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Why Facial Fat Loss Can Occur after Lasers and RF Devices

People contacting us who are concerned about facial fat loss following treatment with thermal energy devices are a growing problem in the aesthetic field. Thermal devices, such as laser and radiofrequency devices, are frequently aggressively marketed as alternatives to surgical procedures such as facelifts and neck lifts. Although these devices can help with facial aging by stimulating collagen and remodeling the skin, they are not a replacement for surgery.

Aggressive Marketing, and the Risk of Overusing Lasers and RF Devices

I’ve noticed that these devices are being overused for people who aren’t candidates for this technology, yet they’re still aggressively and deceptively marketed as surgical alternatives. People who use lasers and radiofrequency devices in the state of New York are not required to be licensed physicians or nurses. This means that unlicensed individuals can perform procedures on your skin that can permanently alter and even harm it.
laser volume loss illustration
effects of heat on fat layer and facial volume illustration

Regardless of who uses these devices, improper and overly aggressive use of lasers or radiofrequency devices can cause facial fat 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.

Laser Treatment vs. Chemical Peels

Prior to the introduction of the CO2 laser, chemical peels were the gold standard for treating lines, wrinkles, and skin discolorations. Chemical peels, whether superficial, medium, or deep, ablate different levels of the skin, resulting in the regeneration of new skin. In response to the facial peels, a certain amount of collagen was produced, which improved the skin’s texture, quality, and color.

fractional laser demo
CO2 lasers have a skin tightening effect that chemical peels do not have because of the thermal energy delivered to the skin by the laser. The idea behind laser treatment is to use a laser device to apply a specific amount of heat to the skin, causing it to contract, and to induce collagen production through a controlled injury response. These principles apply when treating skin with a thickness of about 2 mm.

The Role of Bone Loss in Facial Aging

There is a widespread belief that facial aging only affects the skin, which explains the popularity of anti-wrinkle creams and skin procedures. In reality, facial aging is more closely associated with bone loss, and weakening as well as sagging of supporting soft tissue. In clinical practice, I frequently see people in their 40s and 50s who believe they may require a tightening procedure.
non-surgical face lift before and after
non-surgical facelift before and after
This is because they pull their cheeks up and show me that they look better. The basis for this perception is that this action repositions soft tissue volume, improving the appearance of areas where volume has been lost. Neither surgical lifting nor heat-induced skin tightening, in my opinion, is the best way to handle this situation. If there is a volume loss, volume should be restored. However, it is critical to restore volume in the most anatomically beneficial way possible.

Why Structural Volumizing is Better for Facial Fat Loss Treatment

Injectable fillers are used to manage volume loss. In my practice, I prefer hyaluronic acid fillers such as those found in the Restylane and Juvederm lines. Fillers are traditionally placed within the skin at the level of the dermis or just below the skin. I approach facial volume loss in a unique way. Since there is a significant amount of volume loss at the bone level, I use a procedure called Structural Volumizing.
how Dr. Prasad avoid pillow face from fillers - liquid facelift or y lift before and after recovery
how Dr. Prasad avoid pillow face - y lift before and after recovery
This method is based on the principles of facial implant placement, such as cheek and chin implants. These implants are typically placed on the bone and beneath the facial muscles. As a surgeon, I’ve performed many of these procedures and am well-versed in this field. To restore volume at the cheeks, chin, and jaw angle, I use long-lasting fillers like Juvederm Ultra Plus or Juvederm Voluma. This method of restoring volume lost due to aging has a far greater impact than any thermal energy procedure. When you understand this principle, you’ll understand why heating the skin makes no sense when the underlying problem is facial bone volume loss.

Facial Volume Loss Treatment for Women above 50s

Sagging of the supporting tissue called the SMAS, and platysma muscle causes jowls and loose neck skin in people in their 50s and older, so facelift, or face and neck lift surgery are the best option in this situation. This demographic is especially vulnerable to the false promises of non-surgical thermal face lifting.
surgical facelift and facial laser skin tightening before and after
surgical facelift and facial laser treatment before and after

Furthermore, at this age, the skin is thinner, and the layer of youthful fat beneath the skin is diminishing. Over the last two decades, I have helped many people overcome their fear of facelift surgery by performing these procedures in my certified office operating facilities under local anesthesia with LITE IV sedation. My patients are able to undergo more definitive surgery with faster recovery by avoiding both general anesthesia, and institutional facilities such as hospitals where you can feel like a number.

