Susan Bratton: Hi, this is Susan Bratton, and I m one of Dr. Steven Struck s patients, and I have a little bit of background in interviewing. And he s giving me the opportunity to talk to him about a liquid facelift, or a non-surgical mini makeover in a little series of interviews we re doing here for his website. So I m really happy that you found us and that you re going to download and listen to this because Dr. Struck is obviously an amazing plastic surgeon. He s a board certified plastic surgeon with the American Board of Plastic Surgeons. He has gotten five years of his training at Stanford University, and he s also been involved in 20 FDA studies for Fraxel Lasers, which in a minute, after listening to this, you ll understand why it s so important in the world of the liquid facelift to know about lasers too. So I d like to introduce you to my favorite plastic surgeon, Dr. Steven Struck. Hi Steven. Dr. Steven Struck: Hi Susan. Thanks for the great introduction. I m really excited to share my experience with you with this procedure. I have many patients who think this is one of the best things they ve ever done. Susan Bratton: Well I m one of them, and so it s really fun for me to get to talk to you even more about it. I think any woman who hears about a liquid facelift is really going to think to myself, Boy, I wish I d known about this a long time ago, because it s a really easy procedure in the grand scheme of things. So lets talk about it just from a really macro perspective, the big idea of what this non-surgical mini makeover is. You ve kind of broken it into a two-part structure, so take us there first. Dr. Steven Struck: Well I think the biggest thing with the liquid facelift is number one, sometimes in plastic surgery we oversell things, overstate things. There s a great deal of marketing by companies and manufacturers. I always try to be real honest with my patients. I think that s a strong point. Many of them have told me that. And this is something that delivers. See someone right now might be listening and thinking, Oh yeah, how can you have a nice facial rejuvenation with a liquid facelift without surgery? But you actually really can achieve that, and I think the best way to think of it is holistically. Like you said, you want to know how a patient looks in the mirror? They can look at their skin surface. Is it dull? Does it have fine lines, wrinkles? What would you like to work with there? That s the first component. Usually that s a laser component to treat the skin s surface, get it looking more youthful. The next thing you can look at is do I have jowls? Do I have tear troughs under my eyes, which are kind of a little sunken area, which can often have a bag around those? The structural features are usually dealt with some form of an injection, and I use a variety of products based on the area that I m injecting and what I want to achieve. There really is no one superior filler. Often I ll have the patient come in and say, I want Restylane, that s the best filler. It is a great filler, but with the liquid facelift you re really using a hand full of fillers, each of which is superior treating one thing. Susan Bratton: So what you re really talking abut is dealing with the texture of my skin externally, as well as bolstering where it starts to get saggy or hollow from my natural fat
deposits diminishing and the gravity taking over the skin s sagging. So you re puffing it up from the inside and smoothing it or fixing damage on the outside all in one procedure, right? Dr. Steven Struck: That s absolutely right and very well said. Interestingly in the last year they ve done several MRI studies where they were doing MRI s on peoples faces, and they actually showed how much bone volume we lose as we age and they ve determined that women lose a little more facial bone volume a little younger than men. Both men and women do this procedure. So that s kind of, within the last year or something there s a great deal of interest in our field, is volumization of the face and creating that youthful fuller face as opposed to removing fat from the face, which we used to do five to ten years ago, which actually made people look older. Susan Bratton: Well you ve also told me that a lot of your clients, they get really thin. You know, they go on diets, they get really thin; as they get older it makes their faces look even older. So you have to, you have to modify for that too if they re not curvy girls, right? Dr. Steven Struck: That s exactly true. I have a lot of patients like that. I remember one named Cindy who I ve changed the name, but I really have quite a few patients who are extremely athletic, run everyday. We re in the Bay area, they re in the sun, so they re getting the sun exposure, the loss of facial volume, little bit of weather in their face and they love the way that their body looks and they feel great about their fitness and they don t want to gain weight to make their face look better, and this procedure is perfect for them. I give them facial volume actually with a fairly simple Sculptrainjection and I polish their skin, if you will, with the laser, and they re extremely happy. They can go out and stay fit, stay in shape and have a youthful beautiful face to match it. Susan Bratton: Nice! Well I really appreciate the aesthetic, the eye that you bring to things too. I ve seen your work on a number of my friends, and you ve taken beautiful women and made them extraordinary. I know we re going to get into all of the specific fillers and how you use them, like the kind of systematic approach that you take. You take a top down approach to a woman, start from the outside and work your way in. Start from the top, work your way down, as you ve explained it to me. And we re going to go through that. Before we do there are two things. One, it kind of dawned on me in talking to you about this that, you know, the old thinking about facelifts was you go in and you, you know, you d get cut and pulled and tucked and tightened and it wouldn t look good for a while and, you know, it was always a little more severe in the beginning and there was a lot of recovery, and now we have the non-surgical mini makeover. And when you call it a liquid facelift, what you re really doing is leveraging all this new medical science and technology, like all the Fraxel s and the laser technologies and all the injectible, which is where we get the liquid facelift concept, all the injectibles, and putting those two things together. That s what you ve done.
