Vampire Facelift. How We Do It?

Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radiofrequency delivers a high-frequency electric current—tissue resistance to electrical current results in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment. INITIALLY, the FDA approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is reducing fat and tightening the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin first and then remove excess fat. However, if he determines that there is fat mainly in an area, he will remove the fat first and then tighten the skin afterward. “Radiofrequency is a versatile procedure that can be used on any area of the body – from large areas like the abdomen to minimal areas such as the chin – with the same degree of success.

Fat transfer has become an increasingly important method of facial rejuvenation both as a standalone procedure and in combination with traditional rejuvenation methods, like face-lifting, brow lifting, and Blepharoplasty. A variety knows fat transfer names, of which the most commonly used are fat transfer, fat injection, and autologous fat grafts. The word autologous means material (fat) is harvested from one area and donated to another in the same individual. Fat transfer is particularly suited for restructuring the proportion of the face. Typical facial structures can also be aided by adding constructive elements to correct a broad range of perceived facial deficiencies. For example, a stronger jawline creates a youthful, more powerful-looking face; eliminating the hollowness of lower lids helps reduce that tired, sad appearance; and fuller lips create a more youthful, attractive appearance. Other indications include congenital, traumatic defects, or surgical defects and scars. Nano fat is applicable in a wide range of indications to improve skin quality; trophic skin changes caused by age and sun damage, pigmentary skin conditions, and scarring non-facial areas such as the neck, the décolleté area, and the hands can also greatly benefit from the use of nano fat grafting, sometimes in combination with micro fat.

Facelift filler injections results are very satisfactory for both patients and physicians. Facelift filler injection involve the use of two principal categories of temporary fillers approved by the U.S. Food and Drug Administration for facial rejuvenation: hyaluronic acid and calcium hydroxyl apatite. The selection of HA implant is based on the indication and site of placement. For lifting and restoring volume and improving the structural foundations and facial contour, a high-density HA implant is injected deeply into the supra-periosteum. To treat medium-deep depression, we used a mid-density hyaluronic acid filler injected subdermal. For treating the periorbital area and the area around the lip, giving finished facial refinements, a low-density hyaluronic acid filler is selected with a water-like consistency filler. The most significant limitation of a filler is the cost. Each syringe can be expensive. The greatest benefit of a filler is accuracy. The other benefit is that a filler is bioinert and does not increase with a patient’s weight gain but obviously may not look good when a patient gains or loses weight as the filler has been injected to match a person’s current weight status.

Facelift Botox injection result is the most appreciated in cosmetic medicine. BOTOX dosing and injection points should be based on assessing the patient’s anatomy, goals, preferences, and the physician’s own professional experience with prior treatments. Gender, cultural, and ethnic standards of attractiveness may significantly influence the patient’s preference. Each patient’s treatment should be individualized for the best results. Cosmetic BOTOX in the mid and lower face and neck has increased drastically over the past few years. Indeed, there is now a greater appreciation that BOTOX-A is one part of overall facial rejuvenation therapy, in which all aspects of aging are addressed in the same individual. Finally, new esthetic indications emerge, including the treatment for scars, the horizontal upper lip line, musculus risorius excessive gingival display (‘‘gummy smile’’), and masseter reduction to improve facial shape. BOTOX is also beneficial with other aesthetic modalities, such as dermal fillers, laser, skin resurfacing, and surgery. Several more general applications push BTX-A toward an ‘‘art,’’ rather than a clinical procedure.

Fat Injection results in satisfactory rejuvenation around the eyes or periorbital region with little recovering time. Fat transfer to the forehead is an excellent method to lift the eyebrows without raising the brow to an unnaturally high position. Micro-fat or nano fat grafting can fill the skeletonized upper lid sulcus. Fat injected into the lower eyelid region will shift the cheek up and build the convexity of the youthful eye. Lower-lid volume replacement is also helpful in treating dark circles under the eyes by reducing shadows and the appearance of blood vessels under the skin. Microfat Injection is also an excellent choice for correcting static wrinkles that it cannot treat with BoNT alone. In most patients, I must undertake the treatment of the infraorbital, cheek, and tear trough areas together. I must combine fat Injection with a skin-only eyelid lift to achieve desirable rejuvenation.

