Thank you for your question.
You submitted a question with two photos and you're asking this question about the relative
benefits of microneedling with PRP stem cell with CO2 versus facelift for a concern that
you elaborate which basically seems to describe an issue with your skin quality in terms of
pores and you want to rejuvenate and restore glow.
You feel that you've been sagging and you're trying to, I think, really look for what is
optimal because interestingly, you have an issue with Botox® which you say causes you
to breakout.
And in the end of your question, you're talking about relative cost of everything
between PRP and microneedling versus facelift.
Were they to cost the same?
What would be optimal for you?
Well, I can certainly share with you my approach to this type of question which comes up pretty
much every day in our practice in different ways.
A little bit of background, I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And helping people with facial aging has been a focus and an area that has been an area
of significant work in my practice for more than 20 years.
I think it's very easy to understand why you are asking these questions because certainly,
when people look at themselves when aging, they often look at the skin.
And essentially, the perception is that things are sagging.
And when you try to do research about what to do about these issues, you can be overwhelmed
from claims made by skin care products, like creams, for non-invasive products and procedures
to very extensive procedures.
So I help my patients kind of understand the strategy by first understanding what is the
anatomic issues and then try to separate the solutions or at least customize the solutions
specific to those issues.
So to begin with, understand that facial aging has two major components when you notice the
lines.
You mentioned you are concerned about the lines from your nose to your mouth and you
want those to be gone.
Well, facial aging is a combination of volume loss and the volume loss has to do with not
just thinning of the skin.
The skin is only about 2 millimeters in thickness.
So what else thins?
There's bone loss, there's fat loss, soft tissue.
There's a change in the architecture of the face with aging.
In addition, there's also laxity.
So the connections between the skin and the deeper tissues start to loosen and therefore,
there is some sagging.
So when you ask about the solutions, well, let's look at how do we approach the issues
first from the inside outward?
Well, to begin with, when I do an evaluation for a patient and when we do a consultation,
very often, one of the first things they do is they'll hold the mirror and they'll
pull their skin up and say, "This is what I want."
And what we call that is we call that the mirror lift and that's what a lot of people
do at home.
And understand that, it doesn't always mean that you're a candidate for a facelift.
But essentially, it does help you appreciate the relative elasticity of the skin as well
as the contribution of volume loss.
And what does that mean?
Well, when you lift upward, you're moving volume from the lower part to the upper part
of your face.
So one of the opportunities that I find for patients like yourself, and again, this is
in the absence of a physical exam as well as not seeing other angles of your face but
one of the things that I find that has been really significantly of benefit that's not
included in the question in terms of your choices is something called structural volumizing.
Now with structural volumizing, what we're doing is we're addressing up to a point
the volume loss that's related to both bone as well as fat and soft tissue.
By using long lasting fillers such as Juvederm Ultra Plus and Juvederm Voluma placed in a
very specific method at the bone level, we're actually able to restore cheek volume, chin
projection, jaw angle definition.
And what I think you'll find interesting is, when you're concerned about a particular
line, it's interesting to see the perspective change when you restore volume in the adjacent
areas.
So when you look at patients who've had structural volumizing, they may come in concerned
and you may notice that area that you're concerned about, the nasolabial fold.
But when you restore volume in the cheek and the jawline, it actually creates the effect
of looking like you added volume to the nasolabial fold when you actually didn't.
So consider that as one of the potential solutions for more of the global issue.
Now as far as understanding the differences between microneedling and PRP versus CO2 laser
and the face and neck lift, there is a very strong dividing line there.
A facelift or a face and neck lift is the repositioning of sagging skin as well as the
muscle connection between the skin and the underlying facial muscles called the SMAS
or superficial musculoaponeurotic system.
Basically, it's a surgical procedure to reposition and restore relationships so that
the jowls improve and the neck angle improves and the cheeks are elevated.
That's a face and neck lift or facelift.
Now when you describe the procedures microneedling, CO2 laser and PRP, we're talking about systems
to treat skin quality and to improve fine lines, wrinkles, discolorations.
That's the most superficial.
All those are good options but a proper examination is necessary to determine what works best
for you.
The photos are helpful but a proper examination will reveal the things that can actually be
beneficial.
Now a lot of times when people try to do the less invasive procedures first like by working
on the skin, from the outside only, they often get frustrated because they're expecting
more dramatic improvement out of a procedure that only treats a very thin layer and doesn't
treat the underlying layers.
I've seen this particularly in patients who are dealing with acne scars as well as
volume loss that want to try to smooth their skin of wrinkles, or like I said, acne scars.
But when you put volume underneath such as in the cheek area then the benefit can actually
be significant and the patients can be considerably happier.
So I think the take home message here is, you've missed one particular category that
can be of benefit, that can be useful in the overall treatment plan for you.
So understand that you are really comparing a skin procedure with the microneedling, laser
and PRP versus a surgical procedure that's much deeper, much more aggressive when you
talk about a facelift and face and neck lift and then add it to that and then maybe eliminating
the other options might be to do something like structural volumizing which can last
up to two years and really can help restore a lot of the balance in the facial aesthetics
and facial proportions.
So meet with qualified, experienced cosmetic surgeons and learn about these different options.
I think it's very important for you to just be aware and really get detailed understanding
of the outcomes, what can you expect.
You know, it's very routine for me to see patients who have tried all kinds of superficial
skin procedures and they finally then get to a point where they then seek me out as
a cosmetic surgeon and then when they hear about this strategy, it makes it a little
bit more sense.
And ultimately, we're able to communicate a level where we're actually achieving what
they set out to actually accomplish.
So it takes time.
So you have to meet with a doctor who spends time with you and learn about your issues
and review your photos in detail and really gets to the heart of what you like to accomplish.
It doesn't mean you have to do everything at once but at least, you'll be able to
develop a plan.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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