Tell us about Ultherapy.
Ultherapy utilizes direct ultrasound technology, which first looks at the skin and the layer below it and then delivers small points of heat to the underlying support structures (shrinking the SMAS* muscle), which lifts, tightens and tones the skin. Visible improvement of the jowls, neck and central face are immediate and improvement continues for two to three months with just a single treatment! Full results can take up to six months.
Ultherapy is becoming a cornerstone in the non-surgical aspect of my practice for facial rejuvenation and is an adjunct to facial fillers. Ultherapy subtly builds collagen through the body’s own gentle healing response, which further improves overall skin health while tightening the skin.
I will often will recommend Ultherapy before fillers, since it may reduce the amount of filler a patient needs, as well as prevent the over-injected, over-filled pillow face.
*SMAS means superficial musculo-aponeurotic system, made up of multiple fibrous extensions that attach through the fat to the epidermal and dermal layers of the skin. These connections cause the three layers of facial skin to act as one and move together. As the skin on our faces ages, there’s a gradual loss of elasticity in the epidermal and SMAS membranes, which contributes as much to the aging face as does the loss of elasticity in the superficial dermal layer.
So Ultherapy is non-invasive, right?
Yes, Ultherapy is non surgical and non invasive. The FDA approved Ulthera’s patented DeepSEE technology in 2009, which allows us to both see and treat deep below the skin, without surgery. Ultherapy doesn’t use laser or injections, but directly delivers focused ultrasound to deep structures under the skin’s surface. The results of Ultherapy are superior to radiofrequency, which is the science behind Thermage.
Where on the body, besides the face, can Ultherapy be used?
Ultherapy can be used on the neck, underarms, to treat laxity of the knees and elbows. As the technology evolves, who knows where we will go on the body next!
Is everyone a candidate for Ultherapy?
Patient selection is very important and setting patient expectations is key. If a patient has severe facial laxity, surgery will provide the most dramatic results. The Ultherapy procedure appeals to men and woman in any decade of life. As patients begin to experience the gradual descent of tissue of the cheek and hint of jowls, Ulthera is the obvious choice. Ultherapy is the most effective technology we now have for patients who prefer non-surgical tightening of the skin.
How long does it take to perform the procedure?
One to two hours.
How do the results compare with those of a surgical facelift?
They differ from patient to patient, but results can range from 30 to 50 percent, with high patient satisfaction. Combining Ultherapy with other procedures further improves the results.
An Ultherapy procedure performed by Dr. Tehrani.
How long do results last?
The effects of Ultherapy are permanent, but since aging continues, patients may decide to have a second treatment in 2 to 3 years.
This sounds almost too-good-to-be-true. Is it?
Yes, it’s true. Ultherapy results do vary, but I haven’t had an unhappy patient. Patient selection is key, as are the number of lines (or small points of heat, which are delivered).
How much does Ultherapy cost?
About $3,500 for the brow, full face and neck areas.
Can patients get a light sedation, like we get prior to having a colonoscopy?
Patients are typically pre-treated with a combination of Vicodin and Valium. We sometimes give IV sedation, supervised by an anesthesiologist, although this is rare. Patients seem to respond well to the cocktail of pain medication and relaxant by mouth. We also provide comfort measures through biofeedback.
Dr. Kevin Tehrani
521 Park Avenue
New York, New York 10065
Tel: (212) 439-9900
Click here to view Dr. Tehrani’s patient before and after.
Given the proliferation of facial procedures available today, from fillers to surgery, how does a woman intelligently decide the best treatment(s) for her face and the best doctor to do it?
Yes, the incredible array of procedures is confusing to patients, as well as to doctors who want to perform at a state-of-the-art level. That’s the reason some doctors decide to specialize in only one or two procedures. Often patients will seek out a doctor they heard is the ‘best’ for Botox injections, for example, then go to someone else who they heard is great for another procedure.
Is that a smart move on the patient’s part?
