Face lifts-Worth it?

As I favour a minimally invasive and indeed scarless approach to facial cosmetic enhancement, I now receive fewer enquiries about formal face lifting. What I have noted is that many face lift surgeons are promoting "less aggressive" face lifts. These are variously named the "Mini Lift", "S Lift",  "MACCS Lift", "Weekend Lift" etc. Despite claims of being less aggressive, the fact remains that there is still (at the very least) a significant scar created in front of the ear that is going to be there for ever. Give that a scar is inevitable whether the lift is aggressive or not,  I have had a look at the website and blog of a highly renown US facial plastic surgeon Dr. Joe Niamtu for some guidance.
I quote from his blog on the subject and link to it as below.
"I was recently asked by a major cosmetic publication to discuss my feelings on minimally invasive facelifts. Although I think they are a possible option for younger patients, I believe they are over used on patients that actually require a more comprehensive facelift and therefore lead to many unhappy patients that are left with a lesser result, all in an effort to attempt to shave a few days off of recovery. The following represents my thoughts on this issue".
http://niamtu.wordpress.com/category/minimally-invasive-cosmetic-facial-surgery/

Dr. Niamtu was a star guest speaker at our recent annual conference in Hobart and was very well received. There is not doubt that he he is a very honest and well regarded senior colleague. Essentially he takes the view that if you are going to perform a surgical face lift and create an incision, dissection and an inevitable a scar, then it must be done thoroughly and without compromise. He seems not to be a fan of mini face lift lift techniques.
Dr. Niamtu is very polite about it but he suggests that most of these less than comprehensive face lifts are sub-optimal and ultimately leave many patients unhappy.
These are also the observations I have made at my clinic. In many circumstances I feel that we achieve more pleasing outcomes with our neck liposculpture, fat transfer graft and non-scar suture lifts techniques than many of the so named surgical "mini-lifts" that I see from other clinics. The big advantage with our method is that there are no scars (just almost imperceptible mini-stab incisions). Nevertheless it remains that advanced cases of facial aging may require formal and comprehensive face lifting.
However if you have not had the opportunity to observe a surgical face lift and have been persuaded that it is not such a big deal, have a look at the following link. http://www.youtube.com/watch?v=gizZ_OyqwXg&feature=related

Non-Surgical Rhinoplasty

Some more news on minimally invasive nose reshaping. The following y-tube link demonstrates an American colleague's technique that is again similar to what I perform here at our clinic.
http://www.youtube.com/user/Rhinoplastynosejob
There are very few procedures that excite as much as an immediately new nose shape. An undulating nose looks long. Take out the peaks and valleys and the nose is shortened as the path is straight.

Deceptive "Before and After" photos.

Returning from a holiday break this week and reviewing patients treated before the break, I noted with satisfaction how much better patients look in real life after treatment than before and indeed far more than still photographs seem to indicate. The reality is that we should always try to standardise photos to reflect outcomes that may (or may not) indicate enhanced results.
With this in mind I have re-worked some concepts by an overseas colleague whose views on deceptive cosmetic surgery photography are very laudable.
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While it must be stated that the majority of doctors are not professional photographers, before and after photos should faithfully try and reproduce genuine outcomes.

Photographs of cosmetic surgery outcomes should naturally be as consistent as possible. They should be taken from the same angle and distance. Many photos that imply wonderful results are actually taken from different distances, making the "after" photo look smaller. Nothing important should be concealed and any surgical scars should be exposed. Beware of different before and after postures and positioning. For instance a post- treatment happy, broadly smiling face on an after-photo can falsely exaggerate pleasing cheek and eye enhancements compared to a downcast and  unhappy pre- treatment photo.

Examples of Deceptive Photography

In this ad, the "after" photo is MUCH smaller than the "before" photo, and this is quite deceptive. Ultrasonic liposuction is being advertised. While advantages are often claimed for exciting sounding technologies there are often disadvantages and risks that may surmount the the advantages.

The scar from the "tummy tuck" is covered up in the "after" photo by underwear. This is commonly seen in website ads about tummy tucks.

