Episode 55 - The 20/20 Facelift: Dr Steven Struck Shares With Beauty Now This Revolutionary Lift.

Transcript

Teri Hausman: I’m Teri Stuck, host of Beauty Now, a weekly podcast that brings you the latest in all things beauty. We’ve had shows on lifts, lasers, lipo, breast augs, tummy tucks, keeping your skin young, weight loss, rash and hair extensions, with many, many famous experts. Today we have Dr. Steven Struck, a Stamford trained, board certified plastic and reconstructive surgeon. Welcome Dr. Struck.

Teri Hausman: Thank you.

Teri Hausman: Today you’re going to tell us about the 20/20 facelift, and that’s actually a facelift that’s combined with, is it called the repair laser?

Dr. Steven Struck: Yeah, it is. It’s a full facelift, and I combine that with the Fractal Repair Laser, which is a fractional Co2 laser.

Teri Hausman: What are the benefits of doing the laser with the facelift?

Dr. Steven Struck: Well I think the benefit is, is that the two procedure, fractal laser resurfacing and facelifts are really completely different procedures and they treat different things. The facelift treats the jaw line, creates youthful structures to the face, gets rid of the bands of the neck and hanging skin. However, it doesn’t really do anything for the actual skin quality. Whereas a laser makes the skin look more youthful, it gets rid of photo damage, and most people who need a facelift also need to have their facial skin rejuvenated, so if you can do them both at the same time you’re going to get a youthful face with youthful structures and youthful skin.

Teri Hausman: I don’t know why people haven’t thought of this before. I mean, going in just for the laser procedure is pretty, you know, time consuming.

Dr. Steven Struck: Well we have, people have, we have thought of it before. The difficulty is that when you do, historically speaking, when you do a whole facelift we have limited the laser to only the mouth area and only the forehead and nose area. And the reason for that is that the lasers that we used before surgically have been too harsh to treat the face that you’ve actually lifted during a facelift, which is the neck and cheek skin. So with the advent of fractional lasers, like the CO2 laser, we’ve been able to treat that skin less harshly and now we can treat the entirety of the face as opposed to only isolated areas.

Teri Hausman: So you’re saying that this laser is completely different than the old lasers that they were using.

Dr. Steven Struck: It’s similar but different. It’s the same technology and that it’s a CO2 laser, and what’s nice about that is CO2 lasers are kind of the gold standard because they do deliver. A CO2 laser’s not a no downtime laser, it’s a laser that actually does treat the skin so that you get predictable results. The difference is that the laser energy is provided fractionally, and to make that, just a kind of a short explanation of that is we treat twenty percent of the skin surface as opposed to a hundred percent of the skin surface with this laser.

Teri Hausman: Well lets start actually asking about the facelift. Do you do the facelift first and the laser second or vice versa?

Dr. Steven Struck: In surgery I do the facelift first. I like to do that because when we’ve treated the laser, when we use laser to treat the skin, the skin has been burnt, it’s swollen, it’s a little bit traumatized, so I like to set the foundation first by doing the facelift so that I have the neck line how I want it, the jaw line is created the way that we want it, all the deep structures are dealt with first, and then we can come in secondarily and go over the skin with the laser once we’ve set our foundation.

Teri Hausman: So basically you’re saying a woman’s going to come in to you and she’ll be having saggy skin, but also sun damaged skin.

Dr. Steven Struck: That’s correct.

Teri Hausman: And she can correct both of those by doing the 20/20 Facelift.

Dr. Steven Struck: That’s right.

Teri Hausman: So tell our listeners for the ones who haven’t listened to the facelift show, there is another show on facelifts, but lets talk about that really quick… What is, how is a facelift done? A woman comes in to you for a consultation, how do you proceed?