So for a woman who s thinking that, you know, she s never really been a candidate for a facelift, she didn t want to have surgery, this gives her an option. But who are these women that are the best candidates for this kind of non-surgical procedure. Are there certain women that are perfect for it? Are there clusters of kinds of women? Who do you help them most? Dr. Steven Struck: Well I think there are two subsets in that area. One of the most common ones is someone who s youthful with some signs of early facial aging. They want to do something, they re emotionally not ready for a surgical procedure. And usually those patients aren t even, I wouldn t even recommend a surgical procedure to them. That s the biggest group. And they ll do some either sub portion of this procedure or the entire procedure. They usually come in for a consult and you can tell when they sit down they re just not ready for surgery. I can usually look at someone and get a real good feel, you know, is this a person who wants to start out with injections and work their way up, and that s often the group that we have here. And in their consultation I usually give them a mirror and they show me what they want to work on. Most people have a really good eye for what they want to work on, and we usually start at the top and work our way down, picking a filler or a product for each area and then discussing the laser. So that s the first subset, early facial aging, not emotionally ready for surgery, doesn t need surgery yet. Another group that you ll see is someone who may have done some surgery and the surgical procedures are nice because they last ten years. They re more lasting. There isn t quite as much maintenance. But the truth is when someone has had a really nice facelift and they look good three to five years after, they re ready to do some injectibles to maintain things and continue to look good. They don t want to go the whole ten years and just redo the whole thing. They want to maintain their natural appearance. So that s the second set, someone who you re giving a little boost or two to kind of get them through the last five years until they do another surgical procedure. Susan Bratton: Are there women who never have plastic surgery and they always how long can you keep doing these liquid facelifts? Can you do them forever? Dr. Steven Struck: Most of that depends on their genetics and what they re born with. There are people who, if people don t show deep structural signs of aging, which are normally heavy jowls, what people will commonly call a turkey neck or something that s really hanging, I mean that stuff does need surgery. But there are a large number of people who with maintenance can really maintain that, and they re my favorite group. I ll have them in my waiting room and someone will say, Oh that woman out there looks so fantastic, and they think I ve done a whole body overhaul on them. And often it s just someone that has put the time in, the hard work and they come in once every six months and do a limited injection, maybe once every three years they do a liquid facelift and a laser, and they can look fantastic with that and have truly beautiful harmony of their face. So that s one of my favorite subgroups that s served by this procedure.
