This content discusses the longevity and limitations of aging face surgeries, explaining that while procedures offer significant improvements, they cannot fully restore lost tissue layers or achieve perfect symmetry due to the complex and multifactorial nature of aging.
Mind Map
Cliquer pour agrandir
Cliquez pour explorer la carte mentale interactive complète
live hello everybody my name is Benjamin
tale and I hear I'm here working for uh
Esther Rodriguez and this is Marcos from
Mexico and today's lesson of the day is
you should drink tequila
and have Chick-fil-A so
lesson of the day today if anybody's
wondering was Wednesday it's hump day
and we tell everybody hump day means
that's the day I get home so it was it
was a rough one today my poor patients
have to wait a long time today
um they always look at me like why why
why and I just feel so terrible
um lesson of the day today oh hello in
Pakistan uh lesson of the day today is about
about
longevity of surgery because this was
something where I got a lot of questions
about it today question I have for
everybody though and you can answer as
we go along is what do I do with this
painting so I have this it's been
sitting in the office for a while it was
a gift Esther so we don't trash give sit
on sale but uh
I wonder what people will think if I
have this hanging so where shall I put this
this
um other thing if you guys haven't seen
yet we have a wall of visitors here
that's starting and everyone who's
visited is going to be up on this wall
so we have to like fill the rest of the
wall we have tons and tons of photos
um and that's that's uh oh somebody says
trash can bathroom okay there we go okay
all right in the bathroom lots of
bathrooms bathroom options okay well so
just so people know what my bathroom
looks like
little fancy guys this is a mosaic
um that's that's what the bathroom looks like
like so
so
we'll see if we can go over there so
um perfect so
now the question I got today a lot this
is Alex fancy
um was
how long was my surgery supposed to last
and this was from patients who had had
surgery by other uh surgeons and this
led into a lot of questions about why
they look so good initially and why
things went way quickly and all these
things so first off when you do aging
face surgery aging face surgery is like
brow lifts and eyelids and things where
you look older that's called the aging
face surgery most of them are likely
going to last about 10 years if it's
done properly so if you do like a really
really good surgery that should all last
about 10 years and then you age out of
it because you keep aging and it's not
that you've stayed perfect for 10 years
it's you get improved from here to here
and then it lasts about like this to
nine years 10 years eight years whatever
one year so uh it lasts about 10 years
before you do these surgeries again
most people look fantastic the first six
months after a facelift or upper eyelids
because they have extra volume in the
face and this blows out the shadows and
it's because all tissue layers are
hydrated so most people wonder why they
looked so good the first six months and
then things tend to kind of deflate and
go a little bit worse after and it's
because the face is healing the
lymphatics are impaired you can't drain
properly so your face just has more
fluid in it your immune system is more
active and you don't drain them as well
so the tissue layers get more cushioned
and you have less Shadows on the face
and people love that they love the way
it looks they love the way their lips
look their face looks their eyes everything
everything
now some of the heat treatments are like
that too like ulthera and those kind of
things they tighten you up and sip in
you for like six months then they go
away because your immune system is
active during that time healing the
injured areas and then it tends to calm
down and then you lose that effect
so I tell patients if you want to
maintain that effect there's no great
way to do it other than doing PRP micro
needling you could do micro needling
with PRP every uh three four months and
it'll stimulate the skin and hydrate it
the reason you can't fix it or get
anyone to a hundred percent and this was
the other question was Doctor can't we
do anything more about this doctor can't
we do anything more about this and
um it was a patient who had a pretty
impressive result when you look at it
before and after pretty massive but she
still has some shadowing in the face and
is wondering can anything else be done
and I I I said
um I'm not God I'm just a really good
surgeon like maybe you should talk to
God about that one but the answer wasn't
enough so I explained the Aging in the
face is multifactorial there are other
issues that go on in the face that you
can't fix with just a surgery so let's
say I'm doing a facelift
this area over here in the jowls and
pre-jowls if you look at my photos they
get huge changes but there's always some
residuals so I tell people when they say
is it going to be like this I say no no
it'll be like 80 you'll get like an 80
Improvement you're always going to have
about 20 remaining from all these other
factors and it is because there are so
many changes in the face in different
layers not only do we not know exactly
what to do with each layer but it's
