Trends in cosmetic enhancement for 2020 and Beyond

a Quest for natural and subtle enhancement all the while maintaining your essence!

We live in an exciting time where the technology in the field of cosmetic surgery has improved by leaps and bounds. However due to so many available technology, it is ever becoming more confusing for consumers to know what available technology is best for the individual. It is always best to look at yourself in the mirror and see if you want to:

1. improve the quality of your skin texture and tone
vs
2. improve the laxity of your skin
vs
3. Restore the loss of volume of your face
or
4. any combination of the above.

After consultation with your cosmetic surgeon, you should have a clearer idea how many components of the above will need to be addressed to make you look as rejuvenated and yet remain as natural looking as possible.

To this end natural subtle cosmetic enhancement while maintaining our individual persona is becoming ever so in demand in 2020 and I believe is here to stay.

One of the magical journey of our lives is that every one of us enjoy a unique look that we are born with. The individual essence that we project as we get older is not only the aging changes of our unique look, but also the richness of life we have experienced and the wisdom which we have earned through out our life. Many patients in my practice wish to appear less tired, less worried, less serious looking which comes with loss of our youth; however, they also wish to maintain the richness of their individual persona and want to avoid turning into someone they never were. Another words, they want to avoid looking like they have been over-surgerized or over filled with fillers and fat. To this end, one of the most common remark, often accompanied with a sigh of relief, that’s told to me nearly everyday is “if I knew that the result will come out this natural, I would have had this procedure done a long time ago…..” a true Aha moment for many patients. The fact is many people hold off venturing into the realm of cosmetic enhancement due to the “unknown” of “what if I turn into someone else”. If this is an important concept, do your diligence and find a Surgeon like myself who truly understands the meaning of “natural” cosmetic enhancement. There is enough of us out there.

In this segment, I will discuss three ways which have been definitely proven to improve the laxity of your skin, from the least to the most invasive methodology. The degree of improvement will vary depending on the method selected, but all will yield, albeit in different degrees, a natural appearing cosmetic enhancement while maintaining your unique individual persona.

1. Thermage and Ulthera are the golden standards for “non-invasive” technology, approved by FDA to tighten and strengthen the deeper part of the skin as well as the collagen and tissue layer immediately below the skin layer, thereby providing lifting effect to the sagging areas of your face and neck.

Neither machines are lasers. By the same token, while lasers can improve the tone, texture, pigmentary, and broken vessel issues of the surface of the skin, they do not and should not penetrate below the level of the skin; and, therefore, simply will not provide the degree of “lifting” effect that Thermage and Ulthera can provide. The consumers must understand this very important difference.

Thermage works on principle of high radio-frequency energy while Ultherapy is based on highly focused ultrasound energy. From a technical aspect, the biggest difference between Thermage and Ulthera is how the energy dissipates once it reaches the target tissue and it is up to the operator to best understand and harness the benefits of the machine, and minimize potential pitfalls. Therefore success of both machines rely heavily on operator’s skills to optimally utilize the machine. In contrast, with most lasers, once optimal setting is found for the patient, the use of the machine is less operator dependent. Finally while Thermage and Ulthera can be used in almost all ethnic skin color safely, lasers of different wavelength and different power levels have to be carefully matched to the patients skin tone to minimize any potential prolonged redness and post inflammatory pigmentary issues. It takes about one to two hours to perform Thermage or Ulthera and there is practically no down time after the procedure. Expected period of benefit is usually one to two years, sometimes a bit longer depending on patient’s age and overall condition of the face. In my practice both Thermage and Ultherapy have proven to be excellent in “delaying” the inevitable need for more invasive surgical options as well as an excellent “adjunct”for patients who already had a surgical facelift and wishes to maintain optimal youthful look without further surgeries.

2. The second category which is “minimally invasive” is use of threads or suture material placed in the soft tissue layer below the skin layer to lift up some or most of the sagging areas of the face.

