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About Face: Your Cosmetic Facial Questions Answered

Online Health Chat with James E. Zins, MD

May 6, 2014

Description

Whatever your reason for considering a facial cosmetic procedure, there is a wide variety of techniques that can help you improve your appearance.

Some techniques are minimally invasive, and are accomplished through non-surgical facial rejuvenation (such as Botox® [botulinum toxin] or other injectable fillers). However, some of these techniques do not produce long-lasting results compared to other procedures. Cosmetic procedures include eyebrow and forehead lifts, eyelid surgery, cosmetic nose surgery, cosmetic ear surgery, face or lip lifts, facial implants and chin surgery—to name a few. Various surgical techniques can be used to accomplish a goal, such as a face and neck lift, and depend on a surgeon’s preference and patient’s goal. (These can include short-scar facelifts and other minimally invasive facelift techniques.) Patients need to understand what kind of results to expect, and the risks and benefits of surgery.

While some patients require minimal procedures to rejuvenate their appearance, others may need a safe and effective surgery to change their look. Your facial plastic surgeon can determine and recommend what is best for you. Cosmetic facial procedures can refresh your appearance and provide you with confidence.


About the Speaker

Dr. James E. Zins is Chairman of the Department of Plastic and Reconstructive Surgery at Cleveland Clinic, and specializes in facial cosmetic surgery including face lifts (rhytidectomy); neck, forehead and eyebrow lifts; eyelid surgery and cosmetic nose reshaping (rhinoplasty). His interests include Botox® and cosmetic injectable fillers, including human fat injections, Juvéderm®, Perlane®, Radiesse®, Restylane® and Sculptra®. He is board-certified in plastic surgery by the American Board of Plastic Surgery, and has been listed as a life member of the National Registry’s Who’s Who, in Best Doctors in the Midwest, and in Cleveland Magazine’s “Top Doctors.”

As a frequent lecturer at national and international meetings, Dr. Zins has served as the president of the Northeast Ohio Society of Plastic and Reconstructive Surgeons and the Ohio Valley Society of Plastic Surgeons. He also is a founding member of the American Society of Craniofacial Surgeons, a fellow of the American College of Surgeons and a board member of the American Association of Plastic Surgeons. Additionally, Dr. Zins is Professor of Surgery at the Cleveland Clinic Lerner College of Medicine and serves as an Oral Board senior examiner for the American Board of Plastic Surgery.

He serves on the editorial boards of several plastic surgery journals, including Associate Editor of the Aesthetic Section of the Annals of Plastic Surgery, Associate Editor of Aesthetic Plastic Surgery, and on the editorial board of the Aesthetic Surgery Journal. He has published more than 150 papers in peer-reviewed plastic surgery journals and more than 10 book chapters. He is an innovator of face lift alternatives.

Dr. Zins is board-certified by the American Board of Plastic Surgery. He completed his maxillofacial fellowship at the Hospital for Sick Children, in London. He also completed a craniofacial research fellowship following his residencies in plastic surgery and general surgery at the Hospital of the University of Pennsylvania, in Philadelphia. Dr. Zins graduated from medical school from the University of Pennsylvania School of Medicine, in Philadelphia.


Let’s Chat About Face: Your Cosmetic Facial Questions Answered

Moderator: Let's get started with our questions...


Moisturizers

Dixie1: Is there truly a difference in expensive facial moisturizers vs. drug store options?

James_Zins,_MD: Moisturizers are beneficial for dry skin. Most moisturizers also have the added benefit of an SPF 15 sunscreen. Generally the sunscreen is limited to SPF15 because most higher SPFs are white and therefore patients are unlikely to use them. Healthy skin once properly treated often requires little or no moisturizing. Packaging clearly affects the cost of the skin care products and is a major component in the price. Discussions with your plastic surgeon or dermatologist can often save you significant cost.


Moles and Other Skin Pigmentation

Gail Ann: As I'm aging I am finding changes to my facial skin. Moles are appearing along with isolated red marks and whiteheads. What can be done to remove and also halt the formation of these changes?