Patients considering procedures should view before and after photos with a critical eye for deceptive outcomes as these are very common in advertising despite efforts made by our college to outlaw this sort of activity. http://www.accs.org.au/pdf/accs_code.pdf

Non-Surgical "Nose Job"

We have encountered many patients over the years who have been despondent about the unsatisfactory outcomes of their invasive cosmetic nasal surgery (Cosmetic Rhinoplasty).
In fact I have formed the view that invasive rhinoplasty surgery should be reserved for defects that are not treatable with minimally invasive methods, as the risk/side effect profile of surgical rhinoplasty is significant enough to warrant caution. According to the literature, the complication rate varies from 4-18.8% and that correlates with my own impression
http://emedicine.medscape.com/article/843439-overview#showall

I have linked as below to a Y-Tube feature on non-surgical rhinoplasty that is called "Rinolook". From what I can observe this appears to be a trade marked system of nasal filler injections to fill between trough defects and the results are excellent.
http://www.youtube.com/watch?v=9k5r4F707GQ&feature=related

Trade marking medical procedures has become a bit of a trend and one that implies exclusivity.
However along with some other Australian colleagues I have been using various non-surgical methods  including fillers to correct nasal defects for some years now with many very pleasing outcomes.
Compared to invasive surgical rhinoplasty there are added benefits of reduced costs, relatively minimal risk and downtime.

Does Liposuction Get Rid of That Forever? More Like a Year, Study Suggests

Science Daily (May 29, 2011) has just reported a study suggesting that the return of fat after liposuction occurs after one year but is re-distributed elsewhere. The good news is that the new shape and contour of the treated area remains basically intact. So while the outcome of liposculpture surgery remains successful, the weight lost may recur. However it should be appreciated that the fat removed in a modestly overweight woman by an abdomen/flanks liposculpture is probably no more than 2 liters. This is the equivalent of only 2kg weight loss. Interestingly after liposculpture we observe that most women are motivated to maintain and stabilise their new weight loss advantage though fitness and sensible eating.
In essence liposculpture is an amazing way to re-contour troublesome areas but should not be seen as a procedure for a weight loss. http://www.sciencedaily.com/releases/2011/05/110509122730.htm

Wrinkle treatment by muscle relaxation injections.

We are not allowed to use the medical word that is the injected chemical  typically used for appearance improvement by relaxing muscles that generate frown and smile lines. One word would be a lot easier!
However one can say that every case demands a bespoke approach as we all express our faces a little differently. Additionally many patients are surprisingly asymmetrical. Subtle differences in injection technique are important to achieve an ideal result. It requires artistry and an appreciation of facial aesthetics. Anyone can inject but it is very common to see droopy brows, stiff expressionless faces and inappropriately weakened expressions when injections are performed by amateurs. Many injectors simply follow an injection pattern but not an individual patient's particular requirements. The following Y-tube educational video is very good and does demonstrate the issues of muscle balance in the face. http://www.youtube.com/watch?v=6XEK7AtomWY&feature=fvsr

Art of Liposculpture

I was very fortunate to embrace liposculpture in 2002 under the special tutelage in Paris by the renown liposculpture pioneer Dr. Pierre Fournier http://www.aaamed.org/files/12.pdf
One of my Sydney colleagues summarises well the history and genesis of Liposculpture in the following link.
http://www.s-lift.com.au/LIPOSCULPTURE.html
It should be appreciated that the art of  Liposculpture is literally dependent on sculpting the target fat deposits with various sizes of cannula instruments. In my opinion this fundamental concept in trained and experienced hands remains the gold standard for the attainment of pleasing outcomes. The art of Liposculpture cannot be copied or enhanced by the use of various heat technologies to melt or disrupt fat. Such technologies do not provide for true sculpting. Similarly a Michelangelo could not have carved his magnificent sculptures with a hot knife or blow torch! Despite all the hype and extravagant claims of skin tightening and alike by various manufacturers, the option of fat reduction using expensive laser, ultrasound and other  heat  technologies simply adds a layer of risk and expense without true benefit to the patient. An expensive machine does not necessarily improve the skills of the operator!
http://www.myshapelipo.com/2011/04/18/debate-on-laser-lipo-is-it-really-that-%E2%80%9Csmart-or-that-cool%E2%80%9D/
http://ezinearticles.com/?Are-There-Laser-Liposuction-Risks?&id=2608740
http://www.realself.com/review/smart-lipo-burns
http://www.beverlyhillslipolaser.com/risks.html