I keep seeing patients and they do minimally invasive or noninvasive procedures because they are trying to avoid the big surgery like the facelift or tummy tuck. I get it. I have a surgical practice and 3 kids. I am aging. If there were a way to do a noninvasive, no downtime procedure, I would jump right on it. I do not look like I did 3 years ago. And when Facebook or Shutterfly shows me 10 years ago? I look ridiculously better. If there were good ways to reverse aging that allowed us to continue our work and working out and busy lives I would do it in a heartbeat.
But.
The issue is many of these treatments don’t work. Or they work temporarily. Or they have an unintended side effect you don’t know about.
I see these patients down the road, when the noninvasive procedure didn’t work, or didn’t do what they hoped, or only looked good for a month or two. I see them when they have resigned themselves to do the bigger procedures. But now they have made that procedure harder or hurt their results. This is my opinion (after 25 years in plastic surgery and loads of experience, but my opinion nonetheless)
So what are my current 5 be careful down the road things:
COOLSCULPT or ULTHERA. You can put any noninvasive or minimally invasive “skin tightening” in here. If it heats it up, it is likely not good. Why? All of these hurt the fat directly underneath the skin. That is the fat which nourishes the skin, helps iron out wrinkles, and makes the skin look good. Coolsculpt is aiming to get rid of fat, Ulthera does it by its closeness to the undersurface of the dermis, so when trying to tighten the dermis, the fat is hurt by proxy. Regardless, it hurts you in the long run. It can leave you with more wrinkles and poorer skin quality. Bad skin = bad looks. Even if your skin is tight, if it has poor quality, it looks bad.
SCULPTRA. I love Sculptra for giving a lot of volume diffusely to the face, but it works by stimulating your body to make collagen. That collagen though is scar. So for me, who is a BIG fan of fat transfer, when I try to fat graft down the road after someone gets Sculptra, it just doesn’t work. Sculptra is like throwing clay in my soil when I am planting. **NOTE: HA fillers like Juvederm and Restylane and RHA don’t do this.
THREADLIFTS. The new PDO threads work to help lift. But their issue is just like Sculptra- it is a material that is meant to cause inflammation and eventually dissolve. But this causes scar tissue. Again scar tissue = clay in the soil. I think this is going to hurt my fat grafting results in the future, and I heard a famous plastic surgeon who does tons of facelifts rail against threads recently- It makes the facelift surgery much harder, as the tissue planes are muddied and scarred.
OVERFILLING LIPS. I keep seeing Plastic Surgeons espousing “lip lifts” where we put a scar at the base of the nose to shorten the skin above the upper lip. Lip lifts are now everywhere- why is this now such a thing? And then I heard someone talking about how people are overfilling their lips at a young age, and the lip tissue is stretching out more. That makes sense to me. Just like pregnancy can stretch out the belly, and the more times you do it the harder it is to bounce back, overdoing lip filler can do the same. ** NOTE: This is not doing mild filler to fill an emptying lip. This is when people go above and beyond.
So my thoughts?
Be wary. Understand the longterm consequences. Don’t waste money on treatments which won’t work or may cause longerterm issues. If you have loose skin (on the face if you are over 50, on the belly if you have had a bunch of kids and/or weight loss and/or are menopausal) FIX the issue the right way. It will give you a better result.