The Myth of the Nonsurgical Facelift
On semantics, wishful thinking, and the allure of Morpheus8
For decades, the beauty industry has been trying to convince us that noninvasive tools can lift and tighten saggy skin to near-surgical effect—and despite the blatant lack of unbiased evidence, we still find ourselves holding out hope. We so want it to be true. With every new machine that hits the market—from the latest iteration of Thermage to the Kardashian-endorsed Sofwave to the muscle-toning EmFace—we think, Maybe this is it! Perhaps they’ve finally found a way!
Lately, certain doctors, exhausted by the barrage of baseless or overblown claims, have taken to whistleblowing, using their platforms to vent and debunk and expose.
When Philadelphia plastic surgeon Dr. Christian Subbio posted the above, hundreds of comments rolled in. The majority were practitioners bemoaning the futility of skin tightening devices (or “expensive coat racks,” as one nurse calls them). A few were defending a particular technology that they’ve supposedly seen improve lax skin—often their own, after 8 or 10 sessions. A couple were expressing optimism about a forthcoming machine that might work better than its myriad predecessors.
Curious laypeople chimed in too, mostly to inquire, “But what about [FaceTite, Ultherapy, Sofwave, Ellacor, Evoke, Renuvion, Profound]?” Surely, there has to be an exception!
Holding. Out. Hope.
I get it. I was not blessed with superhuman J. Lo genes. I know what lies ahead. I’m already starting to see it—the jawline’s subtle undulations, the neck’s slow descent. It bums me out, frankly—and, yes, I have done little things to try to feel better about it all. (Does admitting this make me a victim of the patriarchy/a slave to oppressive beauty standards/a bad, bad feminist? Maybe. Personally, though, I think it makes me human.)
Because the changes that I’m seeing are fairly universal, lots of people get facelifts around my age. (Pay a virtual visit to some popular facelift purveyors and witness the 40-somethings parading in and out of their ORs.) Folks who don’t have the money, downtime, nerve, or desire to go under the knife will commonly investigate nonsurgical lifting solutions that seem less scary or more accessible.
And herein lies the problem. It’s threefold, really. Not only are device claims largely misleading (1), but the people considering them are often surgical candidates (2)—they have the classic symptoms that a facelift aims to address—and they’re viewing skin tightening procedures as viable substitutes for surgery (3), fully expecting to see a meaningful (even dramatic) change in their appearance following treatment.
And why wouldn’t they? Isn’t that what they’ve been sold? A nonsurgical facelift?
When I recently interviewed Dr. Mike Nayak, a facial plastic surgeon in St. Louis, he shared this insider tidbit about the latest device-hawking tactics:
“With these softer-promise devices that claim to slowly tighten over time if you do enough treatments, the [sales] reps will say, ‘We’re going to be putting a lot of marketing dollars behind this. It’s going to be in Oprah magazine. It’s going to be on The Doctors. The Kardashians are going to be showing themselves using this device.’ This is a very common thing now. They’re not even saying, ‘It’s an amazing device.’ They’re saying, ‘It’s an amazing way to get people in the door.’”
And they’re not wrong. Take the Morpheus8: The marketing blitz behind this radiofrequency (RF) microneedling device has propelled the machine to stardom. “My celebs and makeup artists are begging me to get it, and I’m like, I already have RF microneedling and I don’t even like it that much—I think it makes you slightly swollen for a couple of weeks, so everything looks plumper right after,” New York City dermatologist Dr. Dan Belkin tells me.
While Morpheus8 has almost transcended its category, it does have some worthy (albeit less buzzy) competitors of varying designs and intensities—Vivace, Genius, Secret, Profound, Virtue. Every doctor has their go-to. Interestingly, at last year’s meeting of The Aesthetic Society, during a discussion on RF needling, it was the Genius that emerged as the overwhelming favorite among the plastic surgeons on the panel.
