Why Dr. Suzman's Facial Plastic Surgery Patients look so natural and improved

With so many treatment option for facial aging, patients and physicians alike have to sort between what will be most effective.  So many treatments are offered by a variety of aesthetic practitioners, with each having marginal overall effectiveness.  Rarely is a comprehensive treatment protocol managed by a single practitioner with the goal of optimizing an a outstanding facial rejuvenation. It is not uncommon for patients to have tried cosmetic creams from one source, a retinoid prescription from another and treatments such as IPL or frameless lasers or peels with another practice.  By the time this patient presents to the plastic surgeon for treatment,  they have felt they have exhausted other options, and looking for something more lasting and effective.

One limitation of our standard surgical approaches to face lifting surgery is that treatments have relied too much on simply on physics-  pulling, tightening and filling.   A second limitation is that too much may be expected for what we can achieve to reverse decades of aging in a single morning’s procedure.   Reversing signs of aging should be seen a a process, not a procedure.  Implementing treatments that leverage enhancements in skin and tissue  aging biology and chemistry, along with the physics of standard plastic surgery techniques is the hallmark of the Phase Lifting approach. 

In a series of three phases, plastic surgeons can map out an effective treatment protocol,  integrating the most current and optimal treatment methods.   In our practice we start patient analysis with the Chemistry-Biology-Physics  (CBP) approach to optimizing skin rejuvenation and health.

Chemistry refers to the biochemical and cellular systems at work in the aging process, mainly oxidative stress and collagen production.  Effective skin care and preparation for Phase 1.  We start in most cases with a Retin-A custom compound including hydroquinone, niacinamide and Zinc.  To reduce irritation, stimulate collagen and reduce oxidase stress we add RescueMD gel serum, our innovative skin care product with Lapachol, peptides, lipids, and anti oxidants.

Biology conceptually focuses on treatments of the important cellular to tissue components of aging, which stimulate repair and rejuvenation of the vital fat compartments, the dermal and extracellular matrix, the muscle and fascial layers.  The central treatments involve cellular stimulation with fat grafting and nano fat injection to the dermis and fine skin wrinkles. Micro needling is a common adjunct.  Others may employ fraxel treatments or other surface energy systems.  The skin can be further improved by energy tightening using a helium plasma energy based system  to tighten collagen and stimulate increased dermal repair and blood flow from underneath. We prefer the Renuvion system for its uniform energy transfer and effectiveness. The ever important role of macro fat grafting to the malar, pre jowl and other fat compartments is essential for the role fat plays in stimulating skin repair, rejuvenation and health.

Other essential parts of biological optimization are patient lifestyle habits.  Whatever we can do to support healthy sleep, nutrition, hydration, physical activity , mindfulness, and stress reduction work in concert with out surgical intervention to enhance outcomes as well and patient engagement in the process.

Physics involves the common mechanical ways of tightening, sculpting and filling:  deep lane face lifting,  liposuction of the under chin area, and targeted filling with hyaluronic fillers like Restylane and Juvederm. 

With the comprehensive treatment of aging from the biochemical to the physical level, we have increased the chances of an effective result that does not over rely on any one treatment.  Overtreatment of fill pulling, filling energy , or any modality is perhaps a leading source of  poor outcomes,  obvious results and patient dissatisfaction.

Now that we have defined the array of our preferred treatments,  we organize or protocal in phases to create the best chance of well-tolerated, natural, effective and long lasting outcomes.

Even the best facelift results over time have recurrences in laxity, platysma bands or other limitations.   By setting patient expectations to  a series of treatment phases, we can plot a more gradual course to success that reduces the surgeon's pressure to deliver perfection in one surgery.

Phaselifting for facial aging:

Phase I:  Skin preparation 

We start with Retin A  and Rescue MD  for 6 weeks to stimulate collagen and skin damage reversal.  We then do our Phase one procedure- Fat Grafting, Chemical Peel with TCA, Nano Fat micro needling and Renuvion helium palsma radiofrequency tightening.  This is done in our offioce surgical suite with  oral sedation ( alprazolam, tramadol, Pronox Tumesence) and can be coupled with some liposuction of the chin area or some skin tightening of the neck. 

Phase 2: For those who need it, we now focus on physics, with our deep lane facelift with SMAS elevation and plication. Typically done 6-18 months  after Phase one,  this surgery is done on the operating room.  Patients can have additional areas treated such as eyelid blepharoplasty or rhinoplasty when needed, and additional body liposuction as well.  Often less OR time and dissection is needed based on the effectiveness of the Phase one and pre flap  elevation

Phase 3:  Evaluation at 12- 24 months and office based additional fat grafting nano fat, repeat peel  or occasional laser resurfacing.  Now is the time to treat any residual areas of concern and maintain results for the long term.

By planning multiple smaller phases of care, the patient and surgeon together can achieve far safer and better results than a single multi hour procedure with a long recovery and higher risk profile.