To lay down a bit of history on the use of threads, The “first generation” of lifting threads introduced roughly more than a decade ago was called “Contour Threads” and had only received its FDA approval for a short period before losing its FDA seal. It was made out of permanent and thick suture material with barb design to anchor the thread into the tissue. Overall the material prove to be too coarse to be well tolerated by the patients and too difficult for most surgeons to reproduce consistent results. I was fortunate enough to have been certified in both the “basic” and “advance” techniques in use of Contour Threads where I learned a lot in the principle of thread lifting techniques. Fortunately for my patients, I never applied it in my practice as I saw too many inherent flaws in the design and technique.

For the past three years we have been offering the non-surgical, minimally invasive thread lifting procedure using the much improved “second generation” FDA approved Silhouette Instalift Threads and PDO Threads with much great success. These Threads have been used both in Europe and Asia for better part of past five to ten years with great results and high patient satisfaction. The success of the Instalift and PDO Threads lie with three very important characteristics of the design.

1. the suture material fully dissolves in time, making it very safe.
2. the suture diameter is smaller than previous generation for patient to better tolerate.
3. most important, the anchoring points are either rounded into miniature cone-shape (Instalift) or well developed barb design (PDO), which can gently lift the overlying skin.

Even the underlying soft tissue can be lifted in the direction of the pull if the Surgeon correctly floats the suture into right layer and anchors the sutures properly. Once again here lies the “varying” degree of success based on the operator skills on how well he/she knows the anatomy underneath the skin and can deftly float and anchor the thread without bruising, swelling, and puckering. The end result should be a perfect blend of volume enhancement as well as lifted appearance to the sagging areas of the face and neck; and, should be significantly more dramatic than using lifting device such as Thermage or Ulthera. Because the suture material safely dissolves, the gain from Silhouette Instalift or PDO Lift procedure is expected to last a few years, of course depending on the age and pre condition of the patient. The procedure usually takes about one hour to perform and patients are advised to rest for a day or two, though many actually are able to return to work the following day. A good surgeon should be able to harness the optimal and safest use of both the Instalift and PDO Threads if properly trained in the use of these various lifting threads and associated threading techniques.

Very often Thermage or Ultherapy is used to tighten the patient’s native collagen in the face first, followed by Thread lifting to physically lift the matrix of the saggy skin and underlying connective tissue all on the same day for optimal synergistic improvement. By combining these two modalities together, many patients feel that they can “indefinitely” delay the need for more invasive face and neck lifting surgery.

3. The last segment of this article is lifting techniques using the classical “surgical” methodologies. This involves the intimate understanding of all aspects of the anatomy of the face, not just skin deep as the old saying goes. The surgeon truly has to understand

1. inherent differences in the bony shape of different faces and
2. how the soft tissue, muscle, fat, and skin drapes around the individual’s facial bone

While the bony shape of the face vary greatest amongst different ethnic groups, the variation of how soft tissue, muscle, fat and skin drapes the bone can truly vary from one individual to the next.

At the time of consultation, the Surgeon has to examine and understand the progression of aging of the individual patient by being able to proficiently gauge

1. Rate and degree of sagging of the skin and underlying soft tissue
2. Volume loss and deflation to the various fat compartments of the face
3. Integrity and tone of the musculature
4. Aging changes to the tone, texture, pigmentation issues, broken vessels of the skin

In conclusion, forever gone are the days when patient had no other choice other than resorting to a face and neck lifting surgery as the only legitimate method of gaining improvement of the sagging skin of their face and neck. While a well performed lifting surgery by an experienced plastic surgeon will always set the golden standard of facial rejuvenation, the trend for 2020 going forward will be that many patients will opt for less permanent but definitely proven non-surgical options of varying invasiveness which can help to delay the inevitable need for surgery; better yet, they represent viable alternatives for those patients who never wish to undergo surgery. At the same time, the patients need to be fully apprised of the benefits as well as the limitations of these non-surgical options. I leave you with the thought that more than ever before, your cosmetic surgeon should be knowledgeable and well versed in all these different techniques in order to offer you the best unbiased method that will meet your needs while resulting in minimal downtime and yielding the most natural result that maintains your essence.

Patient Review: 56 yrs old patient facelift to improve her neck area

Patient Story:: 50 year old female patient Ultherapy/ Thread