“In talking with colleagues [about Morpheus8],” Dr. Belkin goes on to say, “no one has seen results that they’re overly impressed with. But for a while, I was like, What am I missing? Maybe there is something magical.”
Even doctors are prone to wishful thinking.
Other physicians have shared similar anecdotes. The most honest among them will insist that Morpheus8 does not lift or tighten—rather, it shines as a texture tool, a means of airbrushing large pores and acne scars. Still, social media has seemingly brainwashed the masses into believing it’s “a panacea—a treatment for everything,” Dr. Belkin says.
Grasping for a bottom line, I keep coming back to this: words matter. The language of aesthetics—the way the industry (pharma, doctors, media) talks about procedures—is ambiguous and open to interpretation. What a sales rep or aesthetician or fledgling beauty editor perceives as a lifting or tightening effect—a millimeter of movement, a subtle shifting of skin—may not resonate with the 50-year-old who just dropped $3,000 for a result she has to squint to appreciate.
(Notice I’m not outright declaring that these machines don’t work. I’m sure they all do something, but the results they yield may not have you turning cartwheels.)
I’m harping on devices, but filler companies and injectors are guilty of the same sort of double-talk. Exhibit A: “the liquid facelift.” (Editors: Please join me in adding this phrase to your banned-terms list.)
Can fillers lift? is a perennial topic of debate in cosmetic medicine. Usually, in my experience, even when a doctor is arguing that a teaspoon of jelly can, in fact, lift the heavy, tethered tissues of the human face, they’re repeatedly qualifying and couching. Putting quotation marks around the word “lift.” Or hedging: It’s more an appearance of lift. Or clarifying: not an actual lift, but a “displacement” of tissue.
When the average patient asks a medical professional to boost their fallen face, and the medical professional assures said patient that they can, indeed, lift their nasolabial folds and jowls by injecting their cheeks with a hyaluronic acid filler that has the highest G prime, and, therefore, unparalleled lifting power—that patient is going to expect the shot to LIFT THEIR FACE. To literally raise it, at least in part, from a lower position to a higher one. Plain and simple. No air quotes or subtext.
After 20 years of reporting on this stuff, I’ve come to accept the fact that nothing short of a scalpel will hoist my face to a truly perceptible degree—enough to make me happy. (You may feel differently, of course, and that’s okay.) I may still get the occasional Sculptra injection or Sofwave treatment, but my only expectation is that they thicken or firm my skin slightly, perhaps slowing the rate of sag.
Please take to the comments with the treatments you deem to be worth it. I’d especially love to hear from the doctors/PAs/nurses in the house, whose understanding of rheology, physics, and anatomy far surpasses mine.
Lastly, if you would, help me explore the efficacy of this novel noninvasive measure: Tap the heart below for an instant reduction in frown lines (mine, if not yours). xx
What you wrote is all true. The former hope of "miracle in a bottle" now extends to "miracle in a device". There is no miracle, only tissue repositioning, done via incision. Fillers can reshape and plump areas; neuromodulators can soften or remove expression lines (temporarily); relocated, injected fat can plump for a very long time; lasers can depigment, retexture, and cause thickening of the skin. But once gravity has taken noticeable hold on the underlying structures, the only fix is a surgical intervention. And if one thinks about it in financial terms, that surgery is often less expensive in the long run. A few thousand this year on treatments, a few thousand in injectables next year: Suddenly you've already spent what a facelift costs.
Many providers (myself not included) hear the aggravated voice of those aging patients who, for whatever reason, do not want surgery, and believe it is their moral duty to offer anything whatsoever to lift their spirits, if not their skin. They justify their lack of transparency by the belief that as long as the patient feels better, they can be convinced that they look better. This works well if the provider is a salesperson and the patient is feeling despair. I personally do not operate this way and always try to highlight the shortcomings of whatever it is we are about to do.
What is needed practically is an objective way to measure sagging, folds, wrinkles, hollowness and document this info in photos - a better visualization tool. The data will set you free.