Can you really get a facelift without surgery?
Read on for Gary’s take on the risks of non-surgical trends.
What if I told you that you could get the results of a facelift without the surgery?
A few well-placed needles, an energy device or two, no down time, fewer risks?
Let’s not kid ourselves. It sounds good.
When I was performing facelift surgeries, patients would often ask, "How can I lift my face without surgery?"
My honest answer? You can’t.
It’s hard to listen to your inner skeptic when it comes to a topic as sensitive as aging. A lot of advertising dollars have been spent convincing people concerned about signs of aging that there is a way to lift the face without the downtime and risks of surgery. The exponential increase in non-surgical procedures globally over the past few decades tells us that the idea has a strong foothold in our social psyche.
And, while there are great non-surgical treatments available, I think it’s really important to talk about their limits and some of the lesser-known risks – some of which we’re just discovering.
Could you be causing irreparable damage to your skin pursuing a non-surgical fountain of youth?
Read on to find out as I break down the benefits, limits, and risks of some of the most popular non-surgical ‘lifting’ techniques out there!
Is there really such a thing as a ‘non-surgical’ facelift? If it sounds too good to be true…
The Injectables: Botox, Fillers, and Biostimulators
Possibly the most famous (and infamous) category of purported non-surgical facelift techniques are injectables, namely fillers, biostimulators and botulinum toxin.
Fillers come in two flavors, permanent and temporary, and they do what the name suggests - they fill in areas where volume has been lost. Temporary fillers include collagen and hyaluronic acid (HA), both of which can be broken down by the body naturally (HA fillers also being dissolvable with hyaluronidase). They fill tissue by being biocompatible with the body’s natural collagen and HA. Permanent fillers include silicone and Bellafill (polymethylmethacrylate (PMMA) microspheres suspended in purified collagen), and they ‘fill’ by prompting a ‘foreign body’ reaction, where your body tries to isolate what it perceives as an invader by sealing it off with collagen. This same foreign body reaction has the potential to lead to many, many potential complications. Biostimulators Sculptra (poly-L-lactic acid) and Radiesse (calcium hydroxylapatite) are microsphere gels that are broken down by the body over time (unlike permanent fillers) but also use the foreign body reaction, stimulating fibroblasts to make collagen, resulting in the skin appearing ‘fuller’.
As for botulinum toxin (Botox)? Its mode of action is to temporarily paralyze targeted muscles of the face. Though the origins of botulinum can be terror inducing, it’s arguably one of the safest injectable beauty treatments on the market.
There’s no such thing as a non-surgical facelift. It’s just not possible to combat gravity without surgical intervention. So, what can and can’t injectables do?
For the most part, HA fillers and biostimulators can be great for strategically masking volume loss in the face. Used sparingly they can really help address some signs of aging that might be bothering you.
Where things get tricky is when you try to ‘lift’ the face by adding volume that was never there to begin with (or masking bone loss – fillers can’t replace bone). The logic makes sense, but in practice it just doesn’t work. When you’re trying to ‘shore’ things up, faces can start looking ‘inflated’ and unnaturally full. Skin can be stretched out and permanently modified (we’ve seen this with overfilled lips), requiring surgical intervention later, and there’s also the potential for developing scar tissue (more on that coming up).
Botulinum toxin can do a lot to address the signs of aging, but it’s not a replacement for a surgical brow lift.
Botulinum toxin can also have a positive impact on appearance. By targeting muscles that pull the forehead and eyes down, you can partially elevate the brow leading to a more alert, less tired appearance, but it’s not a replacement for a brow lift and treating it as such can lead to unnatural ‘frozen’ expressions.
Thread lifts
I’ve talked about thread lifts extensively before in video and in articles, but the gist of the procedure is that PDO (Polydioxanone) dissolvable barbed sutures are ‘threaded’ under the skin to ‘lift’ it into a new position. They were briefly popular in the late 90s and early 2000s until complications from permanent sutures made them fall out of style. Those complications included puckering, infections, and scarring when repeated – definitely not a pretty or healthy result. They’ve had a resurgence with dissolvable sutures, but a lot of the same problems still exist.
The procedure is more trouble than it’s worth – it’s expensive, very temporary, and people are often left disappointed.
Thread lifts have made a comeback in recent years as a non-surgical lifting technique. It’s expensive, temporary, and doesn’t really lift. Buyer beware.
Radiofrequency +/- Microneedling and Ultrasound
The next two treatments on our non-surgical face lifting list are energy-based procedures that promise to remodel and tighten skin by heating the deeper layers – just in slightly different ways.
Both radiofrequency and ultrasound waves can be used to deliver heat to the dermis at a controlled depth and temperature. When that happens, collagen contracts – it’s being cooked – and subsequently remodels and reorients. Heat response proteins also direct fibroblasts to produce more collagen and elastin to repair the heat damage. Microneedling can be used to ‘double up’ on controlled damage, delivering heat more directly to the dermis while creating micro-wounds to hopefully increase collagen remodelling.
Energy devices heat the skin to high temperatures causing collagen to contract… not unlike cooking a steak.
Radiofrequency and ultrasound do increase collagen, which can make skin appear more youthful, so (for the right candidates) there is a benefit. But once again, energy treatments (and similar micro-coring and microneedling techniques) are not alternatives to a facelift.
Energy based treatments are also still relatively new, meaning we don’t really know what the long-term effects of these treatments are when they’re repeated over and over… and in some cases, the collagen could be remodeled the wrong way.
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Collagen behaving badly
Earlier, when I talked about fillers, I mentioned scar tissue as a potential side effect. When collagen remodels, it can do so in a way that’s unorganized. More collagen isn’t always a good thing, especially when it builds up as scar tissue. Years of filler overuse and repeated (or improper) use of energy device treatments can trigger collagen to remodel in a way where it no longer looks or behaves normally – and what’s worse, it can make surgery later on much more difficult to perform.
Ironic that the pursuit of a non-surgical facelift could lead to a patient still needing to go the surgical route to see the results they want, while making those results more difficult to achieve. Imagine spending years pursuing non-surgical treatments to avoid a facelift surgery, being unsatisfied with the results, only to find out that the non-surgical treatments may have made those same results less attainable because of damage?
An opposite result.
That doesn’t mean fillers, energy devices and coring techniques always lead to collagen behaving badly, but the association is there. Increasing normal, structured, healthy collagen is a great thing. Unstructured, crunchy collagen is… not.
A facelift procedure is a major surgery. It carries risks that shouldn’t be downplayed. However, the idea that non-surgical interventions let you off ‘risk free’ just isn’t true. The risks are different but they’re there and might not make themselves visible for years. That’s not to say they don’t have their place, but you need to educate yourself.
The biggest risk of all trying to ‘lift the face’ with non-surgical treatments? Wasting money and being unhappy with the results, something that’s definitely not in the patients best interest. Keep your skeptics cap on, especially when promises being made seem too good to be true!
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.