Susan Bratton: I like how you think about things you use words like harmony and magic and artistry, and I think it s really true. You re functionally an expert Stanford trained plastic surgeon. I mean you don t get better than that. You re at the top of your league, but you also, it s that eye and your patience with people to really hear what they want that I think is so, is such a nice combination for you. I d like to start with, you said there were, you know, there s the internal structure and the external surface, and when you re doing a liquid facelift you re looking at both of those things. Lets start with the external skin situation and what are the, what s the decision tree that you use with women? How do you look at their skin and what kinds of things do you do to fix the outside during this procedure? And then we ll go to all the fillers and the step by step for that. Dr. Steven Struck: With the skin s surface there are really two things that you look at. One of them is the extent of photo damage, the extent of wrinkles that the patient has. The other component is the color of their skin and their pigmentation. The people you can be extremely aggressive with laser and get great results are fair skin, fair eye color, blond hair. That s the best group for laser resurfacing and treatment. So you can do a very good job on those people. You have to balance that then against the kind of results you want to get, and that s how I usually pick a laser. So when we re talking about picking lasers, photo damage, brown spots, pigmentary irregularity, even melasma or the mask of pregnancy are actually very superficial in the skin. So interestingly you don t have to treat those very aggressively. You treat those with a laser that doesn t go very deep into the skin cause the pigment is very superficial. In that case I use the Fraxel Dual 1927 Wavelength Laser. And it blankets the skin heavily, causes a lot of flaking and peeling. It s interesting cause patients usually want to see a lot of flaking, but flaking doesn t really translate to skin tightening, it translates to superficial skin pigmentary correction. So for those people, I go with my 1927 laser, even up their pigment. Often people with pigmentary irregularities are more on the darker skin side, so you do need to use a lighter laser to prevent them from getting pigmented. I ll have people who are worried and say, My friend had a laser and their skin looks white or they look artificial or they look plastic. That comes from, the pigmentary problems usually come from being too aggressive on a darker skinned patient. So in that case, that s where I like the 1927 pigmentary photo damage, correcting that s. It s extremely effective. That just came out this year and I love that laser for that. Then you get the people with the deeper lines, usually around the mouth, under the eyelids. When you want to tighten skin, you need to use a heavier laser. I use a 1550 Fraxel laser. It actually goes deeper in the skin cause that s where the collagen is. The collagen isn t at your skin s surface. When you use a deeper laser, you can t blanket the surface as heavily, so you don t do as well on brown spots but you get down in there where the collagen is. So interestingly the heavier lasers don t cause as much flaking or scaling; they cause more swelling though for the first two or three days. So heavier laser for wrinkles, one to two to three days of swelling, then that subsides. Lighter laser for photo damage, flaky and scaly for even three to five days, but not as
much swelling. Some people have both, and in those cases we originally, during the research that you mentioned, we originally designed this laser to do them both at the same time, one treatment, one downtime. But we just found that the two together were too much for the skin, so I separate them and I do one laser first and one laser a week later. So that s the ultimate. Susan Bratton: The ultimate. Well I m not sure if that s the ultimate Steve. I think the Steven Struck fully body lift is the ultimate, but you said that and I was like, Well that sounds good. So all right, we ve done the external. We re going to fix the texture, the lines, the bagginess with one or two different kinds of lasers. Now we re going to go into the internal structure of the face, and you re going to assess it. You like to assess it from the top to the bottom, and you have. I kind of have this picture of you in my mind where you re like standing there with a handful of different needles full of different liquids that you re going to use in all the right places on a woman s face, you know. You ve got this arsenal, you know. Like, you should have a bandelier with the little hypodermic needles on it, you know. Be like, I m ready to go. So how do you do it, how do you assess, and what things do you use in different places? Dr. Steven Struck: In a way that isn t that far from the truth. I usually do have a pocket with a large number of different fullers in there. I usually have a good idea of what we re going to use, and that s where the artistic eye creating the harmony of the face comes in. That s what these patients want. We usually are weighing their fear, which they have of looking artificial, and they ll say, Oh I had a friend who had these injections and she looks like a duck and everyone makes fun of her, and that s using good judgment and having that same artistic eye. So you pick something that will correct their problems and make them look youthful and natural, but the goal is for no one to know that they did it and just have a friend say, Wow, where d you go on vacation? What have you been up to? So the way I achieve that is, you re right, I start at the top. Almost everyone has some forehead lines. Everyone has a little bit of dropping of the brow. Everyone has some level of crow sfeet. Those are dynamic wrinkles. They re caused by animation, either frowning or smiling. That s where Botox comes in. Botox is the most commonly used product in all of plastic surgery, and the reason is it works. It will reduce those lines significantly. And it works by weakening the muscle that causes those dynamic lines. Kind of the beauty of that area is in addition you can arch the brows by balancing those muscles, so not only do you reduce the lines you arch the brows, which the eyes are the focal point when you look at someone and you re talking to someone, and then when you see that arch and the weight off the eyelids, it s almost a non-surgical brow lift. It really does work, and it s actually fairly easy to produce by balancing these muscles. So we start out usually with some Botox, arch the brows, get rid of the fine lines and animated lines around the mouth, forehead. Then I usually move down to the lower eyelids. Again, I really like to focus on the eyes. I think people notice that the most, even on people who have a full facelift. And eyelids, often their friends like the eyes the most.
