Ultherapy or ThermiRF for tightening my neck and jowls?

Ultherapy and ThermiRF are both excellent procedures for neck and jowl tightening.  Ultherapy is entirely noninvasive whereas ThermiRF is minimally invasive.

Ultherapy uses focused ultrasound energy to target the SMAS (Superficial Musculo-Aponeurotic System), which is the muscular tissue that is normally sutured or shrunk during a facelift.  Unlike a facelift though, no incisions are required to reach this layer of tissue as the ultrasound will send directed energy waves to shrink it up.  Easy enough and no recovery time required.  A second pass is also made which targets the dermal collagen and forces the skin to generate healthy new collagen fibers to keep the skin firm.  Although the procedure does hurt during treatment, there is no pain afterwards.  Patients are able to tolerate and get through the procedure just fine.  You can resume all normal daily activiities right away.

ThermiRF is a monopolar radiofrequency device.  First, the neck and jowl skin is numbed using a small blunt canula.  The procedure is entirely pain and sensation free after the numbing.  Next, a thin probe is inserted in a fan like pattern across the neck and jowls, while heating the area of the SMAS and skin.  Temperatures of 60-65 degrees are reached under the skin to enable for tightening and shrinkage of the SMAS.  If there is excess fat in the neck, there will also be some fat apoptosis for better contouring.  The skin temperature target is 42-45 degrees for optimal collagen stimulation.  After the procedure, a chin strap is worn for 48-72 hours to provide mild compression to the area.  Swelling is seen for several days.  There is minimal to no bruising afterwards.  We recommend restricting activities for a few days or a week until the swelling subsides.  ThermiRF certainly delivers the more dramatic results for patients with more significant skin laxity.  It is the perfect procedure for someone requiring a facelift but does not want surgery.  You are entirely awake and alert throughout this painless procedure.

Both procedures are excellent options with excellent safety profiles and excellent results.  Give us a call at 513-985-9885 to learn more and help us help you decide which would be a better option for you.  There are a few other skin tightening procedures we offer as well including Exilis Elite, Skin Tyte, Thermage and Thermismooth which you may also be a good candidate for.  Our passion is to help you look and be your best.

Ultherapy Before and After Photo

ThermiRF Before and After Photo

How can I get my eyebrows to lift back up?

As we age (oh, that dreaded word), we sometimes notice that our eyebrows are beginning to droop, causing our eyelids to look heavier.  What can we do to fix this and why does it happen?  Similar to the drooping we experience in the lower face, jowls and neck, we see a loss of volume, specifically in the temples and above the brows, loosening of the fibromuscularature under the skin and loss of elasticity and collagen in the skin itself as being the prime factors.  Correcting some or all of these factors can give very pleasing and natural results.

Starting with the fibromusculature, there are several ways to achieve tightening of this layer.  First and most dramatic is a surgical or endoscopic eyebrow lift.  This is accomplished with an incision behind the hair line and lifting of the brow area much like a facelift.  If one wishes to avoid incisions and scars, recovery time, and the risk of an "overdone" appearance, there are several excellent noninvasive, nonsurgical options.  The best is Ultherapy.  Ultherapy delivers focused ultrasound energy directly onto the fibromuscular layer to cause a contraction and tightening to occur in this structure without having to suture it surgically.  The area treated is right above the eyebrow to the hair line.  Furthermore, Ultrasound energy is focused also into the deep dermis where it stimulates new collagen and elastin fiber formation.  Results are seen gradually over 4 to 6 months.  Cost for an Ultherapy brow lift procedure is $1500.  The lower eyelids can also be tightened for an additional charge.  If there is concurrent loosening and drooping of the upper eyelid, I recommend using Thermismooth, Exilis elite or Thermage to tighten the eyelid skin.  Ultrasound can not be used so close to the eye area.  Thermismooth, Exilis elite and Thermage are all monopolar radio frequency procedures which heat the skin to a target temperature of 42-44 degrees, inducing new collagen and elastin fiber formation.  The heat also likely affects the ligaments and fascia inducing a contraction within those tissues.  These radiofrequency procedures range from $650-$3500 depending on the technology used.  None of these procedures have any recovery time outside of mild redness and swelling from a few hours to a day.  Make up and  moisturizer can be worn immediately and all normal and strenuous activities can be resumed right away.  Patients can return to work and social activities immediately.  Possible side effects could include bruising, temporary sensation changes such as numbness or a possible skin burn.  While very effective, results can be dramatic or subtle from patient to patient.  Experience in administration and delivering the energy at the correct angle and temperature and time all work to give a superior experience and result for our patients.

