San Diego Facial Plastic Surgery

"Liquid Facelift" was probably coined in regard to Sculptra, which is a "large volume" injectable filler. Unlike a syringe of restylane or juvederm or even radiesse, sculptra comes in a bottle which generally prodcuces 5-6 syringes of product for injection. While scluptra can target specific lines like the nasolabial folds, it is better known for adding plumping volume to thin, "hollow" faces. By changing these hollow areas (below the cheek bones and in the temple, for example) to more convex or rounded, the face looks naturally more youthful. In some cases, if no volume were added and the skin was simply pulled, these thin faces could look unnatural and "operated."
Indeed, sometimes a "liquid facelift" can be better that a regular facelift for the right candidate!

The principle of liquid facelift can also be applied to fat grafting. This is another way of adding to volume to the face to make it look more youthful. It involves an addtitional procedure- liposuction- but the filler is one's own fat and the supply can be plentiful and relatively inexpensive.


So how long will it last? Sculptra has been known to last 2 years PLUS. Fat, after trasnplantation to the face, is generally permanent after six months, with most patients retaining 40-50% of the fat that is grafted.

In our San Diego practice, a "liquid facelift" is generally topped off with a "Total FX" fractionated skin resurfacing treatment. In this way, the refreshed, volume enhanced face receives a new, smooth layer of skin. The Total FX treatment removes lines, wrinkles, scars, hyperpigmentation, and tightens loose skin. The overall look is amazing, and in many cases rivals a surgical facelift.

When considering a liquid facelift, it is important to consult with a board certified facial plastic surgeon who will examine your face and tell you if you are a good candidate. If you truly need a surgical lift, this may still be the best option, and save you substantial money on fillers. Remember, a "Mini Lift" can be performed with no general anesthesia in about 1-2 hours.

Labels: fat grafting, juvederm, liquid facelift, radiesse, restylane, san diego, sculptra

At the recent meeting of the American Academy of Facial Plastic Surgery in San Diego, CA there was some discussion regarding facelifts and smoking.

Conventional wisdom states that nicotine and facelifting are not good partners. This is because nicotine constricts (makes smaller) the blood vessels supplying the skin. During a facelift, the skin is temporarily "lifted" away from the deeper tissues (including the blood supply) so that it can be redraped following tightening of the deeper tissue. In non-smokers and otherwise healthy patients this temporary separation of the skin causes no harm- there is still plenty of collateral blood flow. In smokers, this collateral blood flow is limited, raising the risk of inadequate blood flow to the skin edges.

Inadequate blood flow carries a certain risk for slow healing, and skin complications. A worst case scenario can be prolonged healing and poor scars that require revision.


Most plastic surgeons attempt to reduce this risk for smokers by encouraging them to quit. Generally two weeks of no smoking prior to a lift, and one week after will put patients in a "safe zone" for healing. Occasionally, patients are unable to quit completely prior to surgery and that is where the patient and surgeon need to sit down and have a frank conversation.


Patients who are "light smokers" (less than 1/2 pack per day) can often be safely treated with a "mini facelift." This involves shorter skin flaps, with less stress on the small blood vessels. However, the surgeon should be highly experienced and skilled in face lift procedures to perform this procedure safely and still achieve a good result for the patient. Most importantly, the patient needs to have realistic expectations and understand that they are still at higher risk than a non-smoker for healing complications. If I feel that my patient doesn't accept this, or doesn't understand the risks of smoking, I will not operate. Also, if I feel I cannot safely give the patient what they want- I will not operate. As with all cosmetic surgery, communication between the plastic surgeon and patient is the key to a happy outcome.

Labels: facelift, mini facelift, plastic surgeon, san diego, smoking

Our San Diego Plastic Surgery office has performed hundreds of fractionated CO2 laser resurfacing treatments using the Lumenis Ultrapulse laser. Initially, the technology was called "Active FX" and allowed us to achieve dramatic skin tightening, wrinkle reduction and removal, and removal of sun damage- with a quick recovery of 7-10 days and minimal side effects. This has been an excellent adjunct to our practice, with about 75% of our facelift patients also undergoing an Active FX or Total FX treatment to achieve a "3-dimensional" improvement.

The company later introduced "Deep FX" which was an additional treatment head for the laser allowing a smaller spot size with deeper penetration. By combining Active and Deep FX, one achieves a "Total FX" skin resurfacing which allows resolution of deeper lines and scars as well as more superficial brown spots .

Total FX is our treatment of choice for darker skinned patients (Asian, Hispanic) with acne scars, as well as younger patients with moderate sun damage and lines.

Older skin is often best treated with an aggressive Active FX, or combination of Total and Active FX.

Labels: active fx, laser skin resurfacing, san diego, total fx