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.
Thanks for sharing these insights, Dr. Williams! I'm sure your patients appreciate your transparency re: shortcomings (how else can they set realistic expectations?). I understand what you're saying about certain patients being desperate for a nonsurgical fix, but I have a hard time aligning a provider's moral duty with their lack of transparency--even if they are going for some sort of feel-good placebo effect. Yes to more (any!) real data. Reliable measurement tools and unbiased researchers would certainly help in validating these devices and outcomes. xx
100% agree! the only reason to belive in those devices is that they promise lift… and they actually “lift” the amount of money the patients spend in the clinics for nothing! How those doctors deal with patients that waisted fortune without the results expected?
Right? I’d imagine anyone promising considerable lift/tightening from these machines must be managing their fair share of disappointed patients. What a headache!
Agree so wholeheartedly - and as a fellow beauty writer, I do everything to write without the use of quotation marks and contradictions like “deep within the skin’s surface” and instead propose honest things (like Sculptra, of which I am a huge fan) that keep the sagging at bay until we decide to cut ...or begin living life like the incredible Diane Keaton with her turtlenecks and IDGAF attitude!
Christine! Yes! I would love to not GAF, but alas, I do, lol. To your earlier point, the words lift and tighten are so casually thrown around by writers aiming to describe treatment effects that they don't fully understand. The terms have lost all meaning at this point, because pretty much every product/procedure out there is claiming to lift and tighten (and those PR bullet points tend to find their way into beauty copy). I feel like doctors (the best ones) are starting to be more mindful of this, tho, more careful about the words they choose when talking to patients (and media)--and that's something to celebrate.
This piece really spoke to me. I am 55 and have also "done it all" to keep aging at bay. I've been pretty successful at it, too! But, man, menopause sped up the aging process and I do now need something more than the non-invasive treatments can provide.
I did a ton of research (of course) and chose Dr Chance as my surgeon. She is as lovely a human being as you could imagine and spent a ton of time with me. Because of all of the non-invasive treatments I have done, many heat-based, she said that the surgical process would be more complicated and the healing process less predictable. I would have a longer healing time, with more swelling -- and it would be hard to predict just how much longer it would take until I was in the midst of it.
Knowing that, I simply cannot commit to a facelift. I just can't take months off from work and I probably won't retire for another 10 years or so. So that leaves me with 10 more years to try to keep aging at bay doing the very things that make the eventual FL more difficult! Oh joy.
Dr Chance did say that RF microneedling was ok to do as long as the depth was under 2mm so there's that! ; ). I am also a big fan of chemical peels, which no one seems to want to talk about anymore, but they are effective! And the downtime is predictable.
Hi Amy! Thanks for your thoughtful comment. I feel all of this. And I admire your choice of surgeon :) Dr. Chance is lovely and honest and very talented. She's someone who talks a lot about the potential consequences of nonsurgical treatments and I love that she's raising awareness. I understand your hesitation to commit to surgery, given the unknowns. But, yes, that presents a predicament, doesn't it? I've heard the same about the depth of treatment. It's for this reason that many surgeons approve of Sofwave, which operates at a fixed depth of 1.5mm. Maybe that's worth investigating? It won't give you a facelift, of course, but maybe a slight boost? I'm a big peel fan, too. For me and my melasma, they're safer/more predictable than lasers. Thanks again for sharing your story and good luck! xx
Interesting that you mention Sofwave, Jolene. From what you've learned from providers and patients, is this device more favorably reviewed than the "intense" RF micro devices like Profound and Morpheus? I *think* I recall reading that you use Sofwave yourself so maybe you have a personal opinion on this too ; ). Thank you!
