The Surgeon Minute

About Face: An Overview on Facial Rejuvenation

About Face: An Overview on Facial Rejuvenation

There comes a day when the mirror is no longer our friend. It starts slowly, but eventually there is no use denying that age is taking its toll. Getting older is written all over our face in the form of fine lines, wrinkles, poor skin quality, jowls and hollows. A consultation with a board certified plastic surgeon is a smart action step.  Dr. David Lickstein who practices in West Palm Beach, Florida sees patients of all ages interested in everything from basic skin care and correction of sun damage to full facelifts. “The true power lies in mixing, matching and combining modalities and techniques.”

by Isabel Bolt
and David Lickstein, MD

The Skinny on Skin

Great skin is the foundation of beauty. All the fillers and facelifts in the world won’t make up for poor skin quality. That is why it is essential to seek the opinion of a board certified dermatologist or plastic surgeon who has the tools to make the proper assessment of your skin.  “Rejuvenation, prevention, and protection” is the mantra at Dr. Lickstein’s med spa. Patients interested in counteracting sun damage are assessed with a special 3D Vectra camera at his practice that reveal specific areas affected below the skin’s surface. Intense Pulsed Light (IPL) therapy is a proven technology to quickly reverse signs of aging, breaking up brown spots, removing roughness, and allowing smooth even-toned skin to shine through. For those seeking to diminish age spots, hyperpigmentation or reduce fine lines, wrinkles and enlarged pores, microdermabrasion can be performed. It lightly buffs away damaged outer skin layers and replaces them with healthier skin cells. Dr. Lickstein comments: “With little downtime and a slow but steady improvement in appearance, these procedures are perfect for a wide demographic in our practice.”

A proper skin care regimen includes medical grade products not available in department stores, so step away from the cosmetics counter. The ingredients in skin care lines carried by plastic surgeons are much stronger than you can buy over the counter and work at the cellular level. Regimens are designed to work synergistically with your specific skin issues, so the results are more immediate and long lasting.

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Noninvasive Chin and Neck Improvement

Of all the noninvasive tools at his disposal, Dr. Lickstein is particularly excited about two new procedures involving the chin and neck. “The neck is one of the least satisfying areas we treat as surgeons,” says Dr. Lickstein. “We can now offer improvements to a whole group of patients that might not want surgery through either injections or CoolSculpting®.” Until now, liposuction was the primary tool for eliminating fat at the chin and neck.

KYBELLA has recently been approved by the FDA as a non-surgical injection for reducing the small fat pad under the chin, aka “double chin.” KYBELLA contains deoxycholic acid, which is a substance that occurs in your body. When injected into areas of excess fat under the chin, KYBELLA destroys the targeted fat cells, eliminating them from your body forever. Your chin/neck area will be “mapped” for where tiny injections will be placed. The procedure takes about an hour and there is no downtime associated with it. At least two treatments are often necessary for the best possible results. Patients with larger amounts of excess fat may require additional treatments.

CoolSculpting® is a non-surgical alternative to liposuction that can freeze away and remove stubborn fat bulges. For the past few years CoolSculpting has primarily targeted abs, thighs, arms and hips.  The FDA has just cleared a new fat-freezing treatment for chin fat called the CoolMini. This miniature applicator is designed specifically to target excess fat cells that have collected under the chin. Using the same technique as CoolSculpting®, the CoolMini procedure can destroy the excess fat and cause it to filter out of the body through natural metabolic processes.  Like KYBELLA™, two sessions are often required for the best results and each treatment takes about an hour.

The Tipping Point: Graduating to Heavy Lifting

According to Dr. Lickstein, one of the most uncomfortable conversations he has with patients happens at the tipping point when surgery really is the best alternative. “Some patients are convinced they don’t need an operation, but I have to tell them that despite all these things we can do, the real answer is a facelift or necklift to accomplish what they desire and there is really no substitute.” In fact, injectables eventually reach a point of diminishing return both from the standpoint of appearance and budget. Dr. Lickstein understands it takes time to get accustomed to a recommendation for surgery. “It’s natural if someone is not ready to jump into surgery, so it’s nice to have other options available to at least allow patients to put it off for some time and wait for the right time, knowing there still is a surgical option.”

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The fear of surgery is second only to the fear of looking “done,” says Dr. Lickstein. “Patients are looking for natural results and their greatest fear when we talk surgery is looking artificial, fake or even funny. We can deliver a very natural result where they will look well rested and others won’t even know they had a procedure done.”

Making the Most of your Consultation

A consultation for facial rejuvenation is multifaceted. Skin quality, volume and degree of skin sag will be evaluated. Dr. Lickstein starts from the forehead, down. “I look at the position of the brows, excess skin around the eyes, jowls, loose skin in the neck. All or some of these can be addressed. It is never one operation fits all.” Adding volume with fillers or fat, while taking away volume with liposuction may be necessary.  He cautions against having preconceived notions prior to the consultation. Sometimes it is not what you might expect. “As trained board certified plastic surgeons we know it is our job to explain…and most patients will come to the conclusion there is rationale behind the recommendation. Then they can make up their own mind if it fits into their life at that time.”

In any case, Dr. Lickstein points out that given the number of options available and the infinite ways of combining modalities, long lasting relationships are often formed with patients. “It can be tightening loose skin, resurfacing sun damage, maintenance with a laser, injectables, surgery, or just plain skincare for someone who has never put any effort into that before. It’s a very satisfying continuum of care.”

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