James_Zins,_MD: Brown spots and red spots can be treated with a variety of techniques from skin care done at home using prescription products from our plastic surgeons and dermatologists, to noninvasive and invasive laser treatments and light based treatments. Generally, we begin with home treatment. Once maximized, lasers or other non-invasive means are used to gain further improvement. White heads generally respond to Retin-A (tretinoin) or other exfoliates. If moles are raised, generally removal is required to eliminate them.


Botox® and Fillers

Agnes: Does it matter who you go to for Botox® (botulinum toxin) and other injectables, now that more and more practitioners and aestheticians are doing it? And if so, why?

James_Zins,_MD: I would strongly recommend that you get Botox® injections from a physician preferably a plastic surgeon, dermatologist or oculoplastic surgeon. They are most proficient with the anatomy, potential side effects and most probably have had significant experience. Of course the reputation of the physician in the community with regard to their Botox® and fillers is most important. While physicians who are not plastic surgeons, dermatologist or oculoplastic surgeons may be doing Botox® and fillers, you would generally be in better hands focusing on the former group. The plastic surgeon, dermatologist or oculoplastic surgeon is also most likely to have the most current information on the newest and best products.

jcary: I just turned 40 years old, and I have had some success with Radiesse® (calcium hydroxylapatite) cheek injections. (I had one syringe in April 2013 and another just in March 2014.) It has been a nice improvement for my crows' feet, under-eye dark circles and mild improvement with my “parentheses” lines. Would it be too much to also get Juvéderm® (cross-linked hyaluronic acid) for that area, seeing as I just had the Radiesse® last month? How long do the results last with Juvéderm®? Where does the filler go when it fades away, and is it harmful?

James_Zins,_MD: Radiesse® and Juvéderm® are both filler materials that offer similar results. Whether one is used over the other depends on the location to be treated. Juvéderm® could be used if there are residual areas that need filling. Juvéderm® lasts nine to 12 months. Another method which I use with Juvéderm® is to have the patient return four to five months after injection. If a touch up is warranted at that time, retreatment can prolong the results for one to one and a half years. As fillers lose their effect they are absorbed by the body with no harmful side effects.


Laser and Chemical Peels

jcary: I have a lot of sun exposure damage from my teens and 20s. I use Retin-A (tretinoin) .025% daily and am thinking about starting chemical peels. Is it true they can reverse sun damage? How often should one get a chemical peel? What type of peel do you recommend?

James_Zins,_MD: If you are using Retin-A daily, you are using a good skin care regimen. I would also add sunblock or sunscreen to your program daily to protect your skin. Chemical peels are like cars. There are all makes and models from superficial peels to intermediate depth peels to deeper peels. Superficial peels may be done at home and address the most superficial skin (the dermis). They offer the shortest period of correction. More extensive sun damage including brown spots and fine lines respond more effectively to intermediate depth or deeper peels. Superficial peels can be done on a regular basis (i.e. monthly). Deeper peels generally require a single treatment or an occasional re-treatment. The best type of peel for you would be dictated by an office examination.

laura628: I have had pre-cancer areas removed from my face and squamous cell removed from arms/leg. Would it be best if I stayed away from any type of skin tightening treatment?

James_Zins,_MD: I do not think skin tightening would be a problem. The fact that you have had some lesions removed suggest that you have had significant sun exposure. In fact, laser or chemical peeling would not be harmful. Such treatments may well offer potential benefits by removing sun damaged skin and possibly even reducing the likelihood of skin cancers.


Under Eye Treatment

atgb007: I am in my mid-30s and I have flat dark circles under my eyes. They are not from allergies, but rather from thin skin. I wanted to know more about laser options? What are the risks? Can this be done at Cleveland Clinic?

James_Zins,_MD: The first line of treatment is simple and can be done at home with Retin-A (tretinoin) and hydroquinone. These are prescription products, and with use over several months can be effective. The next line of treatment would be a variety of chemical peels that could be used, or fractionated CO2 lasering. Differentiating dark circles due to pigment (brown color) from vascular problems is essential and requires an examination.


Marionette Line Treatment

SofiaD: I am a healthy 52-year-old female. Marionette lines are present and gravity is winning. What is the best procedure to eliminate those lines? A non-surgical approach that is affordable and with no "down-time" would be perfect. Also, a procedure with the least amount of side effects would be great.

