by team
Looking for non-surgical options to a facelift? We talked with Dr. Nelson Lee Novick about the pros and cons of traditional facelifts and how the advent of the newest form of facelifiting—the "liquid facelift"—is minimizing risk and making the obvious signs of a facelift obsolete.

SKN: For rejuvenating the face, what kinds of treatments and procedures were available in the past?

Dr. Novick: For more than two decades, bovine (calf-derived) collagen injections, Zyderm and Zyplast, were the only augmenting materials available in the U.S. for treating wrinkles and furrows. I was one of the first cosmetic dermatologists to use them when they were first introduced in 1983. From the outset, injectable collagen treatments were fraught with drawbacks.

For one thing, while adequate for treating fine wrinkles, they were often inadequate for dealing with deeper wrinkles and furrows, and they were certainly of little value for facial volumizing and contouring. Moreover, nearly 3 percent of people were allergic to the products, and two pre-treatment skin tests spaced a month apart were required before actual treatment could begin. The benefits lasted between three and six months only before retreatment was necessary. For severe wrinkles, jowls (or slack flesh, a wattle or the pendulous part of a double chin, associated with the cheeks, lower jaw or throat) and sagging, going under the cosmetic surgeon's knife, with all its risks and downsides, remained the only recourse.

SKN: Do you think traditional facelifts are a thing of the past that shouldn't be performed at all?

Dr. Novick: I'm not asserting that there's no place anymore for aggressive, surgical facelifting, technically known as "rhytidectomy" or "rhytidoplasty." For extreme cases of large jowls, excessively sagging and redundant skin (or too much skin) and deep furrows, the facelift remains an appropriate therapeutic option. But we now have the tools to parallel many of the benefits of facelifting without ever touching a scalpel to the face. We can even improve appearance in many ways that traditional surgery couldn't.

SKN: What kind of non-surgical technology has occurred in the last five years?

Dr. Novick: We've witnessed a literal explosion in the number of FDA-approved, injectable filling and volumizing agents in the U.S. - fillers for fine and moderate wrinkles and volumizers for correcting sunken areas, recontouring surface irregularities and restoring fullness to the skin. Along with Botox Cosmetic (not technically a filling agent, but certainly a premier injectable for improving all kinds of expression line, movement-related wrinkling), which received its FDA-approval in 2002, many non-collagen fillers and volumizers were introduced.

SKN: What kinds of fillers and volumizers?

Dr. Novick: These include hyaluronic acid products, such as Juvederm, Restylane, Hylaform, Captique and Elevess and volumizers, such as Radiesse and Sculptra. Unlike collagen, these substances, largely synthetically produced (with the exception of Hylaform which is derived from the cockscomb of roosters), didn't require any prior allergy testing. This meant a person could literally walk in off the street and be treated the same day. What's more, results lasted far longer, especially for the volumizers, whose benefits may persist between 12 to 24 months or even longer. For that reason, these substances are labeled as semi-permanent, rather than temporary filling materials.

SKN: Has the use of these non-surgical methods increased? What numbers are we looking at?

Dr. Novick: Between 2000 and 2005, the use of soft tissue filling agents and volumizers for non-surgical rejuvenation procedures increased by an astonishing 34 percent, and not surprisingly, the number of surgical facelifting procedures decreased by a whopping 20 percent during roughly the same time period. At this point, the liquid facelift had come of age.

SKN: Many of us can notice our aging faces in the mirror; what's actually happening on the inside when we age?

Dr. Novick: Many of the changes we see in facial aging result from the shrinkage of underlying dermal tissue, shifts in fat deposits and alterations in bone and cartilage. In short, the robust, heart-shaped fat pads that sat directly over our cheekbones and gave our face fullness when we were younger not only shrinks with time, but sinks downward and inward toward the nose, leaving the tell-tale signs of its descent in its wake.

When this happens, we find hollow-looking, darkened and crinkly or bulging lower lids, pronounced smile lines on the sides of our noses and drooping, "marionette" or "sad" lines at the corners of our mouths and surrounding the chin. The weight of this fall also accentuates the unsightly jowls along the jawline.

SKN: Many women still opt for traditional facelifting. Do facelifts fix the aging concerns you mentioned?

Dr. Novick: A traditional surgical facelift, by simply pulling taut the skin may soften the lines around the nose and mouth and lift the jowls, but it does nothing to address the underlying volume loss and displacement. In fact, we so often saw people appearing "skeletonized" by the operation. They were left with unnaturally tight-looking skin that was a sure sign of "Oh, she's had a facelift."