I think many view Sofwave as more predictable and less apt to go awry. Morpheus and Profound both have the potential to go deep--deep enough to affect fat and SMAS. If you're looking for skin improvements, then you want to stay in the skin/dermis (that 1.5-2mm depth). Profound is an interesting one. If used appropriately, I think Profound can offer a bigger improvement than something like Sofwave, but it also has the potential to do more damage. (Maybe "damage" isn't the right word. It can impact the deeper tissues to a greater degree, which can give more of a visible "tightening" effect, but it can also alter the anatomy in ways that make surgery more challenging. Gosh, this is complicated, isn't it?) I've done Sofwave twice (full disclosure: both treatments were comped). I wasn't blown away; the effect was subtle. But I'd do it again, because I trust the tech and I like the idea that's it's stimulating collagen production in the dermis, without potentially melting fat, and helping to firm things up a bit. I'd say it's worth a shot. But if you're looking for a bigger payoff, and you're no longer considering a facelift, Profound may be a better option. Do you live in Charlottesville? Maybe Dr. Chance can recommend a good provider for Profound? Do you follow Dr. Ben Talei in Bev Hills? He's a Profound proponent and talks about it frequently.
This is really helpful. Are you saying that some believe Morpheus and profound go deeper than 2mm *even when the are programmed to go only to that depth *? That's concerning. I always put sofwav in the same camp as ultherapy (which I've done once), but which so many providers have a problem with. Maybe I should look at it again.
Dr Chance did in fact refer me to a Profound provider in my area who she recommends. I'm in Washington DC. Part of me just wants to say f*ck the FL altogether. I've already messed up my tissues (but look a good ten yrs younger than my age as a result!). Let me just continue down the non-invasive route and do the best that I can.
I'm in a couple FL groups on Facebook that are super educational. One is "Facelift info and support" - private group. I think the healing time for deep planes is longer than people commonly believe. My personality is such that I would be absolutely freaked out waiting for my face to heal, watching it shape shift, not knowing when it would go back. The group is full of stories like this.
I don't think these devices are going deeper than providers are programming them to go. From what I understand (based on recent interviews with surgeons), some providers are using overly aggressive settings to try to cheat a facelift (to get max tightening, essentially). So, like, Ultherapy has multiple settings and can go as deep as 4ish millimeters--a depth that may affect the layers that surgeons are addressing during facelifts. Sofwave is ultrasound, too, but can go no deeper than 1.5mm. The intensity is variable, though. Nothing is foolproof, of course, and the person performing the treatment will inevitably influence your results.
Thanks for the info on the FL support group. I'll check it out! xx
Thanks Jolene. I'm going to look into these options. I appreciate your candor. Also - an unrelated topic. You mentioned melasma and I think I recall that you wrote somewhere else that traxenamic acid taken orally is really helpful. Is that right?
Yes! I was taking oral TXA for a time, along with using Tri-Luma (an Rx bleaching cream). The combo really seemed to help. I'll probably go back on TXA during the summer when the UV and heat flare my melasma despite hats, sunscreen, etc. There is a risk of blood clots with oral TXA, so you'll want to talk to your doc about that, especially if you have a personal/family history of blood clots or you're on the pill or HRT.
At 47, I’ve had it all. Fillers everywhere, a series of 4 Morpheus8 treatments, Botox. The only one that showed me a result I was thrilled with is Botox. It does what they say. Otherwise, I’m finally at the point where I know only a face lift will provide what I really want to see. Thank you for this piece.
Hi Kelly! Thanks for your comment! I feel the same and find the older I get, the less I do. I have tried Sculptra, and saw a subtle improvement, but probably needed more vials/sessions than I got at the time. I may give it another go. How was your Morpheus experience?
I feel like my skin itself looks better, although my skin was not bad really anyway. (some redness and fine lines, as we all see with age, but no dramatic skin problems). I care for my skin and treat it well (now…can’t say the same for my earlier years spent in the sun without reapplying sunscreen). I also found Morpheus to be pretty spicy, but the numbing and pro nox made it bearable. I don’t believe I’ll bother with the upkeep of it though. just over here saving my pennies thinking of the facelift maybe I’ll get one day (hopefully by Dr. Chance as she is local to me!) 🖤
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.
Agree with every word! Thanks for reading!
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.
