Why did I lose facial volume after laser radio frequency treatment?

We are continuously seeing people who are distressed by facial volume loss after

treatment with thermal energy devices this reflects a growing trend in the

aesthetic field I feel that thermal or skin heating devices such as the various

branded laser and radiofrequency technology are often aggressively

promoted as substitutes for surgical procedures such as facelifts and neck

lifts although these devices can modify the

skin through collagen stimulation and remodeling which can be beneficial for

facial aging they are not in any way replacing surgery I’ve observed the

effects of these devices being overused for people who are not candidates for

this type of technology yet these devices continue to be aggressively and

deceptively marketed as alternatives to surgery in the state of New York people

who perform lasers and radio frequency device procedures do not have to be

licensed physicians or nurses this means that unlicensed individuals can perform

procedures which can permanently change and even damage your skin regardless of

who uses these devices improper and overly aggressive use can cause facial

volume loss I’ll discuss the role of laser or radiofrequency technology in my

practice and how you can understand the indications for this technology so you

don’t overcook your skin I’m Dr. Amiya Prasad. I’m a Board-certified cosmetic

surgeon and Fellowship-trained oculofacial plastic and reconstructive

surgeon I’ve been practicing in Manhattan and Long Island for over 20

years I started using fully a blade of co2 lasers in the early 1990s since that

time I’ve continued to use light and radio frequency based technology in my

practice to help people improve the appearance of their skin prior to the

introduction of the co2 laser the gold standard for treatment of lines wrinkles

and skin discolorations was chemical peels with chemical peels whether

superficial medium or deep there is an ablation of different levels of skin

with regeneration of new skin a certain amount of collagen was created in

response to the peel which then improved the skin texture quality and color the

benefit that co2 lasers have over chemical peels is a skin tightening

effect caused by thermal energy delivered to the skin by the laser

the idea behind laser treatment is to apply a specific amount of heat from a

laser device to cause the skin to contract and to induce collagen

production through a controlled injury response these principles are relevant

when treating the skin which is about two millimeters in thickness there is a

general perception that facial aging only affects the skin which is why

anti-wrinkle creams and skin procedures are so popular the reality is that

facial aging is more significantly associated with bone loss and weakening

with sagging of the supporting soft tissue in clinical practice I’ve often

seen people in their 40s and 50s who feel that they may need some type of

tightening procedure this is because they pull upwards on the cheeks and show

me how they look better the basis for this perception is that soft tissue

volume is being repositioned through this action and improving the appearance

of areas where volume has been lost in my opinion

neither surgical lifting nor heat in skin-tightening is the optimal approach

to this type of situation if there is volume loss you restore volume however

it’s important to restore volume in the most anatomically beneficial way volume

loss is managed by the placement of injectable fillers in my practice I

prefer the hyaluronic acid fillers such as the Restylane and Juvederm family of

products traditional place where the fillers is within the skin at the level

of the dermis or just below the skin I approach facial volume loss differently

since a significant amount of volume loss is at the bone level I perform a

procedure called Structural Volumizing this method is based on applying the

principles used for the placement of facial implants such as cheek and chin

implants these implants are routinely placed on the bone and below the facial

muscles as a surgeon I’ve performed many of these procedures and I’m familiar

with this space I place long lasting fillers such as Juvederm Ultra Plus or

Juvederm Voluma to restore volume at the cheeks chin and jaw angle this method of

restoring volume lost by aging is much more impactful than any thermal energy

procedure once you understand this principle

you’ll recognize why heating up the skin makes no sense when the underlying issue

is the facial bone volume loss for people who are in their 50s and older

sagging of the supporting tissue called the smash and platysma muscle results in

gels and loose neck skin the optimal procedure for this type of situation is

a facelift or face a neck lift surgery this group of people is particularly

susceptible to the false promises of thermal based non-surgical face lifting

in addition at this time of your life your skin is thinner and the layer of

youthful fat under the skin continues to diminish in my practice I help many

people over the past two decades overcome their

fear of facelift surgery by performing these procedures and my certified office

operating facilities under local anesthesia with light intravenous or IV

sedation by avoiding both general anesthesia and institutional facilities

such as hospitals where you can feel like a number

my patients are able to undergo more definitive surgery with quicker recovery

the science behind thermal induced collagen remodeling as well as thermal

induced fat reduction is sound and can be effective the problem is that people

who are looking for a solution for volume loss and deeper tissue sagging of

being sold procedures which don’t deliver an often result in making you

look worse than you did before it is often the case that after thermal

treatment is not successful the practitioner will often dial up the heat

intensity or prolong heat exposure to the skin excessive use of heat or

prolonged exposure to thermal energy devices can result in loss of fat below

the skin a layer of fat under the skin is important for the appearance of

smooth and youthful skin this means that the treatment makes the skin end up

looking older other complications include skin burns blistering scarring

and prolonged redness during consultation it’s routine for patients

to ask me about different devices which they hear about I suggest to them to

first take an overview of the problems which concern them before determining

the options which suit their needs I take an

inside-out approach this means understanding the presence and extent of

one bone volume loss too soft-tissue volume loss three support

tissue and skin sagging and four skin quality in terms of wrinkling

discolorations and vessels based on understanding of the potential benefits

of thermal energy devices in improving skin thickness and smoothness I

developed strategies to achieve these goals with significantly lower risk we

use a variety of lasers in our practice such as fractional co2 fractional erbium

nd AG Q switch as well as radio frequency devices such as peleve when it

comes to aging skin there is usually a combination of issues such as wrinkles

and discolorations if we focus on the typical objectives of a therapy which is

to both stimulate the production of new collagen and improve the arrangement of

the collagen bundles skin looks younger and thicker and more even than we could

look at all the ways these objectives can be achieved

we should also factor in what is the potential capacity of a person’s skin to

produce collagen this capacity to produce collagen will be limited by

factors such as age sun damage smoking and previous treatments for many people

who come in for consultation they’ve previously had chemical peels lasers and

radiofrequency treatments this means there may be no effect or benefit from

thermal energy treatment or even potential breakdown of the skin’s

integrity this is why a proper examination by a highly experienced

physician is important before signing up for a treatment in my practice I

routinely combine technologies to improve the skin let’s consider a common

situation such as skin affected by chronically excessive sun exposure and

aging for the fine lines I use fractional and fully ablative RB

co2 laser for discolorations I use a q-switched laser for dermal thickening I

will use limited heating with long pulsed erbium as well as nd-yag laser

technology the technology used with long pulsed nd YAG can be used for both skin

remodeling and tightening as well as fat reduction for many patients I will also

do a procedure called skin boosting this is where I combine PRP or platelet-rich

plasma combined with hyaluronic acid and use a device to deposit this mixture

directly into the dermis and this is done without any bleeding or bruising

this combination will stimulate the collagen production and improve the skin

without heating many people who come to our office upset and angry about facial

volume loss from overuse of a thermal energy device performed elsewhere are

relieved to have a rejuvenated appearance by a rational approach from

the inside out most often a combination of structural

volumizing with skin boosting and an epidermal treatments such as hydro

facial results in a natural and improved appearance deceptive and high-pressure

marketing in the aesthetic field is not going away anytime soon the key is to

find a doctor you can trust and who you feel understands your cosmetic concerns to help you look your best

I hope you found this information helpful thank you for your question