why did I lose facial volume after laser radio frequency treatment we are
continuously seeing people who are distressed by facial volume loss after
treatment with thermal energy devices this reflects a growing trend in the
aesthetic field I feel that thermal or skin heating devices such as the various
branded laser and radiofrequency technology are often aggressively
promoted as substitutes for surgical procedures such as facelifts and neck
lifts although these devices can modify the
skin through collagen stimulation and remodeling which can be beneficial for
facial aging they are not in any way replacing surgery I've observed the
effects of these devices being overused for people who are not candidates for
this type of technology yet these devices continue to be aggressively and
deceptively marketed as alternatives to surgery in the state of New York people
who perform lasers and radio frequency device procedures do not have to be
licensed physicians or nurses this means that unlicensed individuals can perform
procedures which can permanently change and even damage your skin regardless of
who uses these devices improper and overly aggressive use can cause facial
volume loss I'll discuss the role of laser or radiofrequency technology in my
practice and how you can understand the indications for this technology so you
don't overcook your skin I'm Dr. Amiya Prasad. I'm a Board-certified cosmetic
surgeon and Fellowship-trained oculofacial plastic and reconstructive
surgeon I've been practicing in Manhattan and Long Island for over 20
years I started using fully a blade of co2 lasers in the early 1990s since that
time I've continued to use light and radio frequency based technology in my
practice to help people improve the appearance of their skin prior to the
introduction of the co2 laser the gold standard for treatment of lines wrinkles
and skin discolorations was chemical peels with chemical peels whether
superficial medium or deep there is an ablation of different levels of skin
with regeneration of new skin a certain amount of collagen was created in
response to the peel which then improved the skin texture quality and color the
benefit that co2 lasers have over chemical peels is a skin tightening
effect caused by thermal energy delivered to the skin by the laser
the idea behind laser treatment is to apply a specific amount of heat from a
laser device to cause the skin to contract and to induce collagen
production through a controlled injury response these principles are relevant
when treating the skin which is about two millimeters in thickness there is a
general perception that facial aging only affects the skin which is why
anti-wrinkle creams and skin procedures are so popular the reality is that
facial aging is more significantly associated with bone loss and weakening
with sagging of the supporting soft tissue in clinical practice I've often
seen people in their 40s and 50s who feel that they may need some type of
tightening procedure this is because they pull upwards on the cheeks and show
me how they look better the basis for this perception is that soft tissue
volume is being repositioned through this action and improving the appearance
of areas where volume has been lost in my opinion
neither surgical lifting nor heat in skin-tightening is the optimal approach
to this type of situation if there is volume loss you restore volume however
it's important to restore volume in the most anatomically beneficial way volume
loss is managed by the placement of injectable fillers in my practice I
prefer the hyaluronic acid fillers such as the Restylane and Juvederm family of
products traditional place where the fillers is within the skin at the level
of the dermis or just below the skin I approach facial volume loss differently
since a significant amount of volume loss is at the bone level I perform a
procedure called Structural Volumizing this method is based on applying the
principles used for the placement of facial implants such as cheek and chin
implants these implants are routinely placed on the bone and below the facial
muscles as a surgeon I've performed many of these procedures and I'm familiar
with this space I place long lasting fillers such as Juvederm Ultra Plus or
Juvederm Voluma to restore volume at the cheeks chin and jaw angle this method of
restoring volume lost by aging is much more impactful than any thermal energy
procedure once you understand this principle
you'll recognize why heating up the skin makes no sense when the underlying issue
is the facial bone volume loss for people who are in their 50s and older
sagging of the supporting tissue called the smash and platysma muscle results in
gels and loose neck skin the optimal procedure for this type of situation is
a facelift or face a neck lift surgery this group of people is particularly
susceptible to the false promises of thermal based non-surgical face lifting
in addition at this time of your life your skin is thinner and the layer of
youthful fat under the skin continues to diminish in my practice I help many
people over the past two decades overcome their
fear of facelift surgery by performing these procedures and my certified office
operating facilities under local anesthesia with light intravenous or IV
sedation by avoiding both general anesthesia and institutional facilities
such as hospitals where you can feel like a number
my patients are able to undergo more definitive surgery with quicker recovery
the science behind thermal induced collagen remodeling as well as thermal
induced fat reduction is sound and can be effective the problem is that people
who are looking for a solution for volume loss and deeper tissue sagging of
being sold procedures which don't deliver an often result in making you
look worse than you did before it is often the case that after thermal
treatment is not successful the practitioner will often dial up the heat
intensity or prolong heat exposure to the skin excessive use of heat or
prolonged exposure to thermal energy devices can result in loss of fat below
the skin a layer of fat under the skin is important for the appearance of
smooth and youthful skin this means that the treatment makes the skin end up
looking older other complications include skin burns blistering scarring
and prolonged redness during consultation it's routine for patients
to ask me about different devices which they hear about I suggest to them to
first take an overview of the problems which concern them before determining
the options which suit their needs I take an
inside-out approach this means understanding the presence and extent of
one bone volume loss too soft-tissue volume loss three support
tissue and skin sagging and four skin quality in terms of wrinkling
discolorations and vessels based on understanding of the potential benefits
of thermal energy devices in improving skin thickness and smoothness I
developed strategies to achieve these goals with significantly lower risk we
use a variety of lasers in our practice such as fractional co2 fractional erbium
nd AG Q switch as well as radio frequency devices such as peleve when it
comes to aging skin there is usually a combination of issues such as wrinkles
and discolorations if we focus on the typical objectives of a therapy which is
to both stimulate the production of new collagen and improve the arrangement of
the collagen bundles skin looks younger and thicker and more even than we could
look at all the ways these objectives can be achieved
we should also factor in what is the potential capacity of a person's skin to
produce collagen this capacity to produce collagen will be limited by
factors such as age sun damage smoking and previous treatments for many people
who come in for consultation they've previously had chemical peels lasers and
radiofrequency treatments this means there may be no effect or benefit from
thermal energy treatment or even potential breakdown of the skin's
integrity this is why a proper examination by a highly experienced
physician is important before signing up for a treatment in my practice I
routinely combine technologies to improve the skin let's consider a common
situation such as skin affected by chronically excessive sun exposure and
aging for the fine lines I use fractional and fully ablative RB
co2 laser for discolorations I use a q-switched laser for dermal thickening I
will use limited heating with long pulsed erbium as well as nd-yag laser
technology the technology used with long pulsed nd YAG can be used for both skin
remodeling and tightening as well as fat reduction for many patients I will also
do a procedure called skin boosting this is where I combine PRP or platelet-rich
plasma combined with hyaluronic acid and use a device to deposit this mixture
directly into the dermis and this is done without any bleeding or bruising
this combination will stimulate the collagen production and improve the skin
without heating many people who come to our office upset and angry about facial
volume loss from overuse of a thermal energy device performed elsewhere are
relieved to have a rejuvenated appearance by a rational approach from
the inside out most often a combination of structural
volumizing with skin boosting and an epidermal treatments such as hydro
facial results in a natural and improved appearance deceptive and high-pressure
marketing in the aesthetic field is not going away anytime soon the key is to
find a doctor you can trust and who you feel understands your cosmetic concerns
to help you look your best I hope you found this information helpful thank you
for your question
you