Dr. Steven Struck: Well I think that, well when I see the patient what I like to do is determine what they actually want to achieve. It’s funny, with everyone having so much information available to them I would say 25 percent of patients who come in come in with an idea of what treatment they want, as opposed to what they actually want to correct, and sometimes people will have, you know, a lot of spat of their neck and hanging neck skin and will say they want a laser when a facelift is actually what treats that. So first thing I like to do is determine what they want to achieve. And if a patient wants to get rid of, say, the turkey bands of the neck, which a lot of people describe them, the two lines that go down the middle of the neck, if people point at their jowl and say, “I really want to lift this jowl”, or say they want to make their cheeks more full, those three things are deep issues and those are only going to be treated by a facelift. There are not lasers that are aggressive enough to elevate someone’s jowl or make their neck more youthful looking. So if that’s their complaint, then I think the facelift is the way to go.

Teri Hausman: So basically though you’re saying… is this different procedures though? The lady comes in and wants just her neck to be corrected, then you do the neck. Where are the scars for the neck left?

Dr. Steven Struck: Well if you’re doing an isolated neck lift, the scars are mainly hidden behind the ear. You don’t really need to go in front of the ear to do an isolated neck lift, and patients like that idea ‘cause they don’t want to have the incision up front. You do all the work behind the neck and a small incision under the chin, and through those two incisions you’re able to create a neck, a youthful foundation with retightening the muscles of the neck and then remove some skin of the neck area to tighten some skin over the top of that.

Teri Hausman: But that doesn’t correct the cheeks, does that?

Dr. Steven Struck: No, to get to the cheeks you always need to have some skin removal over the area that you want to treat, and you need to get underneath the area that you want to treat to elevate the chin, the jowl. So if it’s the jowl, you need to make an incision in front of the ear, go under the skin to find the smaz, which is the deep muscular structure that contains the jowl, and then you elevate the smaz, which elevates the jowl, and then you redrape the skin over that.

Teri Hausman: Then the eyes, the saggy eyes.

Dr. Steven Stuck: And then when you get to the eyes there are really two decisions to make. One decision is the area of need only the eyes or do the brows kind of add to the problem. If the brows are below the orbital bone, which most people can just feel their eyebrow and the bone and if their eyebrows lay on or below the bone then they should probably have some type of brow elevation to get a better result, and then we just remove some skin of the eyelids to rejuvenate the eyelids.

Teri Hausman: And when you say some type of brow rejuvenation, do you mean the endoscopic procedure, which, could you explain that for our listeners?

Dr. Steven Struck: Well there’re, again there’re a variety of treatments there also. I think you need to look at each patient. That’s the beauty of plastic surgery, every patient’s different. You don’t do the same procedure to every patient for sure. So what I look for in the brows is I look at the height of the hairline, I look at the level of brow droopage and I look at the number of lines in the brow. If the patient has a high hairline, an endoscopic brow lift may not be the best choice, ‘cause it can aggravate that by further elevating the brow, and a hairline type procedure might be a good idea, where we make the incision right at the hairline. The benefit of that is actually we can remove some of the forehead skin so that their hairline is lowered, and we’ve treated two things; we’ve raised their eyebrows, we’ve lowered their hairline, and we’ve rejuvenated their brows. If the hairline’s normal and they just have some early brow droopage, I’d just do a standard endoscopic brow lift and make a few small incisions and elevate the brow that way.

Teri Hausman: And that is, for our listeners, that’s with the camera, right? You go in with the little camera, and then your scars aren’t so big, like the way that they used to do it?
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Dr. Steven Struck: Yeah, that’s with the camera and usually three small incisions. I think the benefits of that are that, A, there isn’t the big incision, which means less areas of hair loss, less areas of scalp numbness. I think those are the two main advantages. Well when you make that big incision, you cut some of the nerves of the forehead region, there’s no way to avoid that, and after you do that there’s some pretty significant areas of scalp numbness, and there can be some areas of hair loss as well. So I like to do the endoscopic brow lift when I can.

Teri Hausman: So then you do, after all this is done, you’ve done all this work, then you’re going to go on with the laser. Can you do the laser on the neck?

