What are the qualities that make a plastic surgical procedure ideal?  Certainly these five things come to mind:  excellent and long term results, no discomfort, no downtime, no risk of complications or adverse outcomes, and low cost.  As a plastic surgeon, I too would like all of those attributes.  From my perspective, safe, painless, and effective procedures are winners, and patients will flock to me. 

 Certain companies and some less scrupulous surgeons are capitalizing on our desire for better plastic surgery by marketing products as equally effective and safer alternatives to ‘traditional’ procedures.  With regards to facial rejuvenation, there are a few alternative procedures that are touted as having results equal to or better than more traditional surgeries, but with no risk or downtime, and less expense.  Unfortunately, their effectiveness is questionable and usually limited in duration.

Barbed Sutures

 The use of permanent suture material as something more than a ‘stitch’ was first popularized by Dr. Gianpappa in the 1980’s.  It was a fishing line type of string that was pulled across the neck in conjunction with a regular face and neck lift.  Since that time these same sutures have gotten a technological update with the inclusion of barbs along the shaft of the stitch to allow it to ‘grab’ tissue so it can be pulled.  They are now being employed in very innovative ways and have been given catchy names like ‘feather lift’, the ‘seven stitch’ face lift, the ‘one stitch’ facelift (even better, right?), the lunchtime face lift, etc.

 Many of these procedures do not involve any surgery, but merely the placement of the barbed suture through the skin in one direction, then tugging on the suture in the other direction to engage the barbs, pulling and lifting the skin.  When done well and in the right candidate, there can be a very impressive improvement to the contour of the brow, cheek, or neck of the individual.  When done poorly or in the wrong individual, there is abnormal puckering, dimpling, or folding of the facial and neck contours.  Regardless of the initial result, invariably there is a loss of improvement over the short term, typically within a few weeks to months, back to the original facial contours.  In addition, there can be palpable knots or lumps along the tracks of the sutures that are permanent.

 Why do these sutures fail?  Your body is constantly resisting the forces applied to it, especially if there is any tension.  Because there has been no surgery separating the tissues from one another and releasing the underlying anchoring of tissues, there is inherent tension when the tissue is being pulled.  The barbs holding the tissue under tension eventually loose their grip as the tissue pulls back to its original position.

Small incision facelift.

 These procedures  constitute the ‘weekend facelift’ and is an actual surgical procedure involving removing a small amount of skin to give the face some tightening.  When done in the right individual, there can be some improvement to the jawline and jowl.  However, because only skin was removed, the improvement is lost as the original contours return. Why?  Using skin as a ‘bra’ will not last because of the skin’s unique ability to expand under the forces of tension.  Usually there is no significant surgical division of the anchoring tissues below, and the skin is being placed under tension, leading to its expansion and a return of the jowl and jawline.  Occasionally, because the skin was pulled so tightly, thicker scars can form around the ear area

Laser facelifts

 Lasers have been touted as safe and effective alternatives to surgical facelifting.  Unfortunately this is just not the case.  Once again the presumption would be that the lasers tighten the skin and the skin acts like a ‘bra’ to recontour the face.  There are two problems with that line of thought. First that a laser can tighten skin to that extent, which it can’t.  Much time and energy has been place into research in that regard, and there have been some modalities that have shown some skin tightening effect, but not to the degree that is being advertised.  Second, even if skin could be tightened to that, we already know what happens when we let skin be the ‘bra’!

 Lasers and other radiant energy devices certainly have a place in facial rejuvenation, and I have many of the best devices available.  They are designed to improve and rejuvenate the skin and not replace what can be done in a true surgical procedure.

Non-Surgical Facelifts

 Combining the use of Botox Cosmetic with fillers including collagen and hyaluronic acids like Restylane and Juvederm can have a profound improvement to certain individual’s facial appearance, but can hardly replace a true surgical procedure, especially in the neck and brow area.  In the right individual, I employ all of the above to smooth the facial lines along with Sculptra  to re-volumize the face, a very important factor in facial rejuvenation, even when considering a facelift.

Conclusion

 Unfortunately, we have not yet come to the point where we can get the quality or duration of results seen in a true modern face and neck lift with alternative treatments.  The use of barbed sutures or ‘skin only’ mini surgeries is not recommended.  I much prefer my patients who don’t want to have a proper surgical procedure to maximize their potential for facial rejuvenation with safe and effective non-surgical procedures like botox, fillers, and volumizers as well as skin rejuvenation techniques like lasers and peels.  This may tide them over for many years to come.

 So are we ever going to get the perfect plastic surgical procedures we’ve been looking for? To this end, plastic surgical education has funded research grants to devise, perfect and train doctors how to perform procedures that are more effective, safer, and with less risk.  Some of these procedures involve minimal incisions, endoscopes for guidance, and novel approaches to old problems.  All of these procedures are still surgery, and as such still carry some risks, even if less than previous ones.  Surgical science is striving for that goal however!  To learn more about the latest techniques in facial rejuvenation including eyelid surgery, brow lifting, facelifting and neck lifting, please call Dr. Minniti’s office for an evaluation.  Dr. Minniti is an expert in this field and knows the most advanced and safest techniques available.