Thanks for sharing these insights, Dr. Williams! I'm sure your patients appreciate your transparency re: shortcomings (how else can they set realistic expectations?). I understand what you're saying about certain patients being desperate for a nonsurgical fix, but I have a hard time aligning a provider's moral duty with their lack of transparency--even if they are going for some sort of feel-good placebo effect. Yes to more (any!) real data. Reliable measurement tools and unbiased researchers would certainly help in validating these devices and outcomes. xx
100% agree! the only reason to belive in those devices is that they promise lift… and they actually “lift” the amount of money the patients spend in the clinics for nothing! How those doctors deal with patients that waisted fortune without the results expected?
Right? I’d imagine anyone promising considerable lift/tightening from these machines must be managing their fair share of disappointed patients. What a headache!
Agree so wholeheartedly - and as a fellow beauty writer, I do everything to write without the use of quotation marks and contradictions like “deep within the skin’s surface” and instead propose honest things (like Sculptra, of which I am a huge fan) that keep the sagging at bay until we decide to cut ...or begin living life like the incredible Diane Keaton with her turtlenecks and IDGAF attitude!
Christine! Yes! I would love to not GAF, but alas, I do, lol. To your earlier point, the words lift and tighten are so casually thrown around by writers aiming to describe treatment effects that they don't fully understand. The terms have lost all meaning at this point, because pretty much every product/procedure out there is claiming to lift and tighten (and those PR bullet points tend to find their way into beauty copy). I feel like doctors (the best ones) are starting to be more mindful of this, tho, more careful about the words they choose when talking to patients (and media)--and that's something to celebrate.
I GAF right there with you ❤️
This piece really spoke to me. I am 55 and have also "done it all" to keep aging at bay. I've been pretty successful at it, too! But, man, menopause sped up the aging process and I do now need something more than the non-invasive treatments can provide.
I did a ton of research (of course) and chose Dr Chance as my surgeon. She is as lovely a human being as you could imagine and spent a ton of time with me. Because of all of the non-invasive treatments I have done, many heat-based, she said that the surgical process would be more complicated and the healing process less predictable. I would have a longer healing time, with more swelling -- and it would be hard to predict just how much longer it would take until I was in the midst of it.
Knowing that, I simply cannot commit to a facelift. I just can't take months off from work and I probably won't retire for another 10 years or so. So that leaves me with 10 more years to try to keep aging at bay doing the very things that make the eventual FL more difficult! Oh joy.
Dr Chance did say that RF microneedling was ok to do as long as the depth was under 2mm so there's that! ; ). I am also a big fan of chemical peels, which no one seems to want to talk about anymore, but they are effective! And the downtime is predictable.
Hi Amy! Thanks for your thoughtful comment. I feel all of this. And I admire your choice of surgeon :) Dr. Chance is lovely and honest and very talented. She's someone who talks a lot about the potential consequences of nonsurgical treatments and I love that she's raising awareness. I understand your hesitation to commit to surgery, given the unknowns. But, yes, that presents a predicament, doesn't it? I've heard the same about the depth of treatment. It's for this reason that many surgeons approve of Sofwave, which operates at a fixed depth of 1.5mm. Maybe that's worth investigating? It won't give you a facelift, of course, but maybe a slight boost? I'm a big peel fan, too. For me and my melasma, they're safer/more predictable than lasers. Thanks again for sharing your story and good luck! xx
Interesting that you mention Sofwave, Jolene. From what you've learned from providers and patients, is this device more favorably reviewed than the "intense" RF micro devices like Profound and Morpheus? I *think* I recall reading that you use Sofwave yourself so maybe you have a personal opinion on this too ; ). Thank you!
