Why You Should Still Get Fillers after a Facelift

Facial aging has been a frustrating problem faced by the many generations that came before us. It has taken centuries for us to develop proven strategies that get lasting results. For a time, the most effective strategies involved surgery. In recent history, several nonsurgical techniques for cosmetic correction have been developed. These include a sea of injectable products, such as Botox and dermal fillers. When these convenient approaches became available, many people were led to believe that they held their own against surgical lifts. They might, but they won’t replace them forever. Interestingly, we find that the best results often come from a combination of facelift surgery and dermal fillers. This is why.

The Effects of Aging

When we age, we make less collagen than we did when we were young. This is a well-known and often-mentioned fact. More than that, though, the collagen strands that exist in the dermis also degrade. They break down as a result of chemical changes, hormones, sun exposure, and even stress. There’s even more. Studies show that, as we get older, our bone structure changes. The cheekbones degrade and the orbital sockets around the eyes widen. These changes to the very foundation of the face have a profound effect on appearance. They also need to be a guiding factor in how we address cosmetic aging.

What a Facelift Does

A surgical facelift is a technique in which the muscle and connective tissue in the deeper plane of the face, usually the mid-face, are repositioned. Through small incisions at the very outer edges of the face, tiny instruments are inserted to lift this plane of tissue and secure it higher on the cheekbones. After underlying tissue is secured, excess skin is trimmed and incisions are closed. One might think that this process can resolve all of the issues on the mid and lower face. It doesn’t, at least not for everyone.

Fillers Pick Up Where the Facelift Leaves Off

The purpose of dermal fillers is to enhance the volume of the dermis. Enhancing volume means that the contours of the face are improved. Fine lines and creases, those that may not be eliminated by a facelift, can be smoothed quickly with soft dermal fillers. The cheeks can be accentuated so they “pop” and are easier to contour with (or without!) makeup. After a facelift, dermal fillers can be the cherry-on-top that refines the face in subtle yet important ways.

Dr. Salzman has happily served the Louisville area for the past several years. Facelifts are one of his specialties, and each is personalized to the patient’s unique needs. Learn more about the valuable combination of facelift and fillers at (502) 425-5200.

The Truth About Common Facelift Myths

Although the facelift is one of the oldest plastic surgery procedures, there are still some common myths and tropes about it and the patients that pursue it. The truth is that the facelift is one of the most effective facial rejuvenation methods available. Here are some common misconceptions to dispel as you consider your options.

You need to be over a certain age to get one

The truth about this statement is that there is no limit on who can get a facelift when it comes to age. In fact, trends are showing that many patients are pursuing facelifts at younger and younger ages, hence the popularity of the mini facelift. Because everyone ages at different rates and because of different causes, there’s no hard and fast rule about being over a certain age. As a general rule, patients that are beginning to show signs of aging can benefit from facelift techniques.

It freezes your face in place

Although there are some notorious examples of facelifts gone wrong, plastic surgery techniques are constantly evolving. The facelift and the aging process are much better understood than they were a few decades ago, and you may even know someone who has secretly had a facelift. Most board-certified facial plastic surgeons now practice techniques that produce subtle, natural results that reflect a younger version of yourself. For this reason, you should always screen your plastic surgeon’s credentials and prior results to see whether they can achieve the natural results you want.

Non-surgical treatments are just as good

Non-surgical treatments can be a great option for some patients, but in most cases, it can’t beat the deep rejuvenation that accompanies a facelift. One of the most important steps of a facelift is tissue repositioning and muscle tightening, which can restructure the contours of the face. Although some non-surgical treatments can be effective at smoothing wrinkles, they can’t accomplish the long-term results of a surgical facelift. In some cases, a facelift can remove a decade or two from the facial profile. However, many patients still benefit from a combination approach to facial rejuvenation.

The facelift can be one of your best options when it comes to rewinding signs of aging and refreshing your look. To see what facelift options are available to you, schedule a consultation with Dr. Salzman by calling or filling out our online form.