Of course it goes without saying that true, surgical facelifts are real surgery entailing the risks of general or intravenous anesthesia, significant post-operative pain, bruising and swelling, prolonged recuperation times (two weeks out of work and several months before all swelling finally goes away), scarring and a considerable financial outlay. Contrary to popular belief, the benefits of facelift surgery aren't permanent. The surgery may be repeated only once or twice in a lifetime.

SKN: So, we all know Botox is a great wrinkle-reducer, but what part does it play in a liquid facelift?

Dr. Novick: A few microdroplets of Botox is quite efficient for eliminating or softening the horizontal "worry" lines across the forehead, the crow's feet lines on the sides of the eyes, and the scowl (or "frown" ) lines between the eyes. It can also alleviate the crinkly "bunny" lines along the bridge of the nose and a "pebbly" chin.

SKN: What about fillers and volumizers?

Dr. Novick: Non-surgical facelifting, combining Botox Cosmetic with fillers and volumizers, goes to the heart of the underlying problems: dynamic wrinkles (wrinkles caused by the muscles of facial expression) and the replacement of lost or displaced volume. For deeper wrinkles, the effects of Botox may be supplemented with the use of fillers, like Restylane or Juvederm. This combination has been found to be particularly effective and the benefits of combination therapy last far longer than when each material is used alone. These same fillers can be injected to elevate the smile lines and the sad lines.

Jowls along the jawline can be softened with Radiesse by adding volume to the notched areas surrounding the jowl, eliminating the appearance of the jowl and contouring the jawline back to the smooth, straight line of youth. And finally, volume may be restored and recontoured over the cheekbones with Radiesse.

SKN: How does the procedure work exactly?

Dr. Novick: To minimize discomfort, the designated areas are "frozen" beforehand with a small amount of local anesthetic, usually lidocaine, a faster acting anesthetic than Novocaine traditionally used by dentists. Although I personally find it unnecessary, some doctors choose to employ a nerve block to anesthetize the larger branches of the nerves that supply the face, to supplement the local anesthetic.

Once the treatment area is numb, the volumizer or filler is injected and then molded like clay into place to correct the deformity or irregularity. The whole procedure usually takes only about thirty minutes to complete, and to the delight of the patient, in most cases, the results are immediate.

Afterward, you may experience some redness, mild swelling and tenderness, which may last one to three days. Occasionally, you may develop some bruising that can take several days to fade, but is easily covered with proper masking makeup.

SKN: We've included before and after photos to illustrate the amazing results. Please tell us more about what we're seeing.

Dr. Novick: The accompanying figure shows a before and after of a completely non-surgical liquid facelift in a 72-year-old woman. In the "after" photo, note the dramatic improvements in the jawline, absence of jowls, the fuller cheeks and the improvement in the wrinkles around the nose and mouth.

This shot was taken immediately following treatment and serves to emphasize that non-surgical facelifts, which are done entirely under local anesthesia, demand little or no downtime and cause minimal bruising, swelling or tenderness.

You may have noticed that the tip of her nose is upturned in the "after" photo. She also had a non-surgical "nose job" (the subject of an upcoming interview) done at the same time. This patient headed for a social luncheon directly afterward, proof that the day of the non-surgical facelift has definitely arrived.

Got a question for Dr. Novick? Send him an email here (! Your question might be featured in an upcoming article.

Many thanks to Dr. Nelson Lee Novick for speaking with about non-surgical facelifting procedures. For more interviews in this series, great information and upcoming interviews with other skincare industry experts like Dr. Novick, be sure to check back with often.


See also - The Non-Surgical Rejuvenation Series:

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Nose Jobs (Part 2)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Eye and Brow Lifts (Part 3)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Lip Enhancement (Part 4)

Talking Non-Surgical Neck Lifts (Part 5)

On Non-Surgical Chest Enhancement & Breast Lifting (Part 6)

Chatting About Non-Surgical Hand Rejuvenation (Part 7)


In addition to Dr. Novick's role as bestselling author, clinical professor of dermatology at The Mount Sinai School of Medicine in New York City and attending physician, he is also a fellow of the American Academy of Cosmetic Surgery (FAACS) and maintains a private practice in Cosmetic Dermatology and Cosmetic Dermasurgery on Manhattan's Upper East Side. He has been featured on many popular television and radio shows and lends his expertise to scores of major publications.

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