In the short term, that works if all you need is the single treatment. Over time, as aging advances, you want all parts of your face to look harmonious, cohesive and natural and there’s less chance of that happening when you’re using multiple doctors.
What’s your specialty?
I specialize in facial rejuvenation, everything surgical and non-surgical, not just in one or two procedures. Over 70 percent of my practice is devoted to rejuvenation. I look at the full face thinking about what is needed now and coordinating for the future.
Please define facial rejuvenation?
Rejuvenation is the process of restoring a patient’s appearance so she looks more youthful and beautiful, but still normal —like herself, just a while back.
At what age should a woman start to rejuvenate her face?
While it will be a little different everyone, changes start to show in most people by the beginning of their forties. I believe the best strategy is to use the least aggressive options possible at an earlier stage, as issues come up. Then when they are no longer effective, a bigger intervention can be selected. I’d rather keep the face looking young than wait until it falls apart and try to pull everything back together. If you wait until you’re 50 or 60 to get work done on your face, you’ll have to play catch up.
How do you analyze the face to determine what treatments are necessary?
We look at three areas of the face:
- The skin surface: Has the sun affected it, for example? Are there spots, wrinkles, Rosacea? These issues are usually treated with non- surgical, energy-based procedures, such as lasers as well as skin care and skin products.
- The skin laxity: Surgical lifts remedy loose skin on areas including brows, neck, eyes and face.
Non-surgical tightening includes Ultherapy, which uses sound energy, and Thermage, which uses radio frequency energy to stimulate collagen production in the skin without disturbing the surface of the skin. This produces a smoothing and tightening of the skin.
Most of the non-surgical lifting technologies are best if used early, to maintain tightness in the face and neck. They are also best when used on a regular basis, unlike surgical lifts, which have a more dramatic result and longevity. Non-surgical treatments shouldn’t be considered a replacement for surgical procedures, but more as preventative treatments to help increase the time before a surgical intervention is required.
- Volume Loss: Women start to lose facial fat in their thirties, which initially provides a more sculpted look, eliminating the chubby baby face of youth. But it’s not so nice once they reach forty plus. And when they reach fifty plus, the fat loss starts to accelerate, as do bone and muscle loss.
These changes, subtle at first, make women look haggard. Off-the-shelf fillers, such as Radiesse, can be used to increase the volume in the cheeks, fill in the sunken areas under the cheeks, fill in the depression in front of the jowl and help build out the angle of the jaw.
Fat injections, which are minimally invasive and don’t require general anesthesia, can take up some loose skin and restore the volume, but they do have a longer period of downtime and swelling than injectable fillers, which only offer minimal, if any, bruising and swelling.
A facial rejuvenation performed by Dr. Lawrence Bass.
What if a 55-year-old woman wants a non-invasive treatment but you think she needs a surgical lift? What do you tell her?
Non-surgical skin tightening is an extremely useful option in facial rejuvenation, but even in a best case scenario, provides only a fraction of the improvement of a surgical facelift. The facelift remains the gold standard. And remember, it’s not your grandmother’s facelift. There have been so many improvements. It’s safer, with less recovery and better correction than ever before. A modern facelift provides an exceptionally natural look.
Still, everyone’s life circumstances are different. Sometimes, a treatment is selected that doesn’t maximize the improvement because the priority is limiting or eliminating recovery time due to work or family obligations or health issues. Compromise is part of the decision-making in everything we do in life, as long as we make the decision with all the facts –with our eyes open. I partner with my patients to work through these decisions.
Fat injection or fillers can be used to take up a little skin laxity but trying to fix moderate laxity with fillers will leave you looking like a pumpkin. Not a good idea. The issues are different for everyone, but understanding what’s happening to your face overall will help you decide what treatment is wisest.
What do you recommend to a woman who knows she needs a facelift, but can’t afford it?