impossible to rejuvenate those layers so
when we age
you don't just get fat loss it is very
simplistic to think your face is just
fat you don't just get collagen loss
it's very simplistic to think that your
soft tissues are just made of collagen
or your skin is you get lost in all
tissue layers so your dermis can
actually thin a little bit these
hypodermis which is fat you can lose a
little bit the smash layer which is
largely your hydratory layer or the
layer of cushion that retains fluid in
your face and is responsible for some of
the color of your skin and looking
radiant when people wonder like why do
some people look radiant some don't it's
because they have more hyaluronic acid
probably in their dermis and in their
smash or they carry more water in both
and they reflect light better so they
look more radiant regardless of
pigmentation so all these tissue layers
with elastin collagen hyaluronic acid
Desmond vementin you name it every tiny
thing in your skin can become depleted
over time or change its character and
you carry less water you carry you have
have less fat so all these things tend
to atrophy now it's impossible to go
back in and replace every single one
that's why we do a shotgun effect
treatment sometimes where we'll go use a
radio frequency to damage everything in
the dermis and say please I hope you can
recover and regenerate some Alas and
hyaluronic and collagen or are we going
to do fat grafting and we try to do it
in multiple layers to plump it up or we
do hyaluronic in this Mass with these
profilio or other types of fillers but
nothing can replace every layer that was
deflated and so I tell my patients I say
don't expect Perfection I can do a great
great job I can do better than anybody
uh can or as good as anybody else can
but you'll still have some deficits and
I can't fix everything because there are
too many things and too many layers to
fix it's not possible so that's really
what I try to explain in my patients to
expect ultimately makes no difference
they still want everything to be perfect
and still want everything to be better
you can't blame them we're all uh
perfectionist if we're going into this
world of plastic surgery but not every
kind of bit of perfection can be
attained and it's important to know that
because sometimes you chase things and
go too far
um and end up making things worse so the
other thing I try to tell patients today
is that there's not always a solution so
I did have some patients who wait six
months to see me sadly and when they got
here I told them no there's nothing to
do you shouldn't do anything and to them
that's uh you know fortunately they
understood it's it's a good advice and
save them from doing something bad some
people would come in and think I wasted
their time ultimately it's difficult to
assess people sometimes just from photos
so you do have to see them in person so
questions regarding duration of lifting
for each thing came about so how long
does a brow lift last a brow lift for
most people if you do an endoscopic
style brow lift should last about 10
years if you maintain it with botox if
you don't maintain with botox it can
come down around five years or sooner or
if you don't do a great brow lift
obviously you can come down sooner
patient asks me why do I still have
wrinkles here and I explained you can do
the old school style brow lift where you
cut out skin and do a forehead type
reduction or a coronal lift and pull
everything back and you will have
reduced wrinkles but you might look a
little unnatural and age differently
over time because it's impossible to
design a brow lift appropriately for
somebody where you go and cut out a
certain amount of skin because this part
of the brow came up that part of the
brow went down this part of the brow
came down this part medialized that part
lateralized so it's impossible to go try
to draw something that compensates for
all those bits of drooping that have
happened over time whereas if you go in
and do a deep plane or endoscopic brow
lift you're just going through incisions
you release everything and you just go
back to where it naturally came from so
you actually do get a better lift that
way or more appropriate lift so I tell
my patients I would rather do a
endoscopic less invasive a little bit
more natural uh brow lift and then
depend on Botox rather than do those
cuts so let's say you do either one of
those it'll last about 10 years if it's
done properly for upper eyelids same
thing it lasts about 10 years and upper
eyelids you could do skin reduction fat
grafting fat repositioning chemical peel
lasers you could do all that stuff as
far as upper eyelid surgery goes
lacrimal gland pexy all this is upper
eyelid surgery also about 10 years lower
eyelid surgery really depends because
you can do fat repositioning now I
advise people do not do fat reduction
unless there's a specific indication
like you have one fat bag left after two
surgeries okay go reduce it otherwise
fat removal surgery in my opinion has no
place in the year 2022 we do fat
repositioning unless you're doing
grafting at the same time fine but we're
doing fat repositioning and when you do
fat repositioning that should be
permanent if it works so one part of the
lower eyelid surgery can be permanent