Next, we can use fillers.  Fillers are made of natural safe ingredients such as sugar polymers (hyaluronic acid) or calcium particles.  Some of the fillers you may have heard of include Juvederm, Juvederm Ultra, Juvaderm UltraPlus, Volume, Restylane, Perlane and Radiesse.  I have not once seen an allergic reaction from fillers and allergy testing is not required.  Care must be taken that the filler is not injected into a blood vessel or near a neurovascular bundle as it could cause occlusion to these structures.  It's important to choose an experienced injector for this procedure.  Placement is of greatest importance with fillers.  The fillers will last anywhere from about 1 year to 2 years.  For a longer lasting result, I will use Bellafilll in patients who have already experienced fillers and are ready for a more permanent result.  To achieve a brow lift with a filler, I recommend first checking the temple area.  We often see hollowing of this area--the temples begin to look concave versus the youthful convex shape.  Adding volume back to the temples is very gratifying as it helps the brows and also helps to give a lift to the lower face.  The second area to inject is right under and right above the eyebrow itself.  This gives an instant lift to the eyebrow.  There's a small chance of bruising, but can be easily covered with makeup if that does occur.  Cost for filler is $500 and up per vial and several vials of filler may be required to get the right effect.  We will often combine a noninvasive approach such as Ultherapy, Thermage, Thermismooth or Exilis elite with a filler to get immediate and best results.

Another procedure I really like is called ThermiRase.  ThermiRase is a unique procedure using a small probe in the temple area right under the skin via a tiny needle puncture.  I can identify the nerve that causes the brows to move downwards towards the middle of the forehead.  This occurs when one looks angry or is frowning or concentrating.  We often Botox in this area to relax this tense expression and help soften the vertical lines that form between the brows called the elevens.  With ThermiRase, the probe rests directly on the nerve that causes the contraction and zaps it with direct heat, disabling the nerve.  If I can disable about 2 cm of this nerve, it rarely grows back and gives a permanent Botox like effect for the frown lines.  Eliminating the frown expression gives an immediate lift to the eyebrows as the downward pull from the frown muscles is eliminated.  If one is not ready for ThermiRase, of course Botox itself will also give a beautiful brow lift.  Botox will last about 3-4 months, but may not be required as frequently with consistent use, as it relaxes the muscle and the muscle memory or tetany.   Adding a little Botox to the RIGHT areas in the forehead and the lateral brow can give an amazing instant brow lift.  The right areas is emphasized because if injected into the wrong muscle groups, it can do the opposite and cause the brows to droop.  Fortunately, this very rare possibility completely reverses itself within a few weeks if it does occur.   Again, an experienced injector is key.

If one has wrinkles, extensive sun damage, and laxity of the skin, laser skin resurfacing works beautifully to rejuvenate the top layers of the skin and tighten the skin as well for a very dramatic beautiful result.  Recovery time can be from 4-10 days varying on the technology used and depth of laser ablation.  This is the only procedure with any significant recovery time issues.

I hope this is helpful in sorting out some of the options for brow lift.  I will mention but not recommend another procedure out there using threads under the skin to pull tissue up.  I used to do these types of treatments many years ago, but do not offer them any longer as the threads are not strong enough to get any type of long lasting benefit.  The problem is the thread may or not pierce and grab hold of the fibromuscular layer.  Usually it only travels through the subcutaneous fat which does not grab and hold the suture well.  With an exaggerated movement, it is easy to loosen the sutures under the skin and loose the intended effect.

Please also visit our website:  www.cincinnatiskinandlaser.com

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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.