Your Villa Magazine - Foothill Cities - November-December - 2023

Facial Artistry Gregory J. Vipond MD, Inc. Dr. Gregory VIPOND Q: What is the difference between a mini-lift and a full facelift? A: The short answer is that it depends on the surgeon. Traditionally, mini-lifts involve a shorter incision with less lifting of the muscles of the face and neck. The reported advantages were less swelling and bruising and a shorter recovery time. The main disadvantage is that a mini-lift typically gives a “mini” result with a subtle but minimal improvement. I used to work for the company, LifestyleLift, who popularized mini-lifts but had a very large number of unhappy patients. Conversely, a full facelift has traditionally involved a comprehensive face and neck lift, forehead lift, and upper and lower eyelid lifts. These days, many surgeons have turned away from forehead lifting due to unnatural results and scarring. The principle that I follow was told to me by my director during my Facial Plastic Surgery Fellowship. He said that you should do what the patient needs. He had 5 different varieties of face and neck lifts but said that the differences were basically marketing tools. While a patient may feel that a mini-lift sounds less invasive, the surgeon needs to do the correct operation for the patient. He said that most patients requesting a mini-lift don’t visualize “mini-results” but instead the results from a more comprehensive procedure. For the past 5 ½ years, I have been performing deep plane face and neck lifts on my patients. Even though I see a wide range of patient ages, the same muscles droop in all of us as we age. I may be able to lift the muscles of an older patient more than a younger one, but I want to lift as much as the body will let me (without creating an unnatural look) because that will give the longest-lasting and best result. If done properly, incisions shouldn’t be a concern once they heal. Q: What’s the newest thing out there and should I try it? A: In the field of facial cosmetics and rejuvenation, there are always new products and treatments that are being introduced -typically with a lot of celebrity marketing and fanfare. Just as with any new product, there has been some testing to have it FDA-approved, but the real-world experience is often very different from the testing one. Just as we saw with the COVID vaccines, we may get an idea of the outcomes and complications from a trial, but we get a much more comprehensive understanding when used on the general population and long-term effects monitored. One example of this is the newest Botulinum toxin, Daxxify®. During their FDA approval trials, they documented that the majority of patients saw improvement in their frown lines up to 6 months after injection. This represents a significant improvement in longevity compared to the other brands. I was very excited to try it and first used it on myself, my staff, and a few select patients. Unfortunately, the results were not as good as I had hoped. While the effect lasted about 5 ½ months for me, the result did not look as good as other brands. The other difference for patients is that Daxxify® is more expensive than the other brands. Due to my initial experience, I have decided not to use Daxxify® in my practice and am glad that I waited on introducing Daxxify® to my general patient population. Something that I have learned during my 16 years in facial rejuvenation is that it is never a bad thing to wait and see when a new treatment or technology is introduced. There is a long list of treatments and devices that have been introduced with a lot of publicity only for them to fade away once the real world, long-term results are seen. For patients, not only does this wait-and-see potentially avoid wasting money, but it helps avoid a potentially bad long-term result. Q: What is Buccal Fat Pad Removal Regret? A: This is a great question to follow the previous one. Buccal fat pad removal has been around for a long time. Recently, it has become popular due to endorsement from celebrities and social media influencers. It involves removal of part of the fat pad on the inside of your cheek to help create a more sculpted look. This procedure can be performed either as part of a deep plane facelift, or as its own procedure. Buccal fat pad removal can be a great procedure for people who were born with an overly- large buccal fat pad or for older patients whose buccal fat pads are falling below the jawline. When doing a deep plane facelift, I always check the buccal fat pads to see if they should be reduced in size. However, I don’t remove just because I can. Loss of facial volume is a significant contributing factor to facial aging and many people who had their buccal fat pads removed when young and full of volume now look hollowed or gaunt. This deficit in volume can be improved with filler, but often never looks quite as good as if you still had your buccal fat pads. Q: When do I do filler and when should I have surgery? A: Filler and surgery are not necessarily interchangeable. By that, I mean that filler adds volume and surgery lifts loose/sagging muscle and skin. I am often asked if putting filler in the cheeks will lift up the face. Unfortunately, filler only serves to add volume. The aging process is a combination of issues: volume loss, decreased skin and muscle elasticity, and changes in our facial skeleton. So, filler will help restore volume to an area that has lost volume and support, much in the way that adding water to a raisin will help it look more like a grape. However, if your concern is neck banding or sagging jowls, no reasonable amount of filler will help. There is no time limit when it comes to facial rejuvenation and no right or wrong choices. It is important to find a provider that can discuss both non-invasive and invasive options so that you can best meet your goals. Q: What is Ozempic Face? A: Ozempic is a Semaglutide medication that was initially used for diabetes. It was then found to decrease the risk of heart disease in patients with diabetes and also resulted in large amounts of weight loss. Since then, Ozempic has been used by many in Hollywood to lose weight. Its cousin, Wegovy, was recently released as a chronic weight loss medication. While losing large amounts of weight may sound fantastic, there is a downside to it. A lean body may look healthy and fit, but a hollowed-out/gaunt face is more characteristic of a chronic long-term illness. Since the adoption of Ozempic and Wegovy, there has been a number of people who have had significant loss in facial volume or Ozempic face. As mentioned above, facial volume loss is part of the normal aging process and faces with more volume generally look more youthful than thinner faces. Filler may sound like a logical solution to this problem, and it may work in some patients. However, having excess facial volume due to being overweight can cause decreased elasticity in the muscles and ligaments of the face. One of my plastic surgery textbooks discussed this phenomenon and compared the tissue and muscles of the face to a trampoline. A large amount of weight gain was comparable to an elephant standing on that trampoline. Losing this excess weight was like the elephant jumping off the trampoline. The excess weight is no longer there, but now the trampoline has been stretched out. If there is enough looseness or laxity in the face, surgery may be a better, more effective option to help restore a more youthful appearance. Just like in the previous question, it is important to talk with someone who is knowledgeable in both surgical and non-invasive options. While facial rejuvenation is a constantly evolving field, it is important for one to not get caught up in internet or social media and to find a provider that can honestly discuss your options with you without trying to sell you on any particular procedure. The final choice should always be 100% your own. If you have any questions that you would like me to answer in future Cosmetic Corners, please feel free to email me at drvipond@drvipond.org For this cosmetic corner, I would like to address some questions that I was asked by patients in the office recently.