Fractional radiofrequency (FRF) is the newest in the nonabrasive approach. FRF uses an array of microneedles arranged in pairs between which bipolar RF energy is delivered. The fractionally delivered energy creates zones of thermally damaged skin adjacent to unaffected areas. The damaged skin stimulates wound healing and deposits new collagen, elastin, and hyaluronic acid formation. The unaffected areas serve as a reservoir of stem cells that accelerate wound healing.  FRF improves acne scars, large facial pores, and skin quality. FRF devices are safe, tolerable, and effective modalities for wrinkles and facial laxity reduction. I may use a topical anesthetic cream before the treatment to minimize pain. Fractional radiofrequency is combined with PRP with significant amounts of growth factor and heal promoting factors to fasten healing. Recently, Nanofat has been combined with fractional radiofrequency to enhance skin quality and stimulate hair follicles. Fractional radiofrequency gives a wake-up call to your skin to remove injured collagen and elastic fibers, encouraging your fibroblast to synthesize new collagen and stimulate hair follicles to stem cells.

Skin rejuvenation laser peel involves the removal of the outer layer of damaged skin. Many ablative skin resurfacing techniques are available at MSI, broadly grouped as mechanical, chemical, and laser abrasion. All ablative techniques result in upper to the mid-dermal wound. Dermabrasion relies on mechanical 'cold steel' injury, acid peels result in a 'caustic' injury, and lasers result in a thermal injury. All ablative resurfacing treatments work the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Superficial or medium resurfacing is limited to the epidermis and papillary dermis. For deeper resurfacing, I can also remove the upper levels of the reticular dermis. Unlike chemical peels and dermabrasion, laser skin resurfacing (LSR) with the CO2 laser generates heat, which results in immediate tightening because of the shrinkage of collagen, which forcefully shortens the collagen fibers by 30%. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, nevi, epidermal growths, and even tumors, and a tightening effect that improves the skin's overall appearance. The laser stimulates the growth of healthy new collagen and elastic fibers in the skin continuously for six months after resurfacing. Therefore, any wrinkles or scars will continue to improve for up to one year. Nonablative or minimal ablative fractional CO2 holds great promise in both treatments of skin textural abnormalities (acne scarring, wrinkles, and skin mottling associated with photoaging) and pigmentary variation (melasma, hyperpigmented scars, lentigines, and dyschromia

Acne inversa or hidradenitis suppurativa (HS) is a disease that usually begins as pimple-like bumps on the skin. The pimple-like bumps tend to develop in places where everyday pimples do not appear. HS is most common on the underarms and groin. Getting treatment for HS is important. Early diagnosis and treatment can prevent HS from worsening. If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto clothing. This fluid often has a foul odor. As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to improve and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because HS can look a lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis.

A dermatologic surgeon usually does plantar warts removal. Plantar warts are small growths that usually appear on your feet' heels or other weight-bearing areas. This pressure may also cause plantar warts to grow inward beneath a hard, thick layer of skin (callus). Plantar warts are caused by HPV. The virus enters your body through tiny cuts, breaks, or other weak spots on the bottom of your feet. Dermatologists have many treatments for warts. The procedure used depends on the patient's age and health. I prefer to cut the callus by scalpel. Then I use a curette to remove the viral material. Then I use a vascular laser to burn or cauterize tiny blood vessels that feed the virus. Then it cauterizes the base using an ablative laser or chemical TCA. A topical antibiotic is applied, and a special dressing is applied. The patient can walk without any pain immediately

There has been a 70% increase in minimally invasive cosmetic procedures and a 50% increase in dermabrasions over the past decade. Dermabrasion has many applications as a skin resurfacing technique and is used to treat fine perioral rhytids and many scars, including acne scars. It is done under local anesthesia with the option of sedation. The area to be dermabraded is marked. The appropriate diamond fraise tip is chosen, the skin is held taut, and the dermabrader is moved across the surface with constant, gentle pressure. A back-and-forth motion is used for the diamond fraise tip. The borders of the treated area are feathered to prevent any noticeable transitions. The depth of skin that is dermabraded is one of the most critical factors that will determine the outcome. Punctate bleeding is visualized when entering the papillary dermis. The papillary reticular junction is the ideal endpoint of Dermabrasion and is identified by increased, confluent bleeding. Immediately following the procedure, saline-soaked gauze moistened with dilute epinephrine may be temporarily placed on the open wounds to achieve hemostasis. A moist environment is necessary to promote wound healing. Dermabrasion is a useful skin-resurfacing tool; when performed correctly, it can achieve dramatic results and can be more effective than chemical peels or lasers, with a low risk of complications in patients with darker complexions