Wednesday, March 2, 2011
Patients looking to rejuvenate their faces now have more choices. By Lisa Hanchey
With spring approaching, people are finally starting to emerge from their cold, concealing caves and into the hot, revealing sunlight. Once outdoors, there’s no hiding the effects of aging — sun damage, drooping skin and loss of volume. Nowadays, medical techniques to correct facial flaws range from non-invasive fillers and paralyzing Botox to temporary fillers and full surgical facelifts. But what is the best solution for you? The Independent Weekly consulted some of Lafayette’s top skin care and surgical specialists to find out the latest available options.
|Ulthera Day 1 and Day 120|
Brand new to Lafayette is the Ulthera System, a non-invasive ultrasound device that has just been FDA-approved for lifting and tightening lax skin. This in-office aesthetics device enables visualization of tissue beneath the skin’s surface using ultrasound. With this non-surgical procedure, a physician is able to focus energy at prescribed depths and lift the skin tissue. Ultherapy T has a multitude of indications, including improvement in the appearance of the upper eyelid, face and neck, and along the jaw line.
Dr. Christopher Hubbell, a board-certified dermatologist/dermasurgeon and founder and medical director of A Jeuné and Acadiana Dermatology, says he is the first in Louisiana to offer Ulthera. In fact, he has even had the procedure done on himself. “Ulthera actually lifts the skin,” he explains. “It can take years off of your appearance.”
|Ulthera Day 1 and Day 90
After application, Ulthera stimulates reproduction of collagen. While there is initial tightening, full benefits are not seen for about three months. There is no down time after the 30-minute procedure; patients can return to normal activity immediately after application.
Effects last approximately 18 months. Cost ranges from $1,000 to $3,500.
In the past, a surgical facelift was the only way to remove excess skin and wrinkles. Too often, however, faces were stretched too tight, resulting in a “wind tunnel” look. “In the last five to 10 years, it’s become very obvious to most of us who are in the business of facial rejuvenation that tight is not young,” observes Dr. Louis Mes of Plastic Surgery Associates. “The faces of young people are basically plump with strong jaw lines, and you lose fat and a little bone as you get older.”
To re-create fullness non-surgically, the physicians at PSA perform the “liquid facelift” using a number of injectable fillers, including Juvederm, Restylane, Radiesse and Botox, along with a new product, Sculptura. Compared to a regular facelift, the liquid facelift has almost no down time. The cost is significantly less, with surgery running between $11,000 to $13,000, and fillers for around $300 to $500 each. “You get a big bang for your buck, I think,” Mes says.
Mes’s partner, Dr. Terry Cromwell, prefers using the patient’s own fat for the liquid facelift. “I like to do multiple fat injections in all kinds of places, including the eyelids, lips and chin,” he says. “I try to smooth out lines and sometimes change facial shape somewhat with the patient’s own tissue.”
Cromwell harvests fat from the patient’s thighs or abdomen, depending on the patient’s weight distribution. This does not involve any incisions — just putting the fat in strategic places. The advantage with fat injections is that they last much longer than commercial fillers. “I have a lot of patients that still have fat after procedures performed three to five years ago, and I’ve had some that have used fat grafts in the frown lines in-between the eyebrows where they were still looking good at five years post-op.”
With the liquid facelift, patients see results almost immediately. While patients typically stay behind closed doors after a surgical facelift, they can go back to work the next day after the liquid version. “Patients do beautifully with this type of thing,” Cromwell says. “Fillers work very well in older patients, but you have to do them very carefully because they have thinner skin.”
Last month, Mes and Cromwell attended the Baker Gordon Symposium in Miami, Fla., where they learned the newest techniques for facelifts combined with injections. “I learned how to make the fillers more diluted to use in more wider ranging areas and fill in smaller lines and wrinkles more effectively,” Cromwell says.
3-D Lift (Facial Fat Grafting)
As we age, facial fat diminishes and skin loses elasticity. To re-create that youthful appearance, Dr. Bruce Schneider, a board certified oral and maxillofacial surgeon with Acadiana Oral & Facial Surgery and Acadiana Laser Center, performs a 3-D facelift. This procedure restores the skin in three dimensions, addressing both the loss of elasticity and loss of fat within the face.
To learn the technique, Schneider studied under renowned surgeon Dr. Mark Berman of Los Angeles, Calif., an expert in fat grafting. With the 3-D facelift, fat is harvested from another part of the body via liposuction.
Schneider then takes the processed fat and strategically places it in the face. “This is a very technique-sensitive procedure, and its outcome is based not only on surgical skill, but on the artistic ability of the surgeon,” Schneider explains.