I think many view Sofwave as more predictable and less apt to go awry. Morpheus and Profound both have the potential to go deep--deep enough to affect fat and SMAS. If you're looking for skin improvements, then you want to stay in the skin/dermis (that 1.5-2mm depth). Profound is an interesting one. If used appropriately, I think Profound can offer a bigger improvement than something like Sofwave, but it also has the potential to do more damage. (Maybe "damage" isn't the right word. It can impact the deeper tissues to a greater degree, which can give more of a visible "tightening" effect, but it can also alter the anatomy in ways that make surgery more challenging. Gosh, this is complicated, isn't it?) I've done Sofwave twice (full disclosure: both treatments were comped). I wasn't blown away; the effect was subtle. But I'd do it again, because I trust the tech and I like the idea that's it's stimulating collagen production in the dermis, without potentially melting fat, and helping to firm things up a bit. I'd say it's worth a shot. But if you're looking for a bigger payoff, and you're no longer considering a facelift, Profound may be a better option. Do you live in Charlottesville? Maybe Dr. Chance can recommend a good provider for Profound? Do you follow Dr. Ben Talei in Bev Hills? He's a Profound proponent and talks about it frequently.
PS. Yes I do follow Ben Talei! That's how I first heard of profound.
This is really helpful. Are you saying that some believe Morpheus and profound go deeper than 2mm *even when the are programmed to go only to that depth *? That's concerning. I always put sofwav in the same camp as ultherapy (which I've done once), but which so many providers have a problem with. Maybe I should look at it again.
Dr Chance did in fact refer me to a Profound provider in my area who she recommends. I'm in Washington DC. Part of me just wants to say f*ck the FL altogether. I've already messed up my tissues (but look a good ten yrs younger than my age as a result!). Let me just continue down the non-invasive route and do the best that I can.
I'm in a couple FL groups on Facebook that are super educational. One is "Facelift info and support" - private group. I think the healing time for deep planes is longer than people commonly believe. My personality is such that I would be absolutely freaked out waiting for my face to heal, watching it shape shift, not knowing when it would go back. The group is full of stories like this.
I don't think these devices are going deeper than providers are programming them to go. From what I understand (based on recent interviews with surgeons), some providers are using overly aggressive settings to try to cheat a facelift (to get max tightening, essentially). So, like, Ultherapy has multiple settings and can go as deep as 4ish millimeters--a depth that may affect the layers that surgeons are addressing during facelifts. Sofwave is ultrasound, too, but can go no deeper than 1.5mm. The intensity is variable, though. Nothing is foolproof, of course, and the person performing the treatment will inevitably influence your results.
Thanks for the info on the FL support group. I'll check it out! xx
Thanks Jolene. I'm going to look into these options. I appreciate your candor. Also - an unrelated topic. You mentioned melasma and I think I recall that you wrote somewhere else that traxenamic acid taken orally is really helpful. Is that right?
Yes! I was taking oral TXA for a time, along with using Tri-Luma (an Rx bleaching cream). The combo really seemed to help. I'll probably go back on TXA during the summer when the UV and heat flare my melasma despite hats, sunscreen, etc. There is a risk of blood clots with oral TXA, so you'll want to talk to your doc about that, especially if you have a personal/family history of blood clots or you're on the pill or HRT.
At 47, I’ve had it all. Fillers everywhere, a series of 4 Morpheus8 treatments, Botox. The only one that showed me a result I was thrilled with is Botox. It does what they say. Otherwise, I’m finally at the point where I know only a face lift will provide what I really want to see. Thank you for this piece.
Hi Kelly! Thanks for your comment! I feel the same and find the older I get, the less I do. I have tried Sculptra, and saw a subtle improvement, but probably needed more vials/sessions than I got at the time. I may give it another go. How was your Morpheus experience?
I feel like my skin itself looks better, although my skin was not bad really anyway. (some redness and fine lines, as we all see with age, but no dramatic skin problems). I care for my skin and treat it well (now…can’t say the same for my earlier years spent in the sun without reapplying sunscreen). I also found Morpheus to be pretty spicy, but the numbing and pro nox made it bearable. I don’t believe I’ll bother with the upkeep of it though. just over here saving my pennies thinking of the facelift maybe I’ll get one day (hopefully by Dr. Chance as she is local to me!) 🖤
Lucky you! She’s at the top of my list too. ❤️
Haven’t tried sculptra, though lol