Dr. Steven Struck: With the Fractional CO2 laser you can. That machine, earlier I said we do 20 percent coverage, that’s not completely what we do. In the areas where the skin needs more treatment and is more hardy like around the mouth, we will treat at about 40 percent coverage and a higher energy. When we go down to the neck and the cheek we do move it down to about a 20 percent coverage, so that that more delicate skin can go through the process, heal well and be rejuvenated without concerns for healing problems.

Teri Hausman: A lot of women complain about those lines around their lips. So you’re saying this laser can really help that.

Dr. Steven Struck: Yeah, lip lines are probably one of the more difficult areas in plastic surgery, and that’s another example of why you’d want to combine the two procedure. A facelift isn’t going to change lines around your mouth. If we pull tight enough on a facelift to tighten the skin around your mouth, you’d have a pretty strange looking outcome. So we can’t achieve mouth rejuvenation by facelift, so we can with lasers and that’s what I like to do there.

Teri Hausman: So if a woman came in and she just only wanted the lasers, she didn’t have any sagging, what would she ask for?

Dr. Steven Struck: Well usually then they’re pointing at some fine lines. Their chief complaint, I always look for what their chief complaint is, their chief complaint is fine lines. They’re not usually pointing at their neck saying, “I want this hanging skin”, or their jowl, “I want this lifted”, they’re just saying, “I want my skin to glow more. I want to get rid of these lines. I feel like my skin’s dull.” Those patients I would definitely choose a laser technology alone, and do probably a pretty significant fractal resurfacing of their face.

Teri Hausman: And when you say the fractal resurfacing, there’s two different types. Can you explain the two different types real quick?
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Dr. Steven Struck: Yeah. The original fractal machine is now called the restore fractal. It’s a little bit lighter. It’s not as strong as the CO2 laser, so what it does is it still treats about 20 to 40 percent of the skin surface, but it kind of injures that skin and burns it, it doesn’t vaporize it. So it’s good for photo damage, it’s good for fine lines. From the patient’s perspective, the main benefit is the downtime is less. They come into the office, they’re numbed topically with some creams for one hour, and then we treat them, they go home, they’re certainly a little bit puffy and red, but they can do a lot of things if they want to. The repair laser, the stronger laser is the CO2 laser, so it’s actually burning that skin and vaporizing it. The advantage of that is it really does shrink the skin, probably a little better at treating lines than the repair, I mean restore. Restores probably better at photo damage shining your skin, treating really fine lines. If the patient really wants to shrink the skin, they’re probably better off going with the repair, which does have about a five day healing period associated with it that is better at treating your lines.

Teri Hausman: So repair is more downtime. We’re going to need to take a commercial break, thank our sponsors. We’re going to be right back with Dr. Steven Struck. Thank you Dr. Struck. We’ll be right back.

Teri Hausman: I’m Teri Struck. We’re talking with Dr. Steven Struck today. He’s talking about the 20/20 Facelift, a facelift combined with a laser. Welcome back Dr. Struck.

Dr. Steven Struck: Thank you.

Teri Hausman: So today, I almost hear every single day from women calling me up, in fact, just yesterday, “What’s this Lifestyle Lift?”, “What’s this other lift”, “What is…”, you know, you see so many different, lets just call them gimmicks or facelifts with no downtime. Tell us about that.

Dr. Steven Struck: Well I think you’re right. Myself, I’ve had, I usually have at least a couple patients a day ask me about something like that that they’ve seen in the media and are interested in. I think it’s easy to get people interested in something that has no incisions, no scarring, no healing time, no burning. And it’s like everything, you can’t truly get something for nothing. They think those procedures are probably designed for people who really don’t need much of anything anyway. You need to have, to lift skin you need to have an incision, you need to have some work on underlying structures and you need to remove some skin. The funny thing is, is really when you compare the downtime of a definitive procedure to that of kind of a half measure, the healing time really isn’t that much longer, so I think it’s more of just attracting patients with this idea of “I can do a facelift without an incision.” “I can do a facelift without the healing time”, when really if they did a definitive procedure they gets something that lasts on the line of eight to ten years and truly rejuvenated them, still leaving them looking natural, as opposed to something that would last about a year and not be very definitive.

