Face and Neck Lift

A surgical approach vs a dermatologist approach.

In the ever-evolving world of aesthetic medicine, the pursuit of youthful and radiant skin remains a timeless desire. As dermatologists, you find yourselves at the forefront of offering transformative solutions to your patients. Among the myriad of options available, face and neck lifts stand as prominent contenders, each with its unique benefits and surgical techniques.

Making the right choice

Choose your patient and procedure wisely, understand, and communicate the pros and cons to your patient, as well as what the client wants from you.

Dr Sonia Tekchandani, Consultant Dermatologist, Tender Skin International, notes that the Indian clientele predominantly seeks non-surgical treatments, but it is essential to discern when surgical intervention is necessary. Highlighting the importance of surgery versus non-surgical treatments, she presents a case of a 62-year-old female patient with extremely puffy eyes and significant sagging. While non-surgical treatment was not a viable option for the desired results, the patient was hesitant about surgery.

In such situations, Dr Tekchandani emphasises the significance of improving the skin’s texture, a role fulfilled by dermatologists through re-surfacing techniques like microdermabrasion and peels. “Addressing the laxity, a radiofrequency treatment was chosen over HIFU, considering the patient’s specific needs. Additionally, treatments like Nefertiti and platysma were employed to lift the jawline, and dermal fillers were strategically used for voluminisation,” she says. Despite significant progress achieved over four months, the final results were not as dramatic.

Commenting on the case, Dr Medha Bhave, Plastic Surgeon Director, Param Hospital & ICU & Lasercosmesis, acknowledges the challenges of convincing patients to consider surgical options when they are more inclined towards noninvasive approaches. For the presented patient, Dr Bhave recommends a combination of Blepharoplasty and mid-face lift, addressing baggy eyes effectively. “This surgery serves as a foundation upon which subsequent dermatological treatments can yield significant benefits.”

On his part, Dr Preetish Bhavsar, Plastic & Cosmetic Surgeon, Lakshmi Hospital, emphasises the impact of a neck lift on the overall appearance, further solidifying the value of surgical interventions.

Looking for alternatives

Since many patients express reluctance towards surgical interventions, exploring viable alternatives becomes essential. Dr Bhave highlights the availability of semi-surgical procedures, performed in the operating theatre under a single anesthesia. “These advanced technologies offer a remarkable advantage – their results can endure for four to five years. Consequently, patients who seek long-lasting outcomes without the need for frequent fillers or botulinum toxin treatments can opt for these innovative options.”

Indian skin possesses unique characteristics compared to western skin, with a notably thicker dermis. Conversely, individuals in western countries lack such thickness, making them more prone to early sagging. Leveraging this knowledge, radiofrequency technologies like microneedle RF present a promising solution. These procedures focus on thickening the dermis and enhancing skin quality, delivering enduring effects that stand the test of time. By harnessing the potential of these cutting-edge techniques, patients can embrace non-surgical pathways to achieve their aesthetic goals with confidence and satisfaction.

Expectations during downtime

During the downtime after undergoing certain procedures, patients can expect minimal bruising, usually lasting no more than seven days. However, it is crucial to maintain a clean face and wear a supportive garment, particularly at night, to aid in the healing process. Patients are advised against massages during this period. To facilitate healing, lifting creams may be prescribed, and nutritional corrections such as protein supplements, glucosamine, and nutraceuticals may be recommended.

In the Indian scenario, Dr Bhavsar observes that many patients are apprehensive about undergoing surgery. “However, in cases where patients have concerns such as jowls, a lack of a defined jawline, sagging, or deep nasolabial folds, a face-lift and neck lift can provide a long-lasting and improved appearance.”

On the other hand, Dr Bhave emphasises that several small surgeries on the face can create a significant impact, with blepharoplasty being a notable example. Patients need not fear these procedures simply because they involve delicate areas near the eyes. Eliminating lax skin can yield a much fresher look and, in older patients, upper eyelid blepharoplasty can also have medical benefits by helping them open their eyes more comfortably. Additionally, a new and minimally invasive procedure, brow lift, performed under local anesthesia, has shown promising results in achieving favourable outcomes for patients.

When would you advise PRP?

PRP (Platelet-Rich Plasma) therapy is advised by Dr Tekchandani primarily for treating acne scars. Often used in combination with subcision or no downtime TCA peels, PRP proves effective in addressing these scars and promoting skin rejuvenation. Additionally, PRP GFC kits have been utilised to target facial pigmentation concerns with positive outcomes. Recognising that each individual’s needs vary, Dr Tekchandani emphasises the significance of customised combinations of treatments to achieve optimal results.

In conjunction with PRP, microneedling plays a crucial role in the treatment process. Both conventional microneedling and dermapen techniques have shown promising results, with dermapen demonstrating particularly encouraging outcomes. Dr Tekchandani speaks about the exosome therapy, where the exosomes mimic the action of Mesenchymal stem cells and are believed to contain significantly higher levels of growth factors than those derived from blood, potentially yielding even more effective results.

By staying at the forefront of cutting-edge technologies and employing a combination approach, Dr Tekchandani aims to offer her patients the most advanced and tailored solutions, maximising the benefits of PRP therapy and delivering comprehensive and satisfying results for various skin concerns.

Combination treatments

Dr Bhave emphasises the importance of addressing the multiple layers of the face in order to meet the specific needs of each patient effectively. Consequently, combining treatments becomes essential to achieve comprehensive results. However, she advises against performing two different types of treatments in a single session, even if they involve botulinum toxin and fillers. It is crucial to develop a complete treatment plan, including associated costs, at the outset and share it with the patient. This approach ensures transparency and minimises misunderstandings that may arise when patients inquire about treatments after they have already commenced.

Dr Bhavsar views face-lift surgery as a rewarding and durable option, but he highlights the significance of patients expressing their own interest in surgical interventions. He suggests initiating non-invasive treatments initially and transitioning to surgical options if the patient is satisfied with the non-invasive results and prefers a more permanent solution.

Moreover, Dr Bhave draws attention to body dysmorphic disorder, a condition where patients excessively obsess about their appearance and undergo multiple procedures, yet remain unsatisfied. It is crucial for aesthetic medicine practitioners to identify such patients and proceed with caution in their treatment plans to ensure their well-being and avoid exacerbating their concerns.

(The above insights were gathered from a panel discussion at the recently concluded Aesthetic Medicine Conference in Mumbai. The discussion was moderated by Dr Purnima Mhatre, Director & Chairperson, Gorgeous Skin.).