New York plastic surgeon David P. Rapaport, MD is seeing a clear interest in all-things contouring at his Fifth Avenue office. While patients are coming in for both facial and body contouring, there’s one area in particular that’s getting more attention right now: the lower face. “Because of anatomy and gravity, laxity of the skin is most visible in the lower face and neck, and that’s what people are coming to us for the most,” says Dr. Rapaport, citing complaints of jowling and excess fat underneath the chin as the most popular in his office.
Understanding Aging
“The face deflates with age, and as things deflate, they fall,” explains Dr. Rapaport. “But it’s also not the same skin—the skin of a 50-year-old isn’t the skin of an 18-year-old. The skin itself loses elasticity and you have more of it, and it’s following the rules of gravity—it’s dropping,” he adds. “That’s where jowls come in, and that’s where you see the crepiness and the laxity in the neck, and that’s not a problem you can solve with filler.”
Facelift Files
While the gold standard for facial skin-tightening remains the facelift, Dr. Rapaport notes it might not be for everyone. “A well-done facelift is a truly amazing procedure but it’s a significant procedure. It’s expensive, it involves downtime, involves low risk, but still some degree of risk. People are still getting facelifts, but there’s an enormous number of people who will just never get one or they are one, two or three decades away from truly needing one. And that’s the population we’re seeing a lot now that we finally can offer a meaningful treatment.”
Tighten Up
Dr. Rapaport’s go-to nonsurgical solution for tightening skin: InMode’s Morpheus8, a minimally invasive treatment which offers bipolar radio-frequency needling (via gold sheathed needles) to treat laxity and fat. Dr. Rapaport notes the depth of the needles—anywhere from .05 to 4 millimeters on the face, and up to 7 on the body—along with how much energy they emit can be controlled to deliver customized and noticeable results quickly. Another benefit to the treatment: “Only the tip of the needles is emitting energy, which allows us to treat any skin type without worry of hyperpigmentation because we are not heating the top layer of skin,” says Dr. Rapaport.
What to Expect
Dr. Rapaport says the initial heating effect from the treatment works to cinch the tissue, but the real tightening results are due to the new collagen that forms over a period of a few weeks post-treatment. “The patient begins seeing the tightening and fat reduction effects around 3 to 4 weeks after treatment. This treatment is incremental—we’re not trying to damage tissues. We’re doing this as three treatments typically spaced 6 weeks apart. In addition to providing added safety, we want to see the results we’ve achieved and then build on them.”
The 30–45-minute treatment can generally be tolerated with local topical anesthesia, but depending on the patient, numbing may be supplemented with Pro-Nox gas and pretreatment anti-anxiety and/or pain medication. Post-procedure, Dr. Rapaport explains the face will be red and have tiny dots on the surface for no more than three days. “Most patients are able to resume normal activities at most, 5 days after a Morpheus8 treatment. You feel like you have a sunburn for a day or so, but it’s not worse than that.”
Dr. Rapaport notes that because Morpheus8 has only been in use for a couple of years, there isn’t a definite answer of how long results will last just yet. “However, we know that fat doesn’t grow back, so that’s permanent,” he adds. “And because the mechanism of action is the formation of new collagen, we have every reason to believe that too should cause a lasting tightening effect.”
The Trifecta
When patients have more than a modest excess of submental fat, Dr. Rapaport recommends treatment with the “Trifecta,” a term referring to liposuction, FaceTite and Morpheus8 all performed in a less than a one-hour session. FaceTite is another form of delivery for bipolar radiofrequency energy to tighten the deeper tissues of the neck and jowls. Because the “Trifecta” begins with the area getting numbed by gentle injections under the skin, Dr. Rapaport contends it is relatively easy to have done under local anesthesia. It is followed by two more Morpheus8 treatments spaced 6 weeks apart.
The Bottom Line
Dr. Rapaport explains that Morpheus8 has quickly become a game-changing tightening treatment because of its unique ability to remove fat and tighten the overlying skin. “It’s for the person who doesn’t want a facelift or is far away from needing it, but that really can’t be satisfied by what we can do with filler alone.”