So lower eyelids are also a little bit of a difficult area cause surgery isn t always great on lower eyelids, and this is one area where I do believe injectibles are better than surgery. So on the lower eyelids in youth, there is no transition between your lower eyelid and your cheek. It s just a cheek, and your eyelid sits there and looks natural and has that youthful curve that s hard to describe, but I think everyone knows what I m describing. Then as we get older the cheek skin and fat falls, and you get that thinning of the skin at the transition between your eyelid and your cheek and you can see that, and that s when you know that you re having some facial aging. That is treated by filling that tear trough that s called that sunken area underneath the eyelid where the eyelid meets the cheek. I use Restylane there because it s the lightest weight filler. That skin has been thinned. As I mentioned, you don t want a heavy product in there that you re going to feel. Patients often say, Can t you use something that lasts longer? I don t want to come back and do that. That s a big mistake. You want to use a light filler, very malleable, easy to inject in there. So I fill in the tear troughs, get a nice youthful eyelid. Then we ve treated an upper third of the face. Some people that s all they want. Most people have a little more. Then we move to the cheek. Susan Bratton: Before you go on with that, I also wonder, I noticed that if you fill in the tear trough it almost feels like it plumps up the cheek a little bit too. Does it do that? Dr. Steven Struck: It pumps the cheek, and the tear trough lies between the puffiness of the lower eyelid, which the patient usually does notice, and the cheek itself. So there s the puffiness of the lower lid, there s the sunken area, and then there s the cheek itself again. So you re right, when you feel that sunken area, you ve masked the puffiness of the eyelid and you ve lifted the cheek a little bit. So it is kind of a multi dimensional treatment. Susan Bratton: It s fantastic to lift that cheek up a little bit. That looks really, it really makes you look more youthful I think too. Dr. Steven Struck: It definitely does. Susan Bratton: All right, so take us further down the face. Dr. Steven Struck: So now we re to the cheek. Susan Bratton: On our fabulous journey to youth, the fountain of youth. Dr. Steven Struck: Cheeks are another area patients focus on quite a bit. Again, surgical procedures in the cheeks aren t great. Cheek implants are a bigger procedure, real inconsistent, not a great procedure. So I think with the cheek s injectibles are another real strong point there. I often use one of two fillers there. I ll use Radiance, which is a calcium-based filler, if I think it s a one-time injection that ll last a while. Somebody who wants a more gradual natural change to their cheek, which I think is more of my patient base, I will use Sculpture, which is a newer filler. It s very fine. It s ground up sutra material. It s extremely fine and you gradually layer this like with three or four
treatments so that the cheeks, you don t come into me with flat cheeks and leave with these big full cheeks. You come in once a month, and then all of the sudden at the end of our four weeks there s this natural change of youth in your cheek. So in general with the cheeks I like to kind of divide it into four treatments, keep things more natural, more gradual change. Susan Bratton: And where are you putting the Sculptraor whatever you re using in the cheeks? Where does it actually go and what does it look like when you re done layering it up? Dr. Steven Struck: That s kind of where the beauty I remember when I was interviewed for plastic surgery, the interviewer asked me why I wanted to be a plastic surgeon, and the beauty of it is that every procedure isn t the same and every patient isn t the same. It s not cut on the line and this is how you do the surgery. Some patients need some cheek volume laterally, out lateral to the eyelid, more towards the ear and I ll plump them up there. A lot of people, the cheek fat has fallen down into their face lower, and those patients I ll lay it right in the middle of the cheek. So that is truly art in sculpting and every patient s different. That s where the eye comes in; experience and knowing which fillers are the most forgiving in that patient. Susan Bratton: Mm, that s great. Okay, and now what? Dr. Steven Struck: Then usually it gets a little simpler at this point. You move down the line and in between the nose and the mouth, the nasal labial fold. It can be a thicker line and deeper. Deeper, thicker lines you can use deeper thicker fillers. When you use a thicker filler it lasts a lot longer. Thicker fillers can last a year to a year and a half with Radiance. So I like to use that there. I even use Artefill in that area, which lasts five, seven years. I just saw a patient yesterday who was young. She had deep lines there, and we spent a month working on it with two different injections of Artefill. That stuff has last her years now, and we just did a very small adjustment. So in certain patients with