Cosmetic Plastic Surgery Articles

Facial rejuvenation procedures continue to be the fastest-growing segment of cosmetic plastic surgery, and botulinum toxin type A injections are one of the biggest reasons why. Last year, close to 7.7 million of them were done in the United States, which set a new annual high, according to the American Society of Plastic Surgeons.

(Dermal fillers were second on the list of most-performed cosmetic procedures last year, at 2.7 million.)

You’re probably more familiar with the different brand names of botulinum toxin type A: Dysport, Xeomin, Jeuveau, and, of course, Botox. While there are subtle differences between them, they all work the same way, essentially. 

In order for any muscle to contract, the nerves release a chemical messenger called acetylcholine at the point where nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the cells to contract, or shorten.

Botulinum toxin type A injections prevent the release of acetylcholine, which stops the muscle cells from contracting. Basically, they temporarily put the muscles to rest, which helps the muscle become less stiff. In the process, they also temporarily minimize or eliminate altogether creases and fine lines that stem from the constant contraction of those muscles, like forehead wrinkles, crow’s feet, and the dreaded “11” between the eyebrows.

Which one is right for you?

Without getting too technical, a board-certified plastic surgeon distinguishes between the brands based on subtle but significant differences, like how much it will spread after it’s injected. 

First, they’ll want to hear all about your expectations for the procedure. They’ll then be able to select the botulinum toxin type A that’s best suited for that particular area of the face and the desired outcome.

Much of the outcome, however, will come down to the injector. For example, the pressure that’s used to inject the botulinum toxin type A can have a big impact on the results. Also key is the injector’s knowledge of the muscles in the targeted area. It may seem fairly straightforward—rest the muscle, the lines disappear—but the human body is a series of intricate, interconnected networks.

In other words, for every action, expect a reaction.

Case in point: In order to lift the forehead, botulinum toxin type A should be injected into the depressor muscles around the brow, because they’re the ones working to pull the brow (and forehead) down. But simply injecting those muscles isn’t enough. The injections need to be precise because if they land in the wrong parts of the depressor muscles, the botulinum toxin could seep into the frontalis muscle, which lifts the forehead. 

The result in that scenario is an even heavier-looking brow than what the patient started with. And it’s surprisingly common.

Expertise matters most

I have extensive experience with doing botulinum toxin type A injections. Even more, I train plastic surgeons, dermatologists, and nurses across the country on behalf of all of the aforementioned brands in how to use them appropriately and accurately.

I’m convinced of their value in creating a younger, more vibrant appearance. But I also know that those results depend more on who’s doing the injecting than which brand is being injected.

If you would like to discuss your options, my team at Davis Cosmetic Plastic Surgery is available to answer questions and schedule your virtual consultation.

Davis Cosmetic Plastic Surgery finds facelifts to be quite nuanced. The countless buzzwords used to reference them do not add any clarity to the subtle differences between the procedures. Though, DCPS noticed one in particular seems to be drawing most of the attention this summer: the so-called “ponytail facelift.”

The name stems from the lift’s effects, which are meant to mimic that of pulling one’s hair back into a tight, high ponytail, drawing the skin of the scalp and, in turn, the forehead, cheeks, and brows upward in order to create a more youthful appearance.

Because all of that is accomplished without the traditional scars of a facelift, the name is also apparently a nod to the fact that the patient can wear their hair in a high ponytail without fear of exposing obvious scars.

What is it the Ponytail Facelift?

The name, obviously, is a generic-household term, not a medical one. But the ponytail facelift is not a textbook technique that all plastic surgeons learn about in residency. Nor is it new. Davis Cosmetic Plastic Surgery has been using “ponytail” as a descriptor for less-invasive facelifts for decades.

Much like the mommy makeover, there’s no one tried-and-true approach to the ponytail facelift. The nuances of the procedure is dictated by the needs and anatomy of the patient. That said, the overall aesthetic goal is basically the same in every case: elevate the midface and cheeks and, in turn, the partial jawline along the outer jowls for a more elevated look, without any visible scarring.

Keep in mind, plastic surgeons use different names for the various kinds of facelifts all the time, though the intended outcome and the methods used may be similar or almost identical. Also, determining which lift would suit a patient best is a highly-individualized process. 

Generally, however, a ponytail facelift refers to a limited endoscopic lift.

Who is a good candidate?

The procedure tends to be most appropriate for younger patients displaying early signs of aging, such as mild volume loss and fallen cheeks, but not sagging skin and drooping jowls. That’s because the ponytail facelift doesn’t correct a sagging neck and jawline to the same extent than an SMAS or deep-place facelift does.

And endoscopic incisions, while small in size and easily hidden, they don’t allow for skin excision.

The takeaway: Focus more on your goals for the outcome than the name of the procedure. And then once you find your surgeon, trust they’ll use their training and experience to make them a reality. 

If you want to see if this procedure is good for you, please contact the team at DCPS to schedule a consultation.