James_Zins,_MD: The ideal treatment for aging of the lower face is a lower facelift. Alternatively, non-surgical means including fillers, like Restylane® (hyaluronic acid) and Juvéderm® (cross-linked hyaluronic acid), can buy time and reduce the signs of aging. Other non-surgical skin tightening techniques also offer subtle benefits with less improvement than classic lower face lift. Again an examination would be essential to determine the best outcome. Please see our website for patient examples: www.clevelandclinic.org/renewyou.


Noninvasive Sagging Skin Treatment

SMDTS: What is the best non-surgical treatment for sagging facial skin?

James_Zins,_MD: True sagging skin or skin excess is best treated by surgery. Under certain circumstances non-surgical procedures can be beneficial including filler materials, such as Restylane® (hyaluronic acid), Juvéderm® (cross-linked hyaluronic acid), and Radiesse® (calcium hydroxylapatite). Noninvasive modalities (techniques) including ultrasound and radiofrequency offer partial (perhaps 30 percent) correction of what surgery will obtain.


Acne Scarring Treatment

ClevelandClinicAccount: I am a 50-year-old Caucasian woman who has some acne scarring on my face from when I had acne when I was younger. I have minimal sun damage on my skin, minimal sagging of my upper eyelids, herniated fat in my lower eyelids I think that's what it's called) and minor wrinkles. I would like to get rid of the scarring and improve my look by minimally invasive means. I do not want to use injectable products. What kinds of treatments might be good for me to consider? Additionally, when I make the appointment(s) to see a doctor(s) about this for the first time, what type of doctor should I seek out—a dermatologist, a dermatological surgeon, a plastic surgeon or a small team of doctors (e.g. a dermatologist and a plastic surgeon)?

James_Zins,_MD: Acne scarring can be improved by a number of techniques, including fillers, fractionated CO2 laser and chemical peels. Lower lid bags respond best to surgery (blepharoplasty). In some occasions, fillers can offer some improvement for the lower lid bags. Regarding the appropriate doctor, a plastic surgeon or plastic surgeon and dermatologist team at Cleveland Clinic would be best to address your concerns.


Neck Correction

Gorgeous: As I have aged I am getting sagging skin at my jaw line and upper neck especially under my chin. What measures can I take to decrease or slow the progression of sagging neck skin? What least invasive procedures do you recommend?

James_Zins,_MD: There is no method to reduce the aging process aside from avoiding sun exposure and maintaining an ideal body weight. The best answers to extra skin in the neck area is surgical correction. Short of surgery, there are noninvasive modalities (techniques) such as Ultherapy® (microfocused ultrasound) that offers some benefit well short of facelift surgery.

Moderator: For more information on Ultherapy® including what to expect, how it works and how to know if you're a candidate, visit our website at my.clevelandclinic.org/cosmetic-plastic-surgery/procedures/facial-resurfacing/ultherapy.aspx.


Eyebrow Lift

nharward: Does an eyebrow lift still require scalping at the hairline and pulling the face up, or are there some minimal invasive options now?

James_Zins,_MD: No. Non-invasive or endoscopic eye brow lift can now be done, which significantly reduces the scar. Botox® (botulinum toxin) can be used as a chemical brow lift to gain subtle brow elevation.

Moderator: Learn more about eyebrow lifts and see before and after images on our website at www.clevelandclinic.org/eyebrowlift.

Tom467: What is the recovery time for an eyebrow lift? Can this be combined with a mid facelift? If so, is the recovery time longer?

James_Zins,_MD: Eyebrow lift may be combined with any other facial cosmetic surgery. Recovery time is one to two weeks. When combining procedures generally this does lead to a slightly longer recovery.


Facelifts

Alberta: Which is the preferred longest-lasting cosmetic facelift with the least side effects? How do these results compare with a surgical facelift?

