I don't see any changes after PRP facelift. Is this normal? (Photo)

Thank you for your question. I understand you had a “PRP (platelet-rich plasma) facelift”, which involved a few injections, some micro-needling, and the application of PRP in your face. The dermatologist assistant said that you would see results as early as the next day, but you state you still don’t see any difference.I can certainly give you some guidance on this matter. A little about myself — 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.PRP is something that we use in our practice every single day. We use it for wound healing, acne scars, fine line, wrinkles, discolorations, and variety of indications, including scars. We’ve even developed a method of using PRP in combination with extracellular matrix to treat hair loss.Now, the word facelift is very flexible, but for a surgeon, the term facelift really means one specific thing — it refers to a surgical procedure that involves the lifting of the skin’s soft tissue in a vertical manner. The Vampire Facelift®, on the other hand, involves the use of the combination of PRP and one syringe of hyaluronic acid filler, such as Restylane, and injecting them in small amounts into specific areas. Typically, the Vampire Facelift® is done on women in their 40s, who have some volume loss, have reasonable facial structure, want to see some improvement in overall skin quality, and want conservative volume correction done.In your case, I think what the doctor intended to do is more similar to a Vampire Facelift® — to improve the quality and volume within the skin, and to lift the face away from underlying skin to make it look brighter. On the part of the dermatologist assistant, they may have anticipated a little bit of flush or glow to the skin, which is why they said that you would perceive improvement by the following day. It is also important to distinguish the difference between injecting PRP under the skin, and administering PRP via a micro-needling technique. When PRP is injected under the skin, the skin is stimulated through the improved circulation, improved fat cell quality, improved collagen volume and blood supply. It usually takes about two weeks to see results, and I would say that it is rare for someone to have that significant of a sense of improvement by the next day. Micro-needling, on the other hand, is used for fine lines and discoloration. The needling depth must be significant to make a difference, so you will need to allow the skin to heal, which takes about a week. I consider PRP and micro-needling treatments as limited to the top layers of the skin. If you’re looking for more significant volume correction, you will still need a filler. If you want to address sagging, you will need surgery.I think that you probably had some miscommunication with your doctor. I suggest you schedule that follow-up appointment with your doctor, revisit your before and after photos, get feedback, and have another discussion regarding what outcome you expected to have from this procedure. The term “facelift” can be confusing to many, so hopefully understanding some of these basic concepts and terminologies, you’ll be able to better absorb what the changes are over the next few weeks and discuss the details of your perception of your doctor.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

 Hi, in reality PRP is a blood product that's simply incapable of lifting "any" tissues of the face.  I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos your cheeks are very flat (concave) in the front, there is excess fat in the mid and lower face, significant jowls are present and I suspect that the chin is weak with a slight degree of ptosis (can be confirmed with a profile photo).  In addition there is some excess fat in the upper and lower eyelids.  These factors combine to create an elongated, rectangular shaped face.  The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.  Injections of PRP, Fat or anything else can't accomplish the same thing.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  When the cheeks are concave or flat in the front, cheek augmentation with precise placement of a dermal filler or using silastic cheek implants (permanent enhancement) can create full, round cheeks that will feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 It's important to keep all of these "heavily marketed" non-invasive so called facelift procedures in the proper perspective.  Energy based (RF, Ultrasound, Lasers) Non-invasive techniques typically shrink the skin several mm's.  There are 25.4mm's in one inch.  The minimally invasive facelift described here can remove 2 to 3 inches of skin which equals 50.8 to 76.4 mm's or up to 25 times the amount of loose skin provided by non invasive techniques.  That reality should always be front and center in the decision making for prospective facelift patients.  It should also be noted that non invasive techniques have no ability to properly dissect, elevate, trim and re-suture the SMAS layer making them one dimensional at best. Injections provide no plausible modality of tightening the SMAS, reducing excess fat or removing excess skin.Hope this helps.