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About Face

Nonsurgical Face-lifts

Chapter Two Aging Skin Factors That Age the Skin How Skin Ages Hollowing Sagging Wrinkling Vitamin A Acid Cream Nonsurgical Face-lifts Injection Treatments Peels

Another age-diminishing, or so-called age-diminishing, item on the market these days is the “nonsurgical” face-lift. Often you’ll see it advertised at spas or upscale beauty salons. A nonsurgical face-lift, administered by aestheticians, is essentially a procedure whereby electrical currents are applied to the muscles of the face. It seems to me to be an adaptation of the popular muscle stimulators that athletes use the muscle toning, which spas have applied to the thighs and rumps of people who can’t be bothered exercising.

I investigated the procedure several years ago with a control group of patients, but I didn’t see any discernible difference in their before-and-after pictures, even after six months of treatment. There are solid, physiological reasons why simply toning the muscles of the face won’t alter anything - the sag of the SMAS fascia for example - but still, nonsurgical face-lifts are gaining in popularity. To my mind, perhaps nonsurgical face-lifts, as well as commercial anti-aging creams, might provide temporary results of a minor nature.

Injection Treatments

Depending on how deep the wrinkling is, and whether or not the patient has the desire to correct other signs of aging. I can apply a couple of solutions to the problem. If the wrinkling is deep, the patient will often have other noticeable aging details, like cording in the neck. In this case, we would consider a general face-lift, a subject I deal with in a later chapter on face-lifts (Chapter Six). A face-lift can reduce even the deepest groove by about fifty percent. If the groove is reasonably shallow, I can inject collagen. (The same thing I might do with the small vertical lines that frowners get between their eyes, or with small lines around the eyes or mouth.)

If the grove is deeper, I’d be inclined to insert Gore-Tex (expanded polytetrafluoroethylene). Cosmetic surgeons now use it instead of an injectable filler. For lip-cheek grooves, it is surgically implanted while the patient is under a local anesthetic. Gore-Tex creates a good foundation, making the grooves more shallow. Further correction of the problem is then made with collagen injections if necessary.

Silicone was an early and popular injectable filler. It is a manufactured polymer containing silicon and oxygen atoms; it is used as an adhesive, a lubricant, as a hydraulic oil and in electrical insulation, as well as in cosmetics and cosmetic surgery. It can take several forms - fluid, resinous, rubbery or firm - depending on various factors like the arrangement of the silicon atoms and temperature. The silicone I have used, for example, has a viscosity of 1,000 centistrokes. When you push it through a needle, it is clear, with the consistency of liquid honey, or maple syrup.

When silicone was first introduced about fifteen years ago, the problem was that cosmetic surgeons were just learning to use it. Some injected far too much of it, and patients ended up with hard, permanent ridges under their skin. Other surgeons injected it in a helter-skelter fashion, without realizing the consequences, and patients ended up with ridges or scalloped areas of the face; it felt like subcutaneous corduroy to the touch. During my internship, I saw an instance where a patient had had an injection of exceptionally thin, watery silicone (say, twenty-eight centistrokes), and it all ran down to the end of her nose and formed a ball.

Today, although we know much more about the handling of silicone, there is still some danger from injecting too much. For this reason, I generally favor the injection of manufactured collagen. As I mentioned before, collagen is present naturally in the dermis layer of skin, but the material we inject is “manufactured” from the skin, or hide, of cows.

Under a microscope, human collagen looks like cotton wool with fibres in alpha-helical folds - a biological structuring that resembles the coils of a Slinky toy. Collagen given the skin strength and bulk. To manufacture collagen, The Collagen Corporation of California purified the biological composition of cowhide so that it resembled human collagen, then mixed it with a local anesthetic fluid. (Koken, a Japanese company, has a similar product.) Collagen looks and feels a bit like tapioca or toothpaste, and if you rub it between your fingers, it will form into tiny, sticky balls. When it is injected, the combination of elements at room temperature solidifies into a filler - what we call a “three-dimensional volume implant” - ideal for the treatment of human skin.

I like collagen because it allows the use of much finer needles. Injections with finer needles are much less painful. I can use a number 30 needle with collagen - a needle almost as fine as a hair - but I have to use at least a number 26 with silicone. (For comparative purposes, the finest needle is number 30, the thickest is number 16. Laid side by side, the number 16 almost looks like a gardening implement; medical labs use a number 22 to draw blood samples.) Naturally, there are some drawbacks with either product: collagen disperses in the body as a biological product, which makes it safer than silicone, but this requires return visits for continuing injections every three to six months.

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