Teri Hausman: Well that’s actually what I’ve heard too from other doctors is that it just doesn’t last. So you’re spending, you’re spending just about almost about half of a facelift, or do you know the costs of that?

Dr. Steven Struck: You know, I don’t know the costs exactly, but I think that it probably is half, sometimes it might even be more than that. Because we have, as plastic surgeons we have a variety of things that we can offer that can actually be competitive to that. If someone truly wants and needs a mini facelift, we can do a mini facelift on them. We don’t, not every patient needs a definitive CO2 laser, laser facelift, you know, two weeks of healing time. Some people do need a mini facelift and a board certified trained plastic surgeon can do a mini facelift, which is probably closer in cost and still a definitive procedure without going to those types of procedures.

Teri Hausman: And I have to say, I’ve seen results on some of the patients that it’s amazing to see the laser combined with the facelift because of your skin texture, and would you say a lot of patients come in and they just have their face done but they don’t do any injections and lasers, and then their skin quality still needs to be fixed?

Dr. Steven Struck: Yeah. So I think that’s the benefit. We have a lot of things to offer, and I think that’s a nice thing about going to a doctor who is trained in all things is that they can offer you one of those things, they’re not trying to put, you know, the square peg into the round hole. If the patient needs a laser, they’re going to do a laser for you. If the patient needs a facelift, they’re going to do a facelift for you. Someone who can offer all the different technologies I think is most motivated to help the patient choose the right treatment for them.

Teri Hausman: So when they do the laser with the facelift, what is the recovery time?

Dr. Steven Struck: The recover time actually is probably that of a standard facelift, I think that’s a fair statement. A facelift usually has a two week healing period. The laser actually heals much faster than that, so that I think is kind of the beauty of the procedure is, is we’re doing a procedure that has a two week downtime, the downtime is really not changed by adding the laser to it because it’s still a two week healing process. No doubt for the first four or five days of the facelift they certainly look a little more swollen and puffy and, you know, treated. However, by the end of the two week time period when they’re ready to go back to work and ready to do their thing, the 20/20 Facelift, laser facelift patients actually look the same as the standard facelift patients.

Teri Hausman: A lot of women also ask me about laser in the sense that if they have darker skin or if they have skin that they’re afraid that it would leave little white spots or dark spots or burns, what’s your answer for that?

Dr. Steven Struck: I think there, that’s another advantage of the factional treatments like the repair laser. If you have, the rule of lasers is the lighter the skin, the lighter the eye color, the more aggressive you can be with the laser and the less likely your are to have pigmentary problems. As you move into darker skin, darker eye color, you definitely run more risks of either post reactive hyper pigmentation where they get darker, which usually does resolve, or whiter areas of the skin, which are lighter than the surrounding areas. The fractional nature of this allows us to say, “Okay, we have a fair skin patient here, lets keep the energy up high, lets treat them aggressively, they don’t have those risks”, whereas if someone has darker skin you can turn both the power down and the fraction of the skin that you’re treating down so that you decrease your risk of complications.

Teri Hausman: What can African American women do for their skin?

Dr. Steven Struck: I think that’s a tougher area. I think you could do, I would say in that group, I would probably stay more towards a restore type laser. I think that, which is the non burning type of fractal laser. It still delivers, it delivers consistently and usually can meet the needs of those types of patients. I think even with a light repair or a light fractional CO2 type laser, you would run some risks there that you may not want to take on.

Teri Hausman: And then in that case if the patient really, really wanted it, would you do a test patch, or…?

Dr. Steven Struck: You can definitely do that. You can test areas behind the ear, you can test different areas to see. But with that type of laser I wouldn’t be too worried with the restore type laser, I think they would be fine.

Teri Hausman: So the repair is the one that you can do, kind of like the lunch time. And the restore is the more heavy duty one, about five to seven days downtime?

