Why do nonsurgical treatments such as Ultherapy work so well on some and seemingly not at all on others? I have been scanning the “worth it” ratings on Real Self, in particular, the negative reviews for nonsurgical treatments. I wanted to see if I could identify common themes so that I can make the best recommendations for patients, and I did identify some common denominators. The largest category is the thumbs down review that starts something like this: “I wanted to avoid having a facelift, and even though I didn’t expect a lot, it didn’t do anything.” Sometimes the patient states their age or posts a picture, but often not. What is clear is that the majority of these patients were not good candidates for the treatment but were sold on it anyway.
It’s a tricky decision to navigate, for both the patient and the doctor. Patients are understandably reluctant to spend the money and downtime on surgery, and/or are afraid of looking unnatural. Doctors are eager to fulfill this desire with advanced but sometimes expensive technologies. But if the treatment doesn’t fit the condition being treated, the stage is set for disappointment.
When to say no
This is where it is important for the plastic surgeon to “just say no” to the patient who expectations are not in line with what can be realistically accomplished with nonsurgical approaches. I probably turn down more patients for Ultherapy than I accept, though I believe in the technology and have considerable experience with it. If I don’t think you are going to be happy with it, we are both better off if you save your money until you can afford to do what will deliver the best result. If you are absolutely set against surgery, then you must be absolutely willing to accept minimal results with alternative treatments.
No such thing as a nonsurgical facelift
In general, nonsurgical procedures work better on younger patients, which is one of the reasons why I have always maintained that there is no such thing as a nonsurgical facelift. The final effect of nonsurgical treatments is inherently variable, relying on the patient’s collagen-building capability. This diminishes with age and cumulative skin damage, leading to the visible manifestations of aging that are the reason for seeking treatments in the first place.
An advantage to seeing a plastic surgeon for facial rejuvenation even if you are not considering surgery is to get a realistic perspective on what to expect from different alternatives. A practitioner without the option of offering surgery might have an incentive to promote their own particular devices, rather than lose the patient. This is a business after all; devices and products in aesthetic medicine are expensive, and the incentive to hype up expected results is real.