What an Eyelid Lift Can Do for You

The eyes can be one of the first places that aging begins to show. It can come in the form of wrinkles, but it can also manifest in sagging skin and fat as the face begins to lose volume. If your face normally appears angry, sad, or tired, it can sometimes be corrected with rejuvenation around the eyes. This surgical procedure can offer you the following benefits and effectively remove a few years from your facial contour.

Correct Hooded Eyes

Heavy upper eyelids can often be corrected with an eyelid lift or a forehead lift, depending on what’s causing it. An eyelid lift can be most effective on eyes that are naturally hooded or are the result of excess skin below the brow that has lost volume. This lift can create more eyelid space and give the appearance of a wider, younger eyelid crease. Many older women often struggle to wear eye makeup because it can quickly rub off during the constant contact with sagging skin.

Remove Fatty Bags

The lower eyelids and undereye area can be prone to sagging as well during the aging process. The fat and volume that naturally exist under the eye can sink over time, creating bags that are fatty and give the appearance of constant tiredness. This procedure can remove the accumulated fat and restore the undereye to a higher, more awake position.

Widen the Eyes

As aging and gravity take their toll, the eyes can appear heavy, tired, and closed. The overall effect of an eyelid lift is to restore the appearance to one that is alert, awake, and youthful. The effect can be drastic within the rest of the face, especially when coupled with a facelift or other facial procedure to smooth wrinkles and restore volume.

To discuss your eyelid lift and other facial rejuvenation options, contact our office and schedule a consultation with Dr. Salzman.

Moms, It’s Time for Your Makeover

Spring is the time of year for flowers, rain showers, and celebrating what makes mommies great. the Moms make a lot of sacrifices, but feeling great in their body shouldn’t be one of them. Many women experience pregnancy and childbirth but feel resigned to the toll that it can take on their body. A mommy makeover is a set of procedures that can restore and rejuvenate the body to its pre-pregnancy state. Here are some of the things that can be included in your customized treatment.


The breasts play an important part in pregnancy and nursing, but they can, unfortunately, change permanently in shape, size, and position during the process. Many women find their breasts have grown to an uncomfortable size or become stretched out and saggy. A mommy makeover can include a breast procedure to lift, reduce, or augment the breasts to restore them to their natural shape. It can sometimes even be performed with a combination of two techniques, like a reduction and lift. Dr. Salzman can help you plan your treatment techniques to ensure you get the breasts you want.


Perhaps the most affected area during pregnancy and childbirth is the stomach, which can be left with excess skin or pockets of fat due to the way the female body stores fat during pregnancy. Diet and exercise sometimes aren’t enough, so a tummy tuck can restore a slim, contoured abdomen. Many women also struggle with loss of muscle tone in the abdomen, which can be corrected by tightening and suturing the abdominal muscles, which is commonly practiced during the procedure. These can become stretched and ineffective during childbirth and are unable to be restored through exercise.


Although the breasts and stomach are the two most commonly treated areas, many women opt for additional procedures to add the finishing touches to their new body. Whether it’s additional liposuction, fat transfer, vaginal rejuvenation, facial procedures, or non-surgical rejuvenation techniques, it can be a great way to feel like a new, better you.

To begin your mommy makeover journey and discuss any questions you may have, contact our office and schedule a consultation with Dr. Salzman.

Introducing Vivace!

The Holy Grail it seems in plastic surgery, at least over the last 15 years or so, is skin tightening without surgery. We know that a modern facelift can restore a youthful shape of the face as well as tighten the overlying skin of the face and neck. Because a facelift necessitates making of incisions, some type of anesthesia, as well as the perceived downtime away from work or family, there are a multitude of patients who would opt for a noninvasive or minimally invasive modality to accomplish the same goals. While we do have neurotoxins such as Botox, Dysport and Xeomin, which can paralyze underlying muscles rendering the overlying crease less deep, as well as a plethora of different fillers, either made from hyaluronic acid or other substances, to make the face more youthful, none of these entities will tighten the overlying skin or improve upon fine lines for texture.