Dr. Steven Struck: Yeah, they’re reversed to that, so it’s the restore…

Teri Hausman: Okay.

Dr. Steven Struck: Restore is lighter, I think of it that restore, you’re just trying to restore something, you’re trying to make it a little better, whereas that with the repair you’re getting in there and you’re really trying to fix something, so I always get those two confused too, that’s how I….

Teri Hausman: Okay, so the restore is the one, the lunch time, and the repair is the more heavy duty one.

Dr. Steven Struck: Right.

Teri Hausman: And the repair you can actually have even if you’re not having any surgery. You can do that in the office as well, right?

Dr. Steven Struck: That’s right.

Teri Hausman: So what are the costs of the repair and the restore?

Dr. Steven Struck: Usually…

Teri Hausman: Ballpark…

Dr. Steven Struck: with the restore I would say you’re usually looking at about a thousand dollars per treatment, it usually takes a series of three to four. Those can be done about two weeks apart. So benefit, no downtime can, you really don’t need to miss work. You have a day of puffiness and swelling, but most of that can be covered. With the repair, you’re usually looking at four to five thousand dollars, you’re usually looking at about five days off work. So if you really analyze the costs, the repairs only maybe fifteen hundred dollars more, because with the other one you need to do a series of four treatments with the restore. However, a lot of restore patients are kind of younger, really don’t have that much photo damage. Many patients can get a lot of benefit from a restored one or two treatments, which is only a couple thousand dollars, and a lot of them will maybe then want to maintain that with one treatment once every year or two. So I have a lot of patients who really don’t have much going on with their skin, just want to keep it looking useful, and there’ll be one or two repairs in office, and then they’ll continue to follow that up once every year or two.

Teri Hausman: Well we just have a couple more minutes. Lets just go back to 20/20 Facelifts, so that, is there anything that you can tell us about it?

Dr. Steven Struck: I think that we kind of went over the main things we’re dealing with; healthy skin over the top of the healthy foundation. We’re doing them at the same time. It’s pretty hard to get someone to go through a two week healing period for a facelift, and then a month later say, “Okay, come back in and now we’re going to laser your face and you’re going to have another ten day healing period.” I also…

Teri Hausman: That’s a good point. I mean, ‘cause you do see women like that, that need the injections and all that kind of stuff, and you might as well do it at the same time.

Dr. Steven Struck: Yeah, and it can be done. We’ve documented that it’s safely performed. We’ve got the energy set so that we can safely laser the skin without having healing problems. I think another thing that patients think about a lot is, I think the trend is more towards people wanting to look natural. People come in, they say, “I don’t want to look funny. I don’t want to look like so and so in the tabloids”, and actually sometimes the more different treatments that you do, if you add laser to the procedure then you don’t need to pull as tight on the skin ‘cause you’re rejuvenating the skin with the laser, so your hand isn’t forced to being as aggressive with the skin tightening because, you know, the lasers going to do it. So in some ways it’s kind of funny that what seems like a more aggressive procedure can actually yield a more natural result because you’re using the technology to kind of add to each other, as opposed to forcing one of them to work harder than it should.

Teri Hausman: Oh, and I love that because I quoted you on many shows that, you know, you say, “You can always go in back and take out more skin, but you can’t, you know, you can’t do it, you can’t put it back in.”

Dr. Steven Struck: That’s correct.

Teri Hausman: Because that is kind of the fear of most people, that they don’t want to look freaky or look, like they’ve had surgery, they want to look rested.

Dr. Steven Struck: Yeah, that’s right, and patients, the patients see it and they’re very happy with it.

Teri Hausman: Well I’ve seen the results and it’s pretty amazing, so it’s called the 20/20 Facelift, pretty much a laser combined with the facelift. And a lot of doctors are not doing this yet?

Dr. Steven Struck: Oh, I think that there are a lot of doctors who are doing it. I think that they’re, we’re going to have more information in the scientific literature about it that will even add to it, but I think it’s something that, the fractional CO2 lasers have only been out for about two years now, so this is an area that’s kind of a new area, but I think there’s significant data now to support its use.

