Many patients are finding it difficult to understand the difference between a mini-face lift and a traditional one. They want to know what it all means, what procedure would be best for them, and whether or not they would be a candidate for these “new” procedures. We’re here to help answer some of these questions.

Despite what some may lead you to believe, “mini-lifts”, in some shape or another, have been around for decades. For some patients they are an excellent option, particularly those with minimal to no excess skin in the neck and very mild to early jowling. The “mini” part of a mini-face lift refers to the scar, which is shorter than the scar for the standard or traditional face lift. The shorter scar is possible because there is less need to access deeper tissue, and less rearranging of those tissues is needed. Typically, though not always the case, candidates for mini-lifts tend to be younger, in their late 30s to mid 40s with good skin texture, normal skin elasticity and minimal skin excess , especially in the neck.

In a standard or traditional facelift the incisions are longer to allow access to better reposition the jawline and to deal with neck laxity. What is important to understand here is that these incisions are no more visible than those of a mini-lift because they are hidden in the crease behind the ear and in the hair where they are not readily noticeable. Traditional face lifts allow for more definition in the jawline, as well as the ability to greatly improve the neckline and under the chin in patients with excess skin in these areas. Typically, candidates for more traditional face lifts are older and in their late 40s, early 50s and above. They typically have less skin elasticity and more laxity especially in the lower face and neck.

Despite claims to the contrary, the recovery time between the two procedures may not be significantly different. Recovery depends more on the patient, levels and extent of dissection and even type of anesthesia used rather than the length of the scar. Most patients feel well even the next day, though activity is usually restricted to light walking to avoid complications. Within a week to 10 days, all sutures are out and significant swelling and bruising have begun or mostly resolved.

It certainly makes sense that adding the term “mini” to a procedure would make it significantly more appealing to a patient than “traditional”. We would caution the prospective patient to make sure they understand fully what their concerns are and ensure their prospective plastic or facial plastic surgeon communicates how their recommendation will address those concerns. Each patient’s facial structure is unique; therefore, applying a trademarked procedure is unfortunately a “cookie-cutter” method of dealing with a very patient-specific set of needs. The best, and most lasting results are often encountered when the procedure is chosen based on patient characteristics rather than marketing. Happy lifting!

Facelifts, Mid-Facelifts & Mini-Facelifts? Understanding Your Facelift Options

Facelift OptionsAs we celebrate a new year and new beginnings, we may find ourselves thinking about enhancing facial features we thought were lost to past years. This can be achieved through the right facial rejuvenation surgery. A well-done facelift can take years off your face, leaving you looking and feeling brighter, fresher, and more attractive.

At the Emory Aesthetic Center, we understand that no one solution is the answer for all – every patient has different goals and needs. There are many different types of facelifts to give you the look you want. Perhaps you’re still in your early 40s, and a more limited procedure may be just what you need. If you’re in your mid 50s and you see a sagging, heavy neck when you look in the mirror, a full facelift may be the answer. Facelifts can also be combined with other procedures such as eyelifts, brow lifts, lasers, or chemical peels. Newer techniques often combine volume restoration with fat grafts or injectibles to create a softer, more natural and younger look. At the Emory Aesthetic Center, we take great pleasure in partnering with you to customize your procedure in order to fulfill your individual needs.

Although there are many variations, at the Emory Aesthetic Center we offer the following facelift options, and will work with you to achieve optimal results:

  • A traditional, or full facelift is designed to restore a more youthful appearance to the neck and jowl region by removing major wrinkles and sagging skin. If there is excess fat in the neck or chin region, this can be addressed simultaneously with liposuction or direct excision. A face lift can improve a tired facial appearance by smoothing the skin and reestablishing defined contours along the neck and jawline. There are several different full face lift techniques which your surgeon can use, varying the incision location and depth of dissection to tailor the procedure to your needs. It is often performed in combination with other procedures, including a brow lift and eyelid surgery, to create an overall harmonious, youthful result.
  • A limited, small incision, or “mini-facelift” is what it sounds like: a less extensive version of the traditional facelift. A mini-facelift may involve shorter incisions or less dissection, but also it is dictated by the amount of laxity or jowling present.
  • A mid-facelift procedure can be used, either alone or combined with other procedures, to correct hollowing beneath the lower eyelids and deep nasolabial folds, or “parentheses”, that run from the base of the nose to the outer corners of the mouth. It creates a more youthful appearance by smoothing the transition between the lower eyelids and upper cheek region. If improvement in the neck or jowl region is also desired, a midface lift can be combined with a more standard facelift.

Our focus is to help you look as young as you feel, and to make you look naturally more beautiful. We enhance your natural beauty, taking years off your face so that you’re noticeably refreshed and more attractive. What we don’t do is make you look unnaturally “lifted” or stretched—something you see all too often in facelifts.

If you’re thinking about facial rejuvenation, let our team of board certified cosmetic surgeons help you realize your vision of you. Our surgeons will meet with you one-on-one to answer your questions and ensure you are confidently ready to take the next step.