Minimally invasive cosmetic procedures are on the rise. According to the American Society of Plastic Surgeons’ 2018 Plastic Surgery Statistics Report, the market grew 163 percent between 2000 and 2018, and the trend is expected to continue tracking upward.
Among the go-to treatments? Injectables (think: Botox® and filler) and non-invasive fat reduction, which just so happen to be among the best ways to non-surgically lift, firm, plump, and contour the face and neck. Whether you are looking to combat visual signs of aging like volume loss, fine lines and wrinkles, and sagging or are simply looking to further define your facial features, there is an array of non-invasive cosmetic procedures that can reshape the face — sans surgery.
Fillers aren’t just for plumping your pout. Soft tissue fillers like Juvéderm®, Radiesse®, Restylane®, and Sculptra® can be used to re-shape the entire face. Made of hyaluronic acid, collagen, calcium hydroxylapatite, and poly-L-lactic acid (PLLA) to name a few, filler can be injected into the skin to restore volume, smooth out fine lines and wrinkles, and enhance facial contour.
While it probably comes as no surprise that dermal filler is often employed under the eyes to eliminate bags, in the mid-face region to sculpt cheekbones or add volume to sagging nasolabial folds, and on the lower face to define the jawline, a board certified dermatologist or plastic surgeon can recommend less obvious uses as well.
“Dermal fillers can be placed on the bone and within the muscle of the chin to augment its shape and projection,” explains board certified dermatologist Rita Linkner, MD, of New York’s Spring Street Dermatology. “The chin is oftentimes forgotten but adds so much to facial structure. A syringe of filler in this delicate area goes such a long way.”
Using filler to augment the chin is a non-surgical solution to refine a facial feature that previously would have required a more invasive cosmetic procedure — like a facial implant — to correct. So-called liquid rhinoplasties and chemical brow lifts are other common examples of filler being used to mimic the effects of traditional plastic surgery.
One key difference, however, between non-surgical cosmetic procedures and their surgical counterparts is the level of permanence. The results of dermal fillers, while immediate, last an average of six months to two years (depending on the region being treated) compared to the much longer lifespan of surgical procedures. But the downtime associated with filler is minimal, with only about a week (or less) of minor redness, swelling, or bruising.
Botulinum Toxin Type A Injections
Easily confused with dermal filler, botulinum toxin type A (BoNT-A) injections (read: Botox® and its competitors) work in an entirely different way. While dermal filler quite literally fills in the hollows of the face to restore volume and fullness, BoNT-A injectables like Botox®, Dysport®, Jeuveau®, and Xeomin® are FDA approved to reduce the appearance of fine lines and wrinkles caused by repeated facial expressions (think: frowning, squinting, smiling, and the like) by injecting it into the muscles underlying the affected area. But their usefulness goes far beyond smoothing wrinkles.
BoNT-A injections can be used to complement cosmetic surgery procedures like blepharoplasty (a.k.a. eyelid surgery) or brow lifts and can be strategically injected to refine the face shape or define facial features. Botox® and the like can be used to slim out a round face, lift the corners of the mouth, and even soften the jawline (ideal for teeth grinders or those lacking definition).
“I inject a neurotoxin into the masseter muscle to slim the face very commonly,” says Dr. Linkner. “It turns a square-shaped face into a more aesthetically pleasing oval. Studies have been done that show the jawbone itself slims on CT scans with toxin use in the masseters. As the muscles exert less pressure on the bone, the osteoclasts start to reshape the bone itself.”
Like dermal fillers, BoNT-A injections are temporary. Once injected, the results can take up to a week to kick in (patients may experience minor bruising and pain at the injection site) and typically last around three to six months.
Another player in the minimally invasive injectable game? Kybella®.
A form of deoxycholic acid (i.e. the naturally occurring molecule that aids in the breakdown and absorption of dietary fat in the body), Kybella® is FDA approved to reduce fat under the chin and thus improve the contour of the neck. Off-label uses include breaking down stubborn fat deposits on the stomach and back and above the knees and elbows.
When deoxycholic acid is injected directly into the submental fat under the chin, the fat-storing adipose tissue is destroyed. Over time, the fat cells are removed from the treated area via the body’s natural metabolic processes.
The best thing about Kybella®? The results are permanent. Dr. Linkner says that the body metabolizes the destroyed adipocytes (fat cells) over the proceeding six to eight weeks. Unlike liposuction, the fat will not redistribute, but most patients will need multiple sessions (up to six), spaced at least a month apart to see the most optimal results.
Additionally, there is a bit more downtime associated with Kybella® than, say, Botox® or dermal filler. “Expect a 36-hour period of swelling that truly peaks 12 hours post-procedure,” Dr. Linkner warns. “Bruising is common, so I give all my patients arnica post-Kybella.”
PDO Thread Lift
While nothing can replace the long term lifting and firming benefits of a surgical facelift, thread lifts are a worthy non-surgical alternative. Ideal for patients looking for facial rejuvenation (especially as it relates to the lower face and jowls), the minimally invasive cosmetic procedure involves the subcutaneous placement of polydioxanone (PDO) sutures to lift sagging tissue.
Unlike facelifts, which surgically remove excess skin, thread lift techniques focus on repositioning the tissue beneath the surface of the skin. The result? A reshaped face with little to no downtime. In fact, Dr. Linkner says many of her patients can attend social engagements immediately after the procedure, which is performed under local anesthesia.
Like facelifts, however, thread lift results aren't permanent. While most facelifts last a decade or more, thread lifts typically have a one- to two-year lifespan because the sutures dissolve over time, allowing the tissue to move and sag.
Whether you are looking for a minimally invasive face-shaping procedure to replace or complement plastic surgery, volume-boosting fillers, fat-reducing injectables, and lifting thread lifts all provide face shaping benefits without going under the knife. While the results are not always permanent, cocktailing these cosmetic procedures under the care of a board certified dermatologist or plastic surgeon can produce restorative results with minimal downtime.
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