James_Zins,_MD: Facelift surgery can range from a mini-facelift performed under local anesthesia to more traditional facelifts that address cheeks, folds from the nose to the corner of the mouth, and the neck. The degree or extensiveness of the procedure is generally dictated by the degree of facial aging. Mini-facelifts are most effective for younger patients. On the other hand, the surgery certainly can be dictated by the concerns and desires of the patient that include limiting the cost and recovery.

Moderator: To see before and after photos of face lift patients, visit our website at www.clevelandclinic.org/facelift.

Harbortucket: How complicated is a face lift, recovery time and cost?

James_Zins,_MD: Facelift surgery can vary significantly in its level of invasiveness. Mini-facelifts under local anesthesia can address early to moderate facial aging. More significant or extensive facial aging, skin sagging and wrinkles may require a more involved procedure. Additionally wrinkles around the mouth can be addressed at the same time as facelifts. In general the neck is routinely corrected at the time of facelift surgery. Recovery time varies. The average recovery is one to two weeks. The cost depends on how involved the procedure is. You can call and speak to our financial representative at 216.444.4646.


Quick Lift™ and Other Televised Procedures

yless1: I see the television ads for a procedure called a "Quick Lift™". Is this a recognized procedure, and how does this differ from the standard technique?

James_Zins,_MD: There are a variety of commercialized companies offering facelifts and other aesthetic surgery. There is absolutely nothing magic about their specific procedures. Some advocate surgery under pure local anesthesia to reduce cost. Our board certified plastic surgeons perform a wide variety of minimally invasive and standard facelift procedures. We tailor the procedure to the patient’s desires and physical findings. This includes surgery under local anesthesia in a hospital-based outpatient area offering optimum safety and facilities. The cost differential is nominal, and the quality of the plastic surgeon assured.


Cosmetic Practitioners

ClevelandClinicAccount: Will you explain the different kinds of cosmetic practitioner doctors? Why I might choose one over the other (e.g. plastic surgeons, dermatologists, dermatologic surgeons, oculoplastic surgeons and others)?

James_Zins,_MD: The type of cosmetic surgeon/dermatologist would depend upon your area of concern and the need for surgery. A plastic surgeon would be a very good start in evaluating your cosmetic concerns. Most important is the reputation of the physician or surgeon, and his or her breadth of experience. You should interview the doctor asking specific questions about his or her major interest and the number of procedures he or she performs in the area of your concern. You should feel comfortable in his or her confidence. You also should ask to see before and after photographs of patients he or she has operated on. All surgeons have specific areas that they are particularly good at treating. Oculoplastic surgeons generally limit their surgery to the eye and eyelids. Dermatologists generally address noninvasive techniques and lasers. Plastic surgeons treat all of these areas.


Closing

Moderator: I am sorry to say that our time with Dr. James Zins is now over. Thank you for sharing your expertise and time to answer questions today.

James_Zins,_MD: Thank you.


For Appointments

To make an appointment with Dr. Zins or any of the other Cleveland Clinic cosmetic plastic surgery specialists, please call 216.444.6900 or call toll-free at 800.223.2273, ext. 46900. You can also visit us online at clevelandclinic.org/renewyou.

For More Information

On Plastic Surgery

For more information about all cosmetic procedures, to schedule a consultation with one of our specialists and more, visit Cleveland Clinic Cosmetic & Plastic Surgery Center online at www.clevelandclinic.org/renewyou. A full listing of Cleveland Clinic specialists, locations and before and after images can also be viewed on the site.

If you're interested in a consultation but not ready to come into the office, we offer an online consultation option. You can submit pictures of the body part you have questions about, and our expert plastic surgeons will review and provide their consult through our secure online system.

On Cleveland Clinic

Cleveland Clinic’s Department of Plastic Surgery Cosmetic and Plastic Surgery Center provides expertise for both surgical and non-surgical cosmetic procedures ranging from body contouring to breast procedures to Botox® injections. The Center offers patients access to a range of cosmetic specialists including plastic surgeons, dermatologists, oculoplastic surgeons, head and neck surgeons, and aestheticians. Additionally, our surgeons are dedicated to improving patient outcomes through innovative cosmetic surgery advances including minimally invasive facelift techniques, alternatives to face and necklift surgery, short-scar facelifts, and Smartlipo technology™.