Non-Surgical Treatments Cannot Replace Facelift Surgery

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157 patients under the age of 50 who underwent their first face lift at the New York Center for Facial Plastic and Laser Surgery between January 1, 2003, and December 31, 2013 showed that prior to that facelift each patient spent on average a total of $7,000 on nonsurgical treatments. These included fillers, laser, radiofrequency and botox treatments. The patients reported that they appeared 4 years younger after their nonsurgical treatments, but appeared 8 years younger after their facelift. The take home lesson is that nonsurgical treatments are not a replacement for facelift surgery and that is even more true of patients in their 60s and 70s.

Despite that and correcting for the 2008-2009 recession between 2007 and 2015 the population increased by 6.3% while the number of facelifts per year increased by only 6.1%. The percentage of the population undergoing facelift surgery appears to be a relative constant.

How Long Does A Facelift Last?
Face and Neck Lift 1
Face and Neck Lift 2 Dr. Aaron Stone - Plastic Surgeon Los Angeles
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Dark Circles Under the Eyes

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Patients with dark circles under their eyes complain that they look tired. The condition is called periorbital hyperpigmentation. Environmental factors that make the condition worse include sunlight exposure, hayfever, lack of sleep, stress, alcohol overuse and smoking.
The condition is classified by appearance as:

• pigmented (brown color)-congenitally darker skin, nevus of Oti or Hori, dermal melanocytosis, side effect of eyedrops, inflammatory induced pigment increase associated with atopic or allergic dermatitis or eyelid rubbing associated with allergies
  
  increased pigmentation from inflammation
• vascular (blue, pink, purple color)-increased blood vessel density
  
  blue color and structural (tear trough) both treated by filler injection
• thin skin making the underlying muscle color visible
  
  thin lower eyelid skin shows muscle under it
• structural (shadows formed by the surface contours such as eyelid bags, eyelid swelling or tear trough visibility associated with aging)
  
  shadows from eyelid bags
• mixture of 2 to 4 of the above classes

structural shadow from malar bags and over pigmented brown lower eyelid skin that is more visible after bags are removed

Vampire Facelift is Really a Face Fill

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A google search on Vampire Facelift yielded 1,020,000 results. The term was first used by the press in a July 2010 ABC News report on the use of Selphyl for facelifting. Selphyl first became available in 2009 and involves taking a small sample of blood from the patient mixing it in a test tube to separate blood components, which takes about 20 minutes and then injecting some of the components (platelets) into the area to be filled. Your body then makes collagen to fill the depression or fold. The process takes about 3 weeks from the date of injection to become visible. Because the result was rejuvenating and the material came from one's own blood the term Vampire Facelift was employed. Although hyaluronate injectable fillers like Restylane had been around for 7 years at this point the injection of hyaluronate together with this platelet material began around this time.

Skin Necrosis with Dermal Fillers

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The skin necrosis after dermal filler injection is due to direct injection into an artery or compression of an artery by the filler preventing blood flow. This is the only reference I could find "The most serious side effect is localized tissue necrosis, which is induced by mechanical interruption of local vascularity, though it occurs very rarely (nine in 10,000 patients who underwent collagen implantation)". This was a review of collagen fillers done some years ago. When injected with proper technique the incidence should be zero. Certain areas like the area between the eyebrows are at higher risk because of the architectural layout of the blood vessels under the skin. The incidence of heart attack from injection of a skin filler should be close to zero.

The most import thing besides proper injection technique is that if you experience inappropriate pain after filler injection and/or see significant skin discoloration beyond a little bruising your doctor needs to go into emergency mode. That could involve application of nitropaste to the skin surface, application of warmth, injection of a filler dissovling agent, hyperbaric oxygen etc. All of these modalities will minimize the amount of skin necrosis.

With appropriate care and some luck the skin necrosis will be very superficial and heal without visible scarring as in these photos.

Addendum December 13, 2012:
A recent survey of British Association of Aesthetic Plastic Surgeons members found that 69 percent of surgeons reported seeing patients with complications from temporary fillers in the previous 12 months. 49 percent reported seeing patients with complications due to semi- or permanent fillers. More than half of the surgeons saw 1 to 3 patients with these problems in the previous 12 months. Some saw 4 to 6 patients with these complications. The majority of patients seen with semi- or permanent filler complications required corrective surgery or had an irreversible complication. These same surgeons felt the complications were due to incorrect administration by unqualified practitioners.

 Addendum May 28, 2015:
After reviewing information suggesting unintentional injection of soft tissue fillers into blood vessels in the face can result in rare, but serious side effects the FDA issued an alert to health care providers and consumers that unintentional injection into blood vessels can block those blood vessels and restrict blood supply to tissues. Sometimes this can result in embolization where the filler material has traveled to other parts of the body causing vision impairment, blindness, stroke and damage and/or death of the skin (necrosis) and underlying facial structures. 
Their recommendations for consumers were:

• Before deciding to have soft tissue filler injections, talk with your health care provider about appropriate treatment of injection sites and the risks associated with the procedure.
• Be aware that FDA reviewed and approved different products for use in certain areas of the face. The FDA may not have reviewed the use of certain soft tissue fillers for all locations in the body.
• Ask your health care provider about their training and experience injecting soft tissue fillers in the face.
• Read and discuss the patient labeling for the specific filler you are receiving. Your doctor can provide this information, or you can find it on the FDA’s website.
• Seek immediate medical attention if you develop symptoms such as unusual pain, vision changes, a white appearance of skin near the injection site, or any signs of a stroke (including sudden difficulty speaking, numbness or weakness in your face, arms, or legs, difficulty walking, face drooping, severe headache, dizziness, or confusion) during or shortly after the procedure.

Radiesse injectable dermal filler for nasolabial folds
Injectable Fillers - Collagen, Restylane et al
Aaron Stone MD - Plastic Surgeon Los Angeles
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Injectable Fillers - Collagen, Restylane et al

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The first injectable filler available in the United States was Zyderm I. It was approved by the FDA in 1981 for injection into skin folds and wrinkles related to the aging process or depressed skin scars. Zyderm II followed in 1983 and Zyplast in 1985. They were all basically collagen derived from cow hide. Each form was designed for injection at a different depth within the skin. The chemical composition of each differed slightly so they lasted for a variable number of months, usually 2 to 3 months. Aside from their temporary effect the other major drawback to their use was the need for skin testing. A small amount was injected under the skin and if the patient did not react to the material they could go ahead with a full treatment some weeks after the skin test. If the full treatment was given to someone who was sensitive/allergic severe allergic reactions could result including the loss of the skin over the injection site.

Lip Augmentation - How to make the lips fuller or bigger

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Lips express emotion, sensuality, and vitality.  As far back as 69 to 30BC Cleopatra used crushed beetles and ants along with red clay, henna, iodine and seaweed to create a red ink-like substance to apply to her lips. Nowadays we have lipstick to make the lips look more prominent.

In the commonly accepted youthful attractive female lips there is a distinct bow shape to the outline of the upper lip, prominent columns of skin are present between the nose and edge of the upper lip with a curving slope lip skin surface, in repose the lower few millimeters of the upper incisors are visible, the upper lip has a greater fullness centrally near the midline of the body and near the outer corners which turn up slightly while the lower lip has more fullness just to either side of the midline.