One of the most requested demands from patients is the non-surgical facelift. There are a myriad of approaches to this and with time surgical results and medical evidence have shown some winners and losers in this demand.
Originally, non-surgical facelifts consisted entirely of treating the face with either botox and fillers. (show timeline here). As technology evolved, non-surgical facelifts incorporated top down approaches which began with Thermage and Pelleve and later evolved into Ultherapy. While these technologies helped get the nonsurgical ball rolling, the underwhelming results often left patients seeking better alternatives. These top down approaches relied on attempting to heat the underlying tissue while avoiding a a burn to the skin. Despite the modality, these treatments still play a role in conservative nonsurgical lifting and can play a role in maintaining appearance.
Later on radiofrequency technology companies began introducing a series of pins or needles which would penetrate the face (sparing the epidermis) and allowing for direct heating of the underlying dermis and subcutaneous tissues. This technique allowed for patients of all skin types to be treated and and more substantial changes were seen with these types of procedures. Examples of this technology include Fractora, Infini and other penetrating needle devices. These treatments can be placed more superficially and treat like a C02 result without the associated erythema.
The current and final evolution of the non-surgical facelift involves the use of a bottom up approach. Here a probe is placed underneath the skin and used to contour and contract the skin. The benefit here is that controlled energy can be placed to cause realtime contracture of the skin. Here the epidermis is bypassed to avoid trauma here and more substantial results can be achieved. Examples of this technology include Facetite, Necktite, and Thermi RF. Facetite and Necktite use a controlled thermal field and so have the advantage of being able to be used near the medial portion of the face. While this approach offers the closest alternative to surgery, it is important to note that it is not a substitute for a surgical equivalent.
With all of these technologies being used, a combination of techniques can be utilized to create improvement in the face and neck. For example, Facetite can be combined with Fractora for multiple layer improvement and using
What to do about facial jowls?
Facial jowls are collections of fat and roundness along the face which can make the face look bottom heavy. This can also make the face and neck look like one unit and negatively impact the neck shadow which is desirable.
So how do you treat undesirable fat in the face?
In the past, surgeons would attempt to liposuction this area delicately with microcannulas with varied success. Often times, this area would still have fullness and would now have a saggy quality to the jowl which was not aesthetically pleasing.
The Facetite procedure can help to improve this by shrinking the fat and contracting the skin at the same time. The benefit here is that the fat can contract and the skin can simultaneously contract creating improvement in both areas.
Other radiofrequency devices, such as the Thermi, are not safe to use in this area as delicate nerves which control the face can be damaged. The heat from the Thermi is omnidirectional and therefore can be directed near the nerve. Thermi is actually intentionally used to disrupt nerves in the forehead as a “botox alternative”. However, for this application, the device is dangerous. The Facetite only places the energy between the probe and the corresponding impedance device making it perfect for areas which were traditionally difficult to treat.
Thermi RF vs Facetite/ Necktite
Thermi RF was the first FDA approved device, while Facetite and Necktite has only been FDA approved in the later half of 2016. Facetite and Necktite have been used worldwide since 2011. Both devices are a compelling new method of introducing radiofrequency energy below the skin. But there are key differences.
The energy in Thermi RF is not controlled and is omnidirectional, meaning the probe releases energy in all directions from the probe. The energy from the Facetite and Necktite device is unidirectional. Unidirectional is better since the energy only has to be placed between the device and the skin, avoiding potential damage to nerves and other structures where energy is not desired. As a consequence of this, the Facetite and Necktite device can reach much higher temperatures safely as compared to Thermi. One area where this is important is in the jowl area. Underlying structures including the facial nerve (the nerve which controls the face) can be potentially damaged with Thermi device making treatment here either dangerous or at low of an energy to be effective.
Thermi device does not have as sophisticated internal and external temperature systems. It requires an external Thermal camera to be used at the same time. An external thermal camera is not as sensitive as real time temperature monitoring in the Facetite and Necktite device which measures temperatures 1000 times per second. Since the temperature monitoring is in the device itself, the Facetite and Necktite will shut itself off once the desired temperature is reached. The Thermi device does not have this important safety feature.
Fat will coagulate (sounds like bacon cooking on a frying pan) at 40-42 degrees Centigrade. The Facetite and Necktite device can actually cause coagulation of fat and does so easily. The thermi device can also coagulate but must be done with caution as temperatures too high can lead to necrosis and scarring of tissues.
Overall the Thermi device is a great introduction to delivering Radiofrequency energy below the skin. However, Dr. Shah is a Facial Plastic Surgeon and needs a device to be able to be used in difficult to treat areas with extreme safety. For this reason, Dr. Shah’s office ultimately selected Facetite and Necktite because of its better temperature regulation, safety, and efficacy.
Non-surgical Facelift frequently asked questions
A botox lift is used to selectively weaken a portion of the platysma muscle so that the muscle will create a subtle lift. If patients are okay with repeat injections, often 40 units or more of botox, to be repeated every 4 months for life, this technique can be enough of a lift for some patients. The current improvement in neck contouring including such treatment options as Fractora or Necktite makes this a better approach for most patients.
Here is where detailed and expert analysis is best for understanding your treatment options. For some patients if their goals are for more dramatic results, a surgical approach may be better. For other patients, a combination of treatments can be discussed and utilized to depending on the patient’s goals.
Dr. Shah is an expert facial filler injector and utilizes several noninvasive treatments which have proven to be effective in the scientific literature. Furthermore, patients receiving a nonsurgical tightening procedure can apply this amount to a surgical procedure (see office for details) if used within 5 years. This allows patients who are perhaps a few years too young for a facelift to first embrace a nonsurgical tightening approach first and then as they mature progress to a surgical approach if desired.
The main benefits of a non-surgical facelift are less downtime, no incisions, and perhaps less risk (avoiding surgery and anesthesia).