however you do still Hollow over time so
you'll likely need to touch up again
sometime within 10 years could be a
laser it could be a skin excision could
be a cantho pexy if you droop could be a
million things
as far as lip lips go lip lifts I don't
know how long they last I think for most
people we could assume that they will
not grow out of the lip lift in about 30
years 20 years I don't know I've only
been doing them about eight years so my
guess is about 20 30 years although it's
not impossible that somebody would need
a bigger lift facelift there's a
difference between
small smash glycation extended smash
lifts Max lifts Heist Mass lifts deep
plane lifts and extended deep plane lift
so all these have a different amount of
lifting and on different skin types and
different face types work to different
extents so the bigger lift you get in
general the bigger Improvement you get
in general the longer it's going to last
the less scarring you have you can
assume it's going to last longer so the
way these things work which I said in
other sessions before is smash glycation
is done by elevating the skin grabbing
this Mass layer and tying it up with
stitches tightening it up
that you're not really lifting anything
to lift something you have to release it
from its insertion point take it up and
put it back down without any tension so
it heals in that new position if you go
and try to tighten things by pulling you
don't get much of a lift because the
skin the soft tissues just grow around
the the Stitch over time it's a human
body it's not a wooden nails so it tends
to go back down but you can get some
good manipulation of the platysma
because you are everybody who does a
smash application goes in here and does
a little bit of a deep plane whether
they know it or not and they grab that
muscle bring it together and then
laterally there's a bunch they can do so
either way with these Mass glycation
lifts if you look at older series
The more limited smashifications usually
have a big effect for about three years
and then they mellow out the nicer smash
placations are more skilled surgeons
doing them can go five to ten years
really just depending on the surgeon the
quoted uh amount of time in literature
is about eight to ten years if you look
at the studies from mataraso and
everybody who were doing research
studies on when people come back for
surgery it doesn't mean that everything
lasted 10 years it just means that's how
long they go before they come back for a
surgery a deep plane is kind of the same
you look at about eight to ten years 10
years or so
the difference is the Deep plan if you
do a little deep plane you get a smaller
change if you do an extended deep plane
that means you released everything so
modified extended deep plans means you
release everything here you release the
neck you release everything and bring it
up the more you release the bigger
movement you get the longer it lasts
still you're not getting much over 10
years so
is there a difference if you're revising
both of them at 10 years yes there is if
you do a big extended deep plane you
will look better from beginning to end
of that 10 years than you would have if
you did a lesser lift again this varies
from surgeon to surgeon so someone's
saying they did a deep plane versus a
smash really makes no difference you
have to look at the surgeon what kind of
change they're getting you can have
surgeons who do some applications who
get incredible results and you have
surgeons who do deep plane who get
really results so
um it really is all surgeon based so I
think that is largely what we went over
today with all the patients and the
other question was I lost fat over time
can I restore it I tell people no what
we do is we take fat from somewhere else
and we try to mimic the fat that was
lost it does not restore the fat that
you had and in fact it has a different
brain when you bring abdominal fat and
put it in the face it's going to grow
like abdominal fat and they ask does it
survive and I say yes it can survive uh
but no matter what you get a benefit so
people always ask how much of the fats
going to survive the answer to that is
zero to a hundred percent you do not
know no one can tell you 30 or 60 or 75
you have no idea
fat loss however much it lasts all we
know is that if you inject it faster
when you take it out of the body it'll
most likely survive better if you add
PRP to it it'll most likely survive
better but no matter what when you
inject fat it does have some kind of
benefit to the skin it has some kind of
weird stem cell potential and makes
people look a little bit better but does
have a mind of its own which means if
you get fat in your abdomen your face
can get fat if you have hormonal changes
from menopause and your fat cells change
they can change in your face and they
can grow so you never want to inject
enough that you can't control
and fat injected can also add volume
once it's injected so if you inject fat
and you inject one milliliter and it
survives just like Sculptra sitting
there fat can induce an inflammatory
response around it and you can actually
grow volume from granulation around fat
that can happen too especially in the lip
lip
collagen can collagen be restored no
don't be stupid you cannot restore
collagen that's been lost over time you
