Thank you for your question.
You submitted a single photo with a view of your neck, but in your question, you described
what appears to be a combination of issues.
You want to add volume to restore some structure to your face, at the same time, you also want
to smooth the skin in the face and neck area.
You described your experience with a consultation with a physician recommending fractional CO2
laser, but you’re conflicted whether or not the fractional CO2 laser would be enough,
or whether or not you would benefit from a real CO2 laser.
I think I can certainly give you perspective and options.
You’ve also described that you’ve used Radiesse and Voluma and you weren’t happy
with those results.
So, to give you a little bit about my background, I’m a Board-certified cosmetic surgeon.
I’m a Fellowship-trained oculofacial plastic and reconstructive surgeon.
I’ve been practicing in Manhattan and Long Island for over 20 years.
Facial aging is an area of focus in my practice, and I think I have an idea of where you’re
coming from.
Certainly, it appears by the end of the question is you’ve mentioned that the cost was about
half of a lower facelift, so clearly you also understand that there is potentially value
in you having a facelift.
Let’s first begin by just making some distinctions about the CO2 laser.
CO2 laser does not lift the skin.
The CO2 laser, or any resurfacing technology, whether it’s a CO2 erbium laser, is about
resurfacing, and a small but significant amount of what’s called “dermal contraction”,
where the backbone of the skin gets a little bit tighter.
What ultimately results is an improvement in skin quality and texture, but it does not
cause a lifting effect.
Now, there are many patients who come to our practice who know that they need a facelift
or a face and neck lift, but because of time constraints and other limitations, they are
not quite able to schedule, but they want to get something done temporarily.
Now, this is where there is opportunity and one of the things that patients are frequently
frustrated from when they come to us is, like yourself, they’ve had fillers done, and
when they got fillers done, their faces looked kind of weird and pillowy.
It’s because the fillers, which are basically designed to be injected in the skin to add
volume, are limited by the physical weight of the filler in the space it is placed in.
So, if you have sagging skin—if you think about it, facial aging is two things: it’s
volume loss of bone, muscle, fat, soft tissue and descent and sagging—so you take someone
who is sagging and you try to add volume in their skin, beyond a certain point, the skin
kind of gives and it causes things to get worse.
What we do in our practice is something called “structural volumizing” using a method
called the Y Lift.
The Y Lift is based on this idea that the placement of fillers strategically at a deeper
level, in a very specific way, can restore volume in a way that actually does actually
lift, by creating an expansion of the volume at the more solid level, which is more in
the deeper structures of the face, closer to the bone structure.
The Y Lift is a very specific technique and it does require a decent number of syringes,
which often something found to be shocking to patients, but it does actually work extremely
well.
We’ve been very happy with this method in our practice, because what we’ve been able
to do is restore structure—structure meaning cheekbone structure, jawline structure, and
even enhance the projection of the chin, and what that creates is a lifting effect and
a restoration of this very nice look as if somebody had a facelift.
For the right person, who is not that far along in terms of their sagging, it can actually
be a substitution for a facelift.
The results can last 1-3 years, and I think that just by the way you phrase your question,
it would probably be worthwhile for you to consider the Y Lift procedure in terms of
a bridging procedure before having a surgical facelift.
I always explain that even with a surgical facelift, we still have to address volume
loss, so it’s not unusual in a surgical facelift to also put cheek implants or chin
implants to restore volume so that when the skin is redraped, there’s actually structure.
I think that given your question, you would probably benefit from a structural volumizing
procedure like Y Lift and then also do a fractional CO2 laser, which I feel has a much safer profile
than full oblation, even though oblation can be very very effective.
It’s a balance of your willingness to have a certain amount of downtime.
There’s a basic rule for laser treatments: the deeper you go, the better the results
are, but the higher the risk, and the longer the recovery period.
So you have to explore that as well, but I think that for your concern, I think Y Lift
is an option for you that is worth exploring.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.