My Neck and Face are falling. I need help!

Aaah!  The Aging Neck

Among our patients' greatest concerns is that of looking older than we feel.   We all want to look our best because it gives us the confidence to express our personality and thoughts without feeling self conscious of our appearance. 

Several technologies have come along over the years to help with the neck and face falling problem.   There is always a surgical neck or face lift, which may be absolutely essential for patients who have waited a bit too long to take preventive measures and where the skin laxity is too great to correct nonsurgically.  However, for the vast majority of patients, we can accomplish neck tightening without the worry of a long scar along the hairline or ear and without extended recovery times and most importantly, without the danger and fear of looking “overdone”.   Even if a prior facelift has been done, maintaining with these less invasive approaches is important to save one’s investment.

 

Among the two best approaches are Ultherapy and ThermiRF. 

 

ThermiRF is the latest kid on the block.  It uses monopolar radiofrequency energy that is delivered via a thin probe to the SMAS (Superficial Muscular Aponeurotic System).  This is the tissue under the skin which covers and binds all the facial muscles.  During a surgical facelift, the SMAS is sutured in a manner to effectively shrink it and hence tighten the muscles.  With ThermiRF, the SMAS is shrunk using RF heat (essentially think of it as controlled electrocautery).  The procedure is extremely safe with temperature readings coming from the tissue, the probe and through an external heat sensing camera, which helps achieve both therapeutic and safe target temperatures for controlled shrinkage of tissue.  Excess fat tissue can also be targeted and destroyed, such as under the chin, at the same time.  Finally, the heat radiates to the skin itself and stimulates the production of new collagen and elastin fibers.  ThermiRF is performed entirely under local numbing.  The patient is awake and may drive home on their own post procedure.   There is no discomfort during the procedure.  A compressive chin strap garment is all that is required for 48 hours.  No sutures are placed as the three tiny puncture access points close up within 24-48 hours.

 

 Ultherapy is also a highly effective procedure and can be used to treat not only the neck and jowls as ThermiRF can, but also the cheeks, chest and eye areas.   As both a surgical facelift and ThermiRF affect the SMAS, so does Ultherapy!  We can easily see that in order to be effective, the procedure must affect the SMAS.  The difference is that Ultherapy is applied directly through the skin using HIFU (High Intensity Focused Ultrasound).  The tissue is directly visualized via ultrasound so we know exactly where the energy is being delivered.  There is some discomfort as the ultrasound waves travel through the skin to the underlying SMAS target tissue but is well tolerated and well worth it in the end.  There is no real recovery time, outside of mild redness and swelling.  One can resume social obligations and public appearances immediately.  Ultherapy also targets the dermis to stimulate collagen production with a second pass that is highly recommended.  The lips and delicate skin under the eyes are also very responsive to this technology. 

It takes about 4-6 months to see results.  The same is true with ThermiRF.  A procedure called SmartLift uses the SmartLipo probe to deliver heat under the skin and could potentially mimic ThermiRF.  The difference is in the control and constant feedback of the heat delivered to get effective yet safe treatment.  We are not using SmartLift/SmartLipo as much in our practice now due to having the more advanced ThermiRF. 

Please take a look at results from ThermiRF and Ultherapy below.  The patients who have had a combination of both procedures, have seen especially dramatic results.   Please also check out our website www.cincinnatiskinandlaser.com for more information.

 

What should I do about my Cellulite?

With Spring and Summer approaching, that means warmer weather and it means more of your skin will be visible as it escapes the confines of winter clothing.   For many women, cellulite, veins, hairs and brown spots are common concerns.  Fortunately, there are some simple ways to help you enjoy the warmer weather with confidence.  Veins can be treated with sclerotherapy or laser, hairs can be zapped away with lasers too, and brown spots do great with, you guessed it, lasers, too.

 

But cellulite-- how do we deal with the lumpy areas and indentions under our skin?  Not even liposuction is overly successful at removing cellulite.  Cellulite is a combination of 1) Thinning of the skin-- with age collagen is not as tightly wound up; 2) Overgrowth of fat lobules which poke through the thinned skin—they cause constriction to the vessels traveling through the fibrous septae; and 3) Constriction of the fibrous septae due the overgrown fat lobules near the skin surface.  To address cellulite successfully, all three aspects need to be addressed.

We have two methods of treatment.  The first are the noninvasive treatments.  These include Velashape, Thermage and Exilis Elite.  Velashape uses a combination of suction, infrared head and radiofrequency energy to heat and knead the skin.  The idea is to achieve localized fat apoptosis, to lengthen the fibrous septae and to stimulate collagen in the skin.  When performed diligently by an experienced and dedicated clinician, the results are actually very good.  Periodic maintenance after a series of treatments is a good idea to keep the areas smooth. Thermage and Exilis Elite both use monopolar radiofrequency to deeply heat the tissue to induce apoptosis of the fat cells and stimulate collagen in the skin, essentially achieving very similar results.  Thermage is an excellent treatment and can be accomplished in a single visit (though a repeat treatment after 3-6 months would yield heightened results), but it is painful.  Exilis Elite is performed in a series of 4 weekly treatments.   Hydration is very important with all these procedures as well hydrated skin allows for delivery of higher temperatures through the skin for greater efficacy. 

The second method are the minimally invasive technologies which include Cellulaze, VaserSmooth, and the latest ThermiTight.   With all three procedures, the skin is first numbed using a local anesthetic solution.  All of these procedures require wearing a compression garment immediately following treatment for 1-2 weeks and all three follow a single treatment protocol.  With Cellulaze, a spagethetti thin canula is threated back and forth through the cellulitic areas to 1) melt and destroy fat cells, 2) pop and break through the fibrous septae and 3) stimulate collagen via heat delievered directly under the skin.  VaserSmooth works in an identical fashion, but instead of laser energy, uses the gentler power of ultrasound to accomplish the same three goals.  The advantage of VaserSmooth is less disruption to the vessels and nerves, where the laser cauterizes through these structures.  Therefore the recovery time is a bit faster with less bruising and less swelling.  The third method called Thermitight again accomplishes all three end goals, but utilizes Radiopfrequency instead.  The greatest advantage with Thermitight is the strict temperature control of the device both internally and on the skin.  An infrared camera is constantly watching the skin temperature to keep it in a safe therapeutic zone and the tiny probe under the skin also allows delivery of exact therapeutic temperatures to effectively destroy fat cells, break through the fibrous septae and tighten the skin.  Of all three technologies, Thermitight yields the best skin tightening effects and effectively treats the fat and septae as well.  These minimally invasive treatments are perhaps more permanent than the noninvasive options.   Recovery time is typically one to two days with return to exercise after 2-3 weeks. 

Which method to choose can become a challenge, especially when there are so many great options.  The first consideration would be whether a minimally invasive option is acceptable for the patient.  If so, VaserSmooth or ThermiTight would both be great permanent treatments.  If minimally invasive doesn’t sound appealing and there is no time for wearing a garment or recovery, the noninvasive options are all great choices.   The newest of the noninvasive procedures is Exilis Elite.  Even though it is a series of treatments, patients prefer the price point and the comfort during treatment (compared to Thermage which can be painful while being administered). 

We highly recommend doing some research and then coming in for a consultation for further discussion.

ThermiTight 

 Results from ThermiTight

VaserSmooth Results

Exilis Elite Results

Thermage Results