It is never a happy thing to feel that you can’t get what is medically ideal because of money. But because aesthetic surgery is paid out of pocket, budget is a reality of aesthetic decision-making. Sometimes a more limited option, like a mini-facelift, is an excellent alternative to a full procedure.
Still, you only have one face. Everyone sees it all day, every day. Consider this: Your face has been aging over the 30 years since you became an adult. Think about how much money you’ve spent on automobiles, on your favorite hobby, or on vacations during this time. Your one-and-only-face is an incredibly valuable asset. Saving and budgeting money to preserve or restore it still is only a fraction of what you’ve spent on any of these other things over the time your face has been aging.
Dr. Lawrence Bass
Bass Plastic Surgery PLLC
568 Park Avenue
New York, New Yorl 10065
Tel: (212) 593-2600
Click here to view Dr. Bass’s patient before and afters.
What are the best options for a saggy neck and jowls?
Good question, as this is the biggest giveaway of an FOF’s age. Traditionally, FOFs have gotten facelifts as a solution to this problem. However, facelifts can be invasive and have a long recovery time. For the past four years, I’ve been performing a procedure called the “Natural Lift” as a way to avoid or postpone a facelift. I remove a teaspoon of jowl fat and 2 tablespoons of neck fat. It’s a 45-minute procedure, done with local anesthesia and requires minimal recovery time. Consider it the ultimate cheat and prevention for aging.
What are the latest innovations in liposuction? Can you have liposuction anywhere and everywhere?
Yes, you can. This past year two new non-invasive devices have come onto the market that melt fat away when you use them over the skin. They allow you to shrink even the thinnest layers of fat cells in parts of the body that used to be difficult to reach through liposuction cannulas (tools). The device I use is called VASER Shape which feels like a hot stone massage.
What type of implant is better or which do you recommend: Saline or silicone?
I prefer silicone and implant them in my patients 99% of the time. With silicone, the deflation rate is low and they feel more natural. Most women getting augmentation have very little breast tissue and the breast is made up of mostly the implant. In the rare cases where someone with bigger breasts (for example a size B) wanted to go to a size C, then I might use saline.
I’ve heard of a “vampire facelift,” what is this?
Despite its name, the vampire facelift is actually a non-surgical cosmetic procedure, rather than a facelift. It uses the patient’s own blood, which is rich in antioxidants and collagen, to make the skin more radiant. Often times, people combine this treatment with fillers for the ultimate facial rejuvenation. The vampire facelift is the same treatment top athletes such as Tiger Woods have had done to their joints to promote healing and increase vascularity. The way it works is blood is drawn, then the Platelet-Enriched Plasma (PRP) is separated and concentrated. The PRP is essentially tattooed back into the middle layer of the skin to promote radiance. My favorite protocol of this procedure uses the Dermapen. (For more about Dermapen, read below.)
As a teen, I had very bad acne and now I have scars, pitting and large pores. What do I do?
My favorite new device to reverse damage from acne, is the Dermapen. It stimulates collagen in the middle layer of the skin, plumping acne pitting. It’s the only therapy that helps with deep pitting. It can level the top edge of the pit to the bottom. Also, it’s great for fine lines and wrinkles on the upper lip. It can be used on all skin types, is much less expensive than laser devices and does not cause heat damage to the surrounding, healthy skin.
Do you build up resistance to Botox to the point that it stops working?
First of all, there are 3 neuro-modulators on the market today—Botox Cosmetic, Dysport, and Xeomin—each have their own unique properties. You cannot build up a resistance to neuro-modulators. However, the more you use them, the less you need them because you train your face not to make certain movements. For this reason, it’s important to get treatments regularly. I have been using neuro-modulators on myself for 12 years and now I only need to get it done twice a year, whereas when I started I was getting four treatments a year.
Dr. Sharon Giese
114 East 61st Street
New York, New York 10065
Tel: (212) 421-3400
Fax: (212) 421-3435
Click here to view Dr. Giese’s patient before and afters.