1. Q: I’m interested in a non-surgical facelift; what should I look for when checking out doctors?
A: First, you should look for a physician who isn’t just board certified in a particular field, but who specializes in cosmetic procedures. Dermatologists have been the lead developers and innovators of non-surgical cosmetic procedures for nearly two decades.
For a reference, you might check with your family doctor or contact the local medical society. Be wary of physicians whose main focus of practice is non-cosmetic. Unfortunately, there are many health care providers out there who have taken weekend courses in order to supplement their practice income with cosmetic procedures. Keep in mind that, no matter what the price, you wouldn’t want your plumber to be an electrician who has taken a two-day crash course in plumbing.
Next, you should find out whether your doctor has experience with a broad range of fillers, volumizers, and Botox, since a non-surgical facelift often requires a variety of these products, used in combination in skillful ways, to achieve the desired effect.
Ask to see your doctor’s own before and after photos. Don’t rely on standard, industry-supplied pictures. Thoroughly check out the doctor’s Web site and bio. Ask for references — i.e., patients the doctor has treated who would be willing to discuss their procedure with you.
2. Q: Is a physician the only one who can perform Botox injections?
A: No, unfortunately, a physician isn’t the only one who can administer Botox. They should be, however. Physicians, particularly dermatologists, have spent years learning the structure of the skin, the anatomy of the face and neck and the location of the muscles and the delicate nerves and blood vessels below.
I’ve been using Botox for cosmetic purposes since 1991 and was one of the first to do so in all of the U.S. I can tell you from firsthand experience that it takes time and concentrated effort to master the learning curve for administering this product, especially in areas such as the lower face, neck and chest. The allure of "Botox parties" is there, but the risk of complications from inappropriate placement or administration in incorrect potencies and amounts is greater in non-physician hands.
3. Q: I’m thinking about having lip enhancement, but I don’t want to look as though I’ve had "my lips done"; what can a doctor do to make results look subtle?
A: Daffy Duck-like lips or lips like Goldie Hawn had in the movie the First Wives Club after having collagen injections are extremely uncommon in experienced hands. After carefully understanding what the patient wants — whether it’s more of a pout, an accentuated Cupid’s bow or simply fuller, more youthful lips — an experienced doctor can select an appropriate product for the job and determine the precise areas of placement to give you the desired effect without leaving you looking "done."
4. Q: I broke my nose a few years ago and it just looks misshapen; am I a good candidate for non-surgical rhinoplasty or is surgery the best option for me?
A: The answer depends upon a few factors that aren’t clear from your question. If you have breathing problems or congestion or are looking for a permanent fix and don’t mind the cutting, postoperative pain and protracted downtime of a traditional surgical rhinoplasty, then surgery would be your best option.
However, if you simply have a surface deformity, such as a bent nose or hills and valleys along the top of your nose and don’t wish the hassle and expense of surgery, a non-surgical nose job would be just what the doctor ordered.
5. Q: I’m in my 60’s and seriously considering having a traditional brow lift, but after reading your article, perhaps non-surgical is the way to go. Am I better off having a "chemical brow lift" using Botox or, at my age, is surgery best?
A: If you are healthy and fit, surgery remains an option. If you don’t want surgery or for medical reasons are unable to undergo surgery, a chemical brow lift using Botox and perhaps supplemented by a volumizer, such as Restylane, is an ideal, quick fix, no-downtime way of achieving a satisfactory brow lift.
6. Q: After giving birth to my second child, I would like to have a "mommy makeover" with a breast lift, some liposuction and tummy tuck. Should I look into non-surgical procedures? Can a non-surgical procedure provide me with comparable results?
A: If dramatic results are what you’re looking for, surgery would be best. I would suggest, however, that if you’re considering traditional, aggressive surgical approaches to these problems, that you first commit yourself to a proper diet and exercise plan to get yourself to your most ideal weight and fitness level. None of these procedures is a substitute for a healthy lifestyle and people who rely on them for that are putting themselves at high risk for dissatisfaction and disappointment.
If you’re looking for something just to give yourself a "mommy makeover" lift, you might benefit from non-surgical breastlifting and a variety of non-surgical approaches to reducing cellulite and stretch marks. While for the latter problems it takes time to see results, there is little downtime.
7. Q: Can you tell me more about Thermage to tighten facial skin? Is this an effective non-surgical procedure?
A: Thermage is a device for delivering radiowaves to the deeper levels of the skin. The theory is that heat generated within the collagen layers below the skin surface by this process leads to collagen shrinkage and new collagen production and hence tightening of the overlying skin.
The initial excitement surrounding this technology was dampened by reports of highly variable results, pain and adverse reactions. Many patients coming to me after having undergone the process elsewhere have been dissatisfied and report only subtle benefits at best after spending thousands of dollars and undergoing repeated procedures.
More recently, we have been able to achieve remarkable results for softening jowls and eliminating all forms of crinkles, such as those around and under the eyes, quickly and efficiently with Botox, fillers and volumizers and microneedling.
8. Q: Botox is such a popular wrinkle-reducer, but is it possible to be allergic to Botox? And are there any drug interactions?
A: Yes, it’s possible to be allergic to Botox, but this is extremely rare. Given the multimillions of people treated worldwide with Botox for cosmetic reasons, excessive sweating problems and all sorts of neurological and muscular problems, the incidence of allergic reactions has proven so low that no prior allergy testing is deemed necessary for initiating therapy. I wouldn’t be far off by saying that Botox has a track record overall of being safer in routine use than plain aspirin.
9. Q: With a non-surgical facelift, how many years younger can I expect to look?
A: Although I have had quite a few patients who by their own account say they look 15 to 20 years younger, most people can expect to look between five and 10 years younger immediately after stepping off the treatment table. In fact, what I love most about today’s non-surgical techniques is that "Wow!" factor when the patient sees the result in the mirror right next to me after just five or 10 minutes of work.
10. Q: What kinds of risks are associated with non-surgical procedures in general?
A: The main risks of non-surgical procedures are some bruising, swelling, tenderness and redness that may last for a couple of days. These can be covered with makeup immediately, since all the work is done below the surface and there are no significant surface wounds. Even the prick marks from the injections seal quickly (just as they do after a blood drawing needle is withdrawn). Infection is always a possibility when the skin is punctured in any way, but this, too, is very uncommon.
Check out Dr. Novick’s non-surgical series:
Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Facelifts (Part 1)
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 & Breastlifting (Part 6)
Chatting About Non-Surgical Hand Rejuvenation (Part 7)
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To learn more about cosmetic dermatologist Nelson Lee Novick, M.D., F.A.A.C.S., F.A.A.D., please visit his bio.