Will a Laser-Lift Result in Facial Wasting Like Thermage Treatments?

Question

I've read about Thermage's final outcome being loss of sub-cutaneous facial fat resulting in a much older appearance.

Vincent N. Zubowicz, MD · Answer

High tech is appealing to surgeons and patients. However, much of the new technology we see in aesthetic surgery doesn't work and may do harm. If you want a facelift, seek out an experienced and talented surgeon. If he instills confidence, let him do his job and you will be delighted.

Thomas Fiala, MD, FACS, FRCSC · Answer

Hi.  The laser-lift is certainly an area in evolution.  Applying energy to the dermis - with some form of energy - can certainly cause some skin contraction, but it can also cause injury and scar formation.  Loss of fat can also occur with higher tissue temperatures.The jury is still out on which laser and which settings are the best.  Be careful.

Larry S. Nichter, MD, MS, FACS · Answer

Although not written about I have heard on a fat transfer panel that Thermage can cause loss of transferred fat even years later. I have not seen scientific literature that your native fat will disappear.Thermage is not a laser. It is designed to cause skin contraction (to a small extent) and not to replace a facelift. Many of my patients have been disappointed in Thermage and we do not offer this technology.

Otto Joseph Placik, MD · Answer

There are a few individuals who claim benefits from the use of Thermage but it appears that a good number of patients are dissatisfied with treatments, In some instances it has even resulted in fat atrophy or necrosis.

Stephen Prendiville, MD · Answer

Thermage is technique for radiofrequency deep tissue heating, and achieves a completely different result than any laser.  The results from Thermage have not been as impressive as originally hoped. The term "laser lift" may refer to skin resurfacing, which can be achieved via CO2 or Erbium laser, delivered in Fractionated or standard delivery modes.  It could also refer to laser assisted lipolysis which would refer to fat removal and skin tightening.  It could also refer to a marketing "gimmick" : there is no established proof that use of a laser to make incisions and/or other aspects of a Facelift have any benefit over currently available techniques.  Lastly, it could refer to use of fractionated laser resurfacing with a Facelift.
A general rule of thumb in cosmetic surgery is beware of catchy brand names that describe procedures.

Ross A. Clevens, MD, FACS · Answer

The laser assisted 'weekend' necklift represents the evolution of sophisticated facial plastic surgery techniques.These techniques are uniquely combined to achieve improvement in the contour of the chin and neck with minimal incisions and rapid recovery. Cervicofacial liposculpture is first employed to contour the unfavorable fatty changes seen in the face and neck as time passes by, such as the 'Turkey neck' and 'double chin'.Careful attention is then turned to tightening the neck muscles and eliminating neck bands.
Finally, the laser is used to 'resurface' the underside of the neck skin, thereby 'shrinkwrapping' the skin of the neck restoring a youthful contour. This innovative procedure may be performed at the same time as other rejuvenative procedures such as eyelid surgery, midface lifting, endoscopic browlifting and cosmetic laser skin resurfacing.

Michael Kulick, MD, DDS · Answer

Regarding using a laser for actually cutting, while there is not universal agreement, I have been using a laser to divide tissue while doing my Vertical Facelift and have excellent results, fewer complications and the results are lasting.  This does require a surgical procedure. The laser seals blood vessels as it divide tissue.  
In contrast, patients that do not want a "surgical" procedure have turned to non-invasive technologies (many out there) that try and tighten the skin. These treatments have not provided consistent improvement in terms of the skin tightening that surgical treatments afford patients.  
The other use of lasers to tightening the skin refer to when a doctor burns the skin using a laser. It is different than the laser I use for surgical cutting. If a patient has a lot of loose skin, this may not be a good option.

Toby Mayer, MD · Answer

These names of procedures, for various marketing purposes, confuse the issues involved. Yes, a laser causes the vaporization of some fat. It sounds Hi-tech when we use the term Laser. There are many other issues you should be aware of before having any of these done. See an experienced plastic surgeon who will guide you through the various procedures possible and help you pick the one that is right for you. He will be motivated by what is best for you and not best for him.

Kristina Tansavatdi, MD · Answer

Any technology if not properly understood and used appropriately can result in complications. Practitioners who warn you against these devices do so because they don't have the experience using them. Technology has improved almost every aspect of our normal daily lives. It has also transformed medicine and surgery. The most important aspect is making sure your physician understands the anatomy, can perform a traditional facelift, and has experience using traditional techniques and newer modalities. I agree that Thermage can cause some facial wasting but this is usually because the practitioner used the device in the wrong location and was too aggressive. A Laser- assisted facelift (or Laser-lift) provides good control of bleeding, melts fat, and tightens skin. The fat melting should only be directed in the neck. As long as your physician understands this you should not see facial wasting.

Boris Volshteyn, MD, MS · Answer

Any techniques that can damage underlying fatty tissue, can have the undesirable side effect facial wasting. I have seen one patient after Thermage procedure who reported loss of facial fat. I have not personally seen any patients after Smart lipo who reported the same, however, it is theoretically possible.

	However, it is also important to remember that during facelift procedure the surgeon usually uses electrocautery to stop the bleeding. Electrocautery can also destroy small amounts of fatty tissue around the blood vessels that are cauterized.
	
	With better understanding of facial anatomy and with better understanding of value of maintaining facial fullness,  we start looking at new technology with slightly more skepticism.
	
	I believe, there is still a role for laser lipolysis, like Smart lipo, in improving the shape and contour of the neck, I'm not confident that I see a great benefit for Smart lipo in improving the shape of the face.

	Sincerely,

	Boris Volshteyn M.D., M.S.

Will a Laser-Lift Result in Facial Wasting Like Thermage Treatments?

Answers (19)

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