For the last 20 years or so we have had ablative lasers using wavelengths of carbon dioxide or Erbium, whether in a fractional or a full field coverage of the face that can produce skin tightening, these lasers need to deliver their energy to the deeper portion of the skin called the dermis and do not have the ability to spare the outer part of the skin called the epidermis. Therefore, when doing ablative laser resurfacing, when the outside layer of skin is removed, some downtime is necessary for healing and, until the outside skin has grown back, make up cannot be used during this healing process. This forced patients scheduling these more aggressive procedures during periods of time in which they could accept these downsides in order to obtain a result of skin tightening, correction of texture and fine lines, as well as the improvement in brownish discolorations.

Some of the newer technology, have used radiofrequency (RF) as a method of tightening skin. These radiofrequency waves, commonly used in telecommunications, have also been used in surgery for over 75 years, mostly in surgical or dermatological applications for both removal of superficial skin blemishes or cutting, and coagulation of blood vessels during surgery. RF works by rapidly stimulating the oscillation of molecules causing internal friction and thereby heat. The heat produced by RF is thought to ‘injure’ the deeper part of the skin causing an inflammatory response by the patient producing new collagen and elastin. Both of these entities, when increased, produce a more elastic and tightened skin appearance.

The first wave of RF devices applied the heat from the outside-in with some type of method of cooling to allow the heat to preferentially be absorbed in the dermis. Because of the human intolerance of outside-in heat of temperatures in excess of 43°C, there was some limitation in how much tightening one could get in a single session. Multiple weekly or biweekly treatments are necessary to produce the desired effect.

The next advancement in the application of RF was to place the heat under the skin using a long insulated needle. Here, using local anesthesia, higher temperatures at the bottom of the skin could be reached and still tolerable by the patient. The technique is called ThermaTyte and we have had this for several years now. It’s very effective for skin laxity around the belly button as well as neck. It does have some downtime, as a fair amount of dilute numbing medicine needs to be placed beneath the skin to make it tolerable.

The latest advancement in the application of RF for the tightening of skin utilizes the placement of this energy through the skin using tiny, hair size needles, known as microneedling. Microneedling involves, either with a roller or piston type stamping method, the insertion of an array of needles into the skin. No skin is removed and the hole simply closes within hours. While open, topical application of serums, that would otherwise not be absorbed, can be placed over the skin allowing them to gain entry to the deeper layers. The improvement in the quality of skin texture is limited only to the length of the linear hole that is made into the skin. Radiofrequency heat energy can be added to the end of the needle so microscopic injuries in the deeper portion of the skin can be made. We can control not only how much energy, but also how long the energy is applied, as well as the exact depth of its placement using a computerized screen. This new device is called Vivace.


Vivace uses an array of 36, 1/3000th of an inch wide, goldplated needles attached to a computerized mechanism that when placed on the skin can pierce the skin and deliver the radiofrequency energy in a fraction of a second. The technique does require the topical application of a numbing cream for about 45 minutes prior to the procedure. Because not all of the skin can be treated in one session, a series of treatments is necessary to produce the desired result. Multiple treatment depths can be done in the same session. We are commonly treating skin laxity of the face, stretch marks of the abdomen and legs, active acne as well as acne scarring using this new exciting technology.

So far, we have found this technique to be extremely useful in producing nice results in all the patients. Because the energy bypasses the outside layer of the skin, any skin color or amount of skin tan is amendable to this treatment regimen. After the procedure, we have seen that the skin is merely red or pink for a few hours. Makeup can easily be applied the following day. Some patients have found that there is a gritty feeling texture to their skin but is usually not visible under makeup. We recommend a series of at least four treatments at 4 to 6 week intervals. It seems we finally have a method to treat all patients in all seasons with issues of acne scars, stretch marks, skin laxity of different areas of the body.

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