Patients often ask “How long will my facelift last?” or “How often do my breast implants need to be replaced?” After doing plastic surgery for more than 30 years, I have a much better handle on how to answer these questions. I try to post “before and after” pictures that are realistic in terms of complete healing, and representative of a stable long-term result. I am not impressed with the “on the table” before & after so popular on social media, though I appreciate the dramatic effect and instant gratification. But the trend I am seeing is about the long game: longer lasting fillers such as RHA, longer lasting wrinkle relaxers such as Daxxify, better breast implant designs such as Ideal saline implants, and even longevity medicine for longer healthspan.
The original living internal bra
What got me thinking about this subject was a patient I saw recently, more than 15 years after a complex revision on her breast implants. She was an early case with Alloderm, an acellular dermal matrix material I was using as an internal bra. This was before Strattice, and years before Galaflex. I had previously published an article documenting that Alloderm transformed into durable living tissue (the original living internal bra), so I was curious to see how well it held up in this patient. We did a VECTRA 3-D analysis (also unavailable back in the day), and her improved symmetry has remained remarkably stable.
Regenerative facelifts for true anti-aging results
Facelifts are a bit of a different story, since we are “setting back the clock” rather than stopping aging. How far back the clock is set depends on the age of the patient and the condition of their skin. Usually we say 10-15 years, but here again there are techniques that promote longer-lasting results; it may be possible to slow the clock as well as set it back. For example, one major advance is the recognition of facial fat atrophy as a hallmark of aging, and so fat grafting and nanofat to promote tissue regeneration are becoming increasingly used.
Some go so far as to call this a “regenerative facelift,” and I am increasingly adopting this approach. It fits nicely into my interest in longevity medicine. We are doing more microneedling with exosomes, for example, which packs a powerful regenerative punch to the tissues. And we are tracking our results with a validated photo age clock developed from sophisticated artificial intelligence technology.