can however
make more collagen there's a difference
here and it's important to know the
difference because people think that injecting
injecting
sculpture radiesse all this stuff
regenerates collagen that was lost over
time this is not true you're adding
collagen in by forming Scar Tissue but
you're not replacing the collagen that
was lost it's almost impossible to
replace the collagen that was lost by
doing those things however if you do
radio frequency treatments micro
needling with PRP you do all these
different things you can generate new
formation of collagen you can generate
other good um
um
types of connective tissue within the
dermis and underneath however it's never
exactly what was there before so it's
really important to know that in aging
face surgery we are doing everything we
can to mimic what was lost but we cannot
restore to how things exactly were
last question was about symmetry again
um doctor I went to my other doctor and
they said that during the surgery you
could have made the Brows more symmetric
and I said well it's not possible
because we are asymmetric and she said
well I understand but surgery you can
make it more symmetric can you I said
yes to some extent you can so the reason
we have asymmetries in the face is not
only because we grow differently on each
side of the face depending on how we age
or droop but it's also because we have
different neuromuscular dominance
patterns which means that the brain can
tell this part of the face to move
differently than that part of the face
because they're wired differently and
together and this part can actually move
differently than that part and that part
so you can be dominant on this side of
the face but this side of the brow
dominance on one side of the face or one
side of the body is what leads to one
side being stronger than the other just
like if you're right-handed or
left-handed so when somebody is dominant
on one side and their brow is higher on
one side you can do all the lifting you
want in the world that side will always
want to go higher the only thing you can
do to change that is Botox because
you're affecting the neuromuscular
Cascade let's say and the other thing is
if asymmetry is bad enough then yes
physically you can actually do an
asymmetric lift directly to bring one
side higher than the other but it has to
be different enough so you can't just
have like a little shape change and a
minor shape change and say I'm going to
make them symmetric it's not going to
work but if it's bad enough then yes you
can get improvements in symmetry so
symmetry also is really Irrelevant for
most of what we do in Beauty it treats
neurosis meaning it treats uh patients
anxiety and patients nitpicking about
things does not change how people
perceive them nor their beauty and about
90 percent of cases and what people look
for however there are 10 percent of
cases that it is important to treat
asymmetry because the asymmetries are
affecting how someone looks because it's
either affecting their function or it's
straining their face or it's to the
point where you go to babak azizade
who's the master of treating real facial
asymmetries from facial paralysis so
those are cases where you really want to
treat it other cases where you want to
treat asymmetry is where the nose is one
side higher than the other midline
structures tend to be more perceptible
you can see them a little bit better and
notice them and it bothers people's eyes
a little bit more when midline
structures are asymmetric so those are
some exceptions but overall when people
come to me looking for symmetry I advise
them I'm not that kind of doctor I like
to make things look really really pretty
and I do everything I can to make it
look pretty I don't do things for no
point it's not fun I don't enjoy it and
it's not going to improve Beauty
so 90 of people who asked for the
Symmetry I don't really uh do much for
it I don't think it'll help them but 10
of people I certainly do because they
see some things I don't sometimes
they'll see like a cheek is higher on
this side flatter on that side and I say
you know what you're right we should
actually improve that symmetry you look
better on both sides so these were the
questions for today which are uh general
questions that you receive a lot in uh
this world of facial Plastics and
Plastics alike I will post this in case
anybody needs and
um in case I'm a little incoherent it's
because I've been going straight from
six in the morning without a break so uh
seven o'clock and we gotta go hope
everyone has a lovely night I'm headed
Cliquez sur n'importe quel texte ou horodatage pour accéder directement à ce moment de la vidéo
Partager :
La plupart des transcriptions sont prêtes en moins de 5 secondes
Copie en un clicPlus de 125 languesRechercher dans le contenuAller aux horodatages
Collez une URL YouTube
Entrez le lien de n'importe quelle vidéo YouTube pour obtenir la transcription complète
Formulaire d'extraction de transcription
La plupart des transcriptions sont prêtes en moins de 5 secondes
Installez notre extension Chrome
Obtenez les transcriptions instantanément sans quitter YouTube. Installez notre extension Chrome et accédez en un clic à la transcription de n'importe quelle vidéo directement depuis la page de lecture.