This lift naturally restores a patient’s appearance without looking surgically altered or leaving tell-tale scars. The cost for the 3-D Lift is approximately $5,000. Results can last up to seven years.
When there is too much sagging skin for a 3-D lift alone, Schneider adds a lifting procedure. He performs a short incision surgery called the “Weekend Lift.” With this operation, the incision follows the natural curve of the ear, rarely extending behind the ear. Schnieder performs these procedures in his out-patient surgical center, which has a back door for discrete exits.
|J-Lift before and after
J-Lift (Short-scar facelift)
Over the years, Dr. Jeffrey Joseph, a board-certified otolaryngologist and fellowship-trained facial plastic and reconstructive surgeon at Acadian Ear, Nose, Throat & Facial Plastic Surgery Center, has revamped the face lift. With the J-Lift, or short-scar lift, he eliminates the scar on the side of the face by making the incision behind the ear. This operation is particularly effective on patients with a double chin and early jowling, or sagging of the face. “It gives you a really nice result,” Joseph says.
Because the scar is behind the tragus, the cartilage of the ear, it is unnoticeable. Compared to a traditional facelift, the J-lift results in less scarring and quicker recovery. “I always tell patients that with a regular facelift, they can be ‘restaurant-ready’ in two weeks,” he says. “With the J-Lift, it’s five to six days.”
Another advantage is that the J-Lift does not preclude a patient from having another procedure later on. “So, if you are 45 and feel a little tired, you can do this, and then five years later, you will be ready for the bigger surgery,” Joseph says.
Joseph and his medical partner, Dr. Bradley Chastant, also perform non-surgical procedures. For the past few months, they have been using Scuptura, the revolutionary anti-aging treatment. This injectable substance corrects the deep nasolabial fold contour deficiencies and other facial wrinkles by gradually replacing collagen lost during the aging process. “What it does is it takes the ‘shadows’ in the face and turns them into ‘highlights,’” Joseph explains.
Compared to fillers like Juvederm and Restylane, Sculptura is more expensive. However, the results last much longer — up to two years. “I really think the future is going to be doing the Sculptura,” Joseph says.
|Duplechain's combo treatment before and after|
|Cutagenic before and after|
All-in-One facelift and super-oxygenated healing cream
Dr. Kevin Duplechain says the best solution for an aging face is surgery. “I do believe in surgical results,” he confirms, “but I think that the devices are great adjuncts.”
Duplechain is board-certified in otolaryngology (head and neck surgery) and in facial and plastic reconstructive surgery, as well as a fellow of the American Academy of Facial Plastic and Reconstructive Surgery and fellow of the American College of Surgeons. For volume loss, he uses Sculptura and fat transfers in addition to fillers like Juvaderm. Alone, these solutions are only temporary. But, when a patient wants to see real results, he performs a face lift to address the effects of gravity, followed by fat injections for volume, and finishes with a laser to treat the skin. “What we have been able to do is to incorporate that all into one procedure all at one time,” he explains, “because that type of facial rejuvenation lasts a very long time. I don’t think there’s any device that will ever come close to giving you those kinds of results, because we are treating all three components of the aging face.” As opposed to fillers, which last a few months to two years, Duplechain’s combo-treatment lasts 10 to 12 years.
Duplechain has also developed a product, Cutagenic, a super-saturated oxygen emulsion that speeds up healing and prevents complications after a surgery, laser procedure or other type of burn. “We actually have a ‘hyperbaric oxygen emulsion’ in a can,” he says. “What we are seeing is that patients not only heal much better, but they get better long-term results.”
Dr. Kenneth Odinet, a former dentist, is both an otolaryngologist and plastic surgeon, as well as a craniofacial (facial and skeletal) and orthognathic (jaw) surgeon. Over the last three years, Odinet has been performing a less aggressive type of facelift. “We have backed off on the amount of soft tissue undermining the flaps which we are raising,” he explains. “We are moving a lot more of the deeper tissues and fat around rather than just the skin. That seems to give a little more natural look.”
Prior to surgery, Odinet’s skin care department applies a vitamin-enriched pack to the face to reduce bruising. Two days post-surgery, the department performs lymphatic drainage that gets rid of edema to the face, speeding up recovery. By the day after surgery, patients are able to shower and wash their hair. Bruising is normally limited to around the eyes, and stitches are removed with a week.
When time is of the essence, Odinet finds that less invasive procedures that promote quicker healing are the solution. Compared to previous techniques, recovery time is significantly reduced from two weeks to one week. “People are looking better quicker, and they look more natural; they don’t look overdone,” he says. “Sometimes, less is more.”