Teri Hausman: And what about, can you use it on the chest skin?

Dr. Steven Struck: I use it on the chest skin, yeah. There’s a different mode that you can change to that’s even lighter, and that’s an area where obviously we don’t do surgical procedures really to rejuvenate the skin. So you can continue to change your density, which is the number of impulses, and your power to treat the chest skin. Chest skin often has more photo damage than actually lines, so, you know, you can set the settings so you’re treating more photo damage, you know, or if they do have lines you can change the settings and treat the lines.

Teri Hausman: And do you use the restore for that or the repair?

Dr. Steven Struck: It depends. If I’m doing a facelift procedure with the 20/20 Facelift, I’ll treat the chest at the same time because we’re already there and we’re already going to have the healing time. If I’m looking at it as an office based procedure, often I’ll use the restore there, ‘cause that’s usually, like I said, a photo damage area. When you’re thinking restore, you’re usually thinking photo damage and fine lines.

Teri Hausman: What about hands real quick? We only have a couple more minutes left.

Dr. Steven Struck: Hands I think you go with the restore for sure. The, I’d, the CO2 nature machines are a little bit strong for the hands. You could do it, but you’d have to turn the energy down so far that you would actually be doing the same thing as you would be doing with the repair anyway, with the restore anyway.

Teri Hausman: And a lot of women complain about their arm skin, what can they do for that?

Dr. Steven Struck: Arm skin, you can probably go with a more of a restore type technology or a Thermage type technology, something to kind of tone the skin that you can treat large areas of the surface. There are some new things that they’re working on at Thermage to try and tone the skin up in that area also.

Teri Hausman: And there’s the new fat laser for Thermage, is that out yet, is that coming out?

Dr. Steven Struck: Well that’s, those are, you know, I think you’re going to see some new growth in those areas. You’re going to see some growth in all kinds of lasers that treat fat, to tone skin over the top of skin that’s had its fat treated, and that’ll probably be the next area, the no downtime lasers have kind of dominated our field for the last four or five years I’d say as far as new interest, and I have a feeling in the next four or five years we’ll see a lot of stuff with treatment of fat using lasers.

Teri Hausman: But you’re not talking like the suction, you’re talking about the, they’re actually saying that they could melt fat with laser, without…

Dr. Steven Struck: There is data to show that and that’s what they’re working on. Some of that stuff is in the very early phases…

Teri Hausman: We’ll be looking forward to that…

Dr. Steven Struck: But it’ll happen soon…

Teri Hausman: We’ll be looking forward to that and we’ll do another show on that.

Dr. Steven Struck: Okay.

Teri Hausman: So in closing, what’s your last advice for anybody looking for this type of procedure?

Dr. Steven Struck: Well I think, I would say in closing the main thing to think about as a patient what you want to treat first, and then meet with the physician to determine what type of treatment would best meet your needs, and it may be a laser, it may be just simple office injections, it may be a lighter laser or the 20/20 Facelift, but I think if you know what you want to work on and have formalized a plan, a good well trained surgeon can help you achieve that.

Teri Hausman: And again, I always recommend going to a board certified plastic surgeon for facelifts and body work and all that kind of stuff, but there’s great Derm’s out there that do great laser work, and just make sure you do your research on your doctors.

Dr. Steven Struck: I agree with that.

Teri Hausman: Thank you so much for being with us today Dr. Struck. We’ll have you back to talk about all the other great new exciting lasers that are out there. And if anybody would like a transcript of today’s show, just go to personallifemedia.com, and we’re going to link you up to Dr. Struck’s website from our website so you can get a hold of them if you want to go in there and get a consultation or if you have any other questions. If you’d like a transcript go to personallifemedia.com. And if you have any questions, email me at t-e-r-i, @personallifemedia.com ([email protected]). Thanks again for being with us today, and we’ll look forward to having you back.

Dr. Steven Struck: Alright, thanks for having me.