How the Combination Approach is Changing the Facelift as We Know It

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For decades, the traditional facelift has been a straight forward affair. Despite variations in technique, the procedure comes down to, in simple terms, some nips and tucks and voila...goodbye sagging, lax skin. But the facelifts of today are not as cut and dry as the traditional facelifts of the past. Now, patients who want to look 10 years younger have many more options to choose from, many of which require zero scalpels. But as any good plastic surgeon will tell you, although we now have skin tightening devices, “liquid facelifts,” and collagen-stimulating treatments at our disposal, there is still no substitute for a true blue facelift. So, we spoke to Buffalo, NY plastic surgeon Samuel Shatkin Jr., MD—who is actually trademarking the phrase “combination rejuvenation”—to find out exactly how patients today are ordering their facelifts from the cosmetic treatment a la carte menu.

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NewBeauty: What kind of facelifts are you performing at your practice?
Dr. Shatkin: A traditional facelift essentially requires a much longer incision, which extends from the temporal area in the hair all the way in front of the ear, and then back behind the ear into the scalp behind the ear. It’s a much longer incision, but it’s good for individuals who have significant laxity and are in the older population, that's the type of patients that we would recommend a traditional facelift for. However, more and more, I’m doing a procedure that I call the “S-Lift,” which I recommend for people who are a bit younger and trying to stay one step ahead of the aging process. My “S-Lift” is essentially a mini-lift and I call it an “S-Lift” because it’s shortened—it’s a shortened scar and in turn, there’s a shorter recovery. It’s sort of a modification of some of the traditional things that we use for a facelift, but at a smaller scale.

NB: What is the youngest age you’ve had a patient come in and say they want a facelift?
Dr. Shatkin: I've had women in their late 20’s coming in for a facelift. Some people have premature aging changes, and they can thank their parents for that because some of it is heredity. Generally, we age with a combination of gravity, muscle movement, and our environmental exposures such as smoking or sun exposure. And if a patient has any or all of those causes of premature aging, then the timeline for doing a procedure is not as important as the condition we're trying to treat. Some people look great in their 60’s and 70’s and need nothing done. Other people might be looking to undergo a procedure in their 20’s and 30’s because they might need it more than someone who is older. The advantage we have now is that we can, as I tell my patients, “buy some time.” For example, if you want to get rid of the folds around the mouth, we might not need a facelift, where 29 years ago when I started in practice, a facelift would be really the only option. The other advantage of doing these procedures at a younger age is the skin quality is so much better. So, if the patient has poor skin elasticity with a lot of sun damage, and they have a history of smoking, the results for the facelift whether via traditional or an “S-Lift” or a mini-lift, the results are not going to last as long as someone that comes to have these treatments done earlier in their aging process.

NB: What are some of the “combination rejuvenation” treatments that are possible now for patients considering a facelift?
Dr. Shatkin: Right now, we have fillers, we have the benefits of Botox Cosmetic to relax muscles, and we also have skin resurfacing treatments like chemical peels and microneedling, with the more advanced combinations now including microneedling with radio frequency and both ablative and nonablative laser treatments. And the nice thing is we've got this huge armamentarium of various treatments that are part of this “combination rejuvenation” that may buy some time or fend off the aging process for those that may have otherwise 25 years ago needed a facelift. Now we have so many things that can rejuvenate skin without surgery alone.

NB: What is the overall benefit of combining multiple treatments with an “S-Lift” or mini-lift instead of undergoing a traditional facelift?
Dr. Shatkin: If you do just one thing, you're going to get some improvement. And if you do another thing, you're still just going to get some improvement. But if you put multiple components together, it's like one plus one equals three, right? Sometimes you need a little bit of skin tightening along with some rejuvenation of the skin surface. I think that's the biggest change that I've seen in plastic surgery over the last decade, using all of these new nonsurgical modalities in conjunction with the surgical modalities to get the best end result and the patients are the happiest—and when the patients are happy, the surgeon is happy.

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