Thank you for your question!
You submitted this question without photos but you’re asking essentially a simple straightforward
question: can you address deep wrinkles and acne scars with a procedure like deep chemical
peel at the same time as a facelift?
Now, you’ve already seen a doctor who is going to be doing the facelift and this doctor
is advising you to not do both procedures at the same time.
And in your research, seeing people who are getting comparable procedures done at the
same time where they’re having a chemical peel or a laser at the same time as a facelift.
So which leaves you wondering can it be done.
I can certainly give you my opinion and my experience.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
Facelifts are a big part of what I do as well as rejuvenation of the skin for acne scars
and for wrinkles with devices such as lasers and chemical peels. 20 years, you have to
appreciate that I’ve lived through this progression of the different modalities.
A lot of times, life does have the tendency to come around full circle.
So let me first give you an idea of what thoughts go in my mind and I’m sure goes in the mind
of your doctor when considering doing something to the skin at the same time as a facelift.
Well, let’s begin with understanding some basic ideas.
Number one, what exactly happens when you do a facelift?
Well, if you’re doing a facelift where you’re elevating the skin separately from the underlying
SMAS or superficial musculoaponeurotic system, then what you’re doing is you are separating
the skin away from the blood supply.
Now, in those situations, obviously you are very concerned about the blood supply to the
skin and any other stress to the skin.
Now, if you are doing something like a deep plane facelift where you are initially going
under the skin and then you are going under the SMAS or superficial musculoaponeurotic
system, you have a little bit more of a blood supply going to your skin and there may be
some room to work.
But it’s really a question of what is the best procedure to give you the results of
the facelift and not just think of how many things can you do at one time.
So, when you think about blood supply and depth of wrinkles, well depth of wrinkles
and depth of acne scars, there’s a basic rule of thumb.
The more deep you need to go, the more aggressive you have to be, the better results you can
get up to a point and at the same time, the greater the chance for complications.
Now, if you have a lot of deep wrinkles and a lot of acne scars and you want to do a more
aggressive chemical peel or a deeper peel, then it wouldn’t be my recommendation either
to do it in the area of the flap.
Now, something that we do during a facelift where we can be more aggressive is in the
area like around the mouth or the perioral area, we’ll do something like laser or a
combination of laser, fractional CO2 laser but basically, this area has not been undermined.
When I say undermine, as what I was describing, lifting the skin away from its blood supply.
This area, it’s safe to do these treatments because you haven’t separated the skin from
the blood supply.
It’s important to understand that there’s a balancing act here.
And one of the reasons why I think your doctor may be hesitant is that, something that I’ve
observed and I’m sure other experienced cosmetic surgeons have similar observations,
is that as people get older, a lot of times the acne scars start to look deeper.
This is because the skin and collagen, the collagen of the skin and the deeper soft tissues
decreases in volume and so, everything kind of collapses and those wrinkles can look deeper
and the acne scars can look deeper.
In other words, you may be over treating before you can actually improve those wrinkles and
acne scars with a lifting procedure.
When you do a facelift, you are elevating and removing skin which means there’ll be
some more tone to the skin when the procedure is completed.
It would probably be comparable to something I would recommend which is do the facelift,
allow it to heal and see what you want to address and address appropriately after the
facelift is healed.
Now something that we will do in the flap area or to help acne scars is we’ll use
platelet-rich plasma.
Platelet-rich plasma is derived from your own blood and it’s kind of a secondary procedure
and it’s not something I do routinely on facelifts on the flap but in terms of helping
you try to understand other modalities, this is another option which you may want to discuss
with your doctor.
But again, I think your doctor may not have explained it to you in this level of detail
but basically, you don’t want to take more risk than you need to.
There’s already a certain degree of risk in lifting.
And even if you can laser the flap, you can do chemical peel on the flap, you have to
be intrinsically more conservative because if the skin gets compromised, then you’ll
lose the skin.
So it’s not something anybody wants to consider and think about.
So you want to depend on or rely on your doctor’s experience and recommendation and get the
logic behind why your doctor is not recommending both the same time.
I suspect, as I said, that your doctor wants to get the facelift done as best as possible
without any change in the original plan because of having to compromise on the blood supply
because that means less undermining.
There are many ways to do this procedure and certainly you will get many different opinions
but once you find a doctor you trust and you feel good is going to guide you, then maybe
you just follow that doctor’s advice.
So I hope that was helpful, I wish you the best of luck and thank you for your question!