Why Facial Volume Loss Can Happen from Laser / RF Devices

The science behind thermal-induced collagen remodeling, and thermal-induced fat loss is sound, and has the potential to be effective. The issue is that people seeking a solution for volume loss and deeper tissue sagging are being sold procedures that don’t work, and often make you look worse than you did before.
heat affects the fat layer cell illustration

When a thermal treatment fails, the practitioner will frequently increase the heat intensity, or expose the skin to prolonged heat exposure. Excessive heat use or prolonged exposure to thermal energy devices can result in fat loss beneath the skin. The presence of a layer of fat beneath the skin is essential for the appearance of smooth, youthful skin. This indicates that the treatment made the skin appear older. Skin burn, blistering, scarring, and prolonged redness are some of the other complications.

woman with hyperpigmentation on face from laser
During consultation, it’s routine for patients to ask me about different devices that are being promoted. I suggest first taking an overview of the problems before determining options. I take an inside-out approach, which means understanding the presence and extent of: 1) bone volume loss, 2) soft tissue volume loss, 3) support tissue and skin sagging, and 4) skin quality in terms of wrinkling, discolorations, and vessels.
Non-surgical laser jowl lift before and after by Dr. Amiya Prasad Garden City, Long Island
Non-surgical laser jowl lift before and after
If we limit the potential use of thermal energy devices toward the goal of improving skin thickness and smoothness, I have developed strategies to achieve these goals with much lower risk.

Combining Technologies for Optimal Skin Improvement

In our practice, we use fractional CO2, fractional Erbium, Nd:YAG, Q-Switch, and radiofrequency devices such as Pelleve. When it comes to aging skin, the most common problems are wrinkles and discolorations. If we focus on the typical goal of a therapy, which is to both stimulate the production of new collagen, and improve the arrangement of the collagen bundles so that the skin appears thicker and more even, we should consider all possible approaches to achieving these goals.
upper and lower blepharoplasty before and after performed in Prasad Cosmetic Surgery Manhattan office
upper and lower blepharoplasty before and after performed in Prasad Cosmetic Surgery Manhattan office

We must also consider a person’s skin’s potential capacity to produce collagen. Age, sun damage, smoking, and previous treatments will all limit your ability to produce collagen. Many of the people who come in for consultations have previously had chemical peels, laser treatments, or radiofrequency treatments. This means that thermal energy may have no effect, or that the skin’s integrity may be compromised. This is why, before committing to a treatment, a thorough examination by a highly experienced physician is essential.

I routinely combine technologies to improve the skin in my practice. Consider a common scenario: skin that has been damaged by chronically excessive sun exposure and aging. I use fractional and fully ablative Erbium and CO2 lasers to treat fine lines. I use a Q Switch laser to treat discolorations. I plan to use a combination of long pulsed Erbium and Nd:YAG lasers for dermal thickening.

solar lentigo before and after laser treatment for Wrinkles
before and after solar lentigo and laser treatment for wrinkles

Long pulsed Nd:YAG technology can be used for both skin remodeling, tightening, as well as fat reduction. For many patients, I will also perform a procedure known as Skin Boosting. This is where I combine PRP or platelet rich plasma, with hyaluronic acid and deposit the mixture directly into the dermis using a device. This combination stimulates collagen production and improves the skin without the use of heat.

not stem cell facial but PRP and HA fillers for crows feet

How We Can Help You Recover from Facial Volume Loss Caused by Thermal Energy Devices

Many people who come to our office upset and angry about facial volume loss caused by overuse of thermal energy devices elsewhere are relieved to have a rejuvenated appearance, which is a result of a rational approach from the inside out. A combination of Structural Volumizing (Y Lift), Skin Boosting, and an epidermal treatment such as HydraFacial usually result in a natural and improved appearance.

jawline filler before and after Manhattan NYC
jawline filler before and after

Deceptive and high-pressure marketing in the cosmetics industry is not going away anytime soon. The key is to find a doctor you can trust, who understands your cosmetic concerns, and can assist you in looking your best.

I hope you found this information helpful.

Facial Volume Loss Treatment NYC and Long Island, New York

Dr. Amiya Prasad is a Board-certified cosmetic surgeon, and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan, and Long Island for over 25 years. He started using fully ablative CO2 lasers in the early 1990s. Since that time, he has continued to use light and radiofrequency-based technology in his practice to help people improve the appearance of their skin. To schedule a consultation, fill out the contact form below, or you may call any of our offices at (212) 265-8877 for Manhattan, New York City; (516) 742-4636 for Garden City, Long Island; or (703) 356-1336 for Vienna, Virginia.

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