Fotana/4D laser facelifting and HIFU facial/3D skin med risks.

Question

I was considering the HIFU facial/ultherapy however after reading your article about this destroying fat cells I wont be proceeding. I'm considering the Fotana/4D laser facelift. I'm just wondering if the same risks are involved? https://www.realself.com/review/uk-ultherapy-3d-skinmed-hifu-risks

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of your face fro the front and side would help in the evaluation.    It's important to keep all of these "heavily marketed" non-invasive procedures in the proper perspective.  Non-invasive techniques typically shrink the skin several mm's.  There are 25.4mm's in one inch.  The minimally invasive facelift described below in comparison 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 or to accurately shape the underlying facial fat layer making these non-surgical procedures one dimensional at best.  
 If you have "jowls” these are sagging facial tissues and an 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.
 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
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.  If the cheeks are flat or concave in the front, Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 When the chin is weak, this 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.
Hope this helps.

Ronald V. DeMars, MD (Retired) · Answer

The nonsurgical "facelifts" are misnamed as there is no lifting, there is some modest tightening of the skin but it is not a directional lift like the surgical facelift and they do nothing to reposition the volume in the face like a surgical procedure. There are no shortcuts to good results. I see several patients every year who spent their money on these treatments and now have no results to show for it and no money to have the surgical procedure they need. Better to do it right the first time.

Fotana/4D laser facelifting and HIFU facial/3D skin med risks.

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Fotana/4D laser facelifting and HIFU facial/3D skin med risks.

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