some deep lines around the mouth, you can use extremely long lasting fillers that work well there. There s a definitely art to injecting them, but it s really good when you get a nice long result like that. So that s what I use, nasal labial folds, maybe even in the jowl. When you get to the jowl, what happens with the jowl is that the cheek fat falls again Susan Bratton: Yeah, that s where your cheek went. Dr. Steven Struck: Everything falls. The cheek fell down there Susan Bratton: Get my cheek out of there. Dr. Steven Struck: And there s actually a little ligament that sits down right in there that we ve seen in studies that we ve done, and the fat hits that ligament and it stops. So that s why you get a little, some people call it chipmunk cheek or something where they look like a chipmunk there, and then they have a sunken area, and then there s their chin. So you can lift that surgically to lift the jowl, or you can fill that groove in. I usually fill that
groove, again, with either Sculptraor Radiance based on what the patient wants and various choices that we make at that time. So then we ve essentially reestablished a harmonious, youthful, clean jaw line. We ve created youthful cheeks with no transition between the eyelids and the cheek, natural harmony there. We ve lifted the brows minimally. And then we ve polished and rejuvenated the skin with a laser. I think that s the beauty of this procedure, and that s what most people want. Susan Bratton: When you come in as a patient, what s the process if you re having this procedure done on a given day? Lets just say we take a patient who s going to have both lasers. They have pigmentation and you want to get their collagen going again. So you re going to stagger the lasers and then, and you re also going to do the injectibles. What does your patient do? They come in and you do what? How s the pain? How long does it take? What s the downtime that you see? If they come back in a week, what s the follow on time? Can you give us some averages or maybe even like worst and best case? However you d like to answer that. Dr. Steven Struck: Okay. I think in patients who were dealing with mainly lines and a liquid facelift with some laser, those patients I will do the Fraxel 1550 restorer, the one that treats the lines mainly, if they don t have a lot of photo damage. I will do that as a single laser. There are some nice things about that. You numb for an hour with some topical anesthesia. There are no shots. There are no injections. The topicals work if you give them an hour to an hour and 15 minutes to work. I then perform the laser, which only takes about 20 minutes. There s some heat involved. We have a chiller that we blow on the skin and the pain is tolerable. It hurts a bit, but it s not terrible. Susan Bratton: Well and then when the little tears escape out of our eyes, you re super sweet about it. I have to say you go Dr. Steven Struck: We can take a break. Susan Bratton: You do take breaks and you re super sweet about it. Dr. Steven Struck: Yeah, and you have to be a conversationalist in the area. I sometimes am talking away and they re like, I know what you re doing. I know why you re talking to me, but it does work. Susan Bratton: It does. Dr. Steven Struck: If you re a talker, you can usually get people through these things. Susan Bratton: Yeah. Dr. Steven Struck: I learn a lot about my patients and they learn a little bit about me during this, which is actually nice. That s part of I think why it delivers. I learn more about what they want. They re usually long-term patients. I have people I ve injected for ten years, you know, for that whole time period. So that s the nice thing about it. We get
them through the laser, we do the laser. I usually do the injections on the same time as the laser cause number one, their skin is numb now from the laser. I know where I m injecting the product because I ve either marked it beforehand or I just know what the areas are. So after the laser, I ll usually start at the top, inject their Botox, inject their tear trough, inject the nasal labial folds into their jaw line all at their time. That s nice cause the pain is less, the treatment s done. There is definitely some swelling when you do all that, and the laser at the same time as the injections even get a little more of that swelling perhaps. So the next day you look pretty puffy. People who are good with makeup and adventurous, I would say the earliest, maybe three days they look pretty good and they re willing to cover it and do things. A lot of people around here work from home, so they ll do their work from home on the Internet, computer and they re good with that. They can certainly do that. It can be as long as a week though, really to get everything the way you want. Someone who wants no one to have an idea what they ve done, maybe more like ten days if they do all of these procedures. Susan Bratton: Well and you get some bruising from the needles sometimes, right? I mean, I don t know Dr. Steven Struck: You can. Susan Bratton: How often? I ve had that Dr. Steven Struck: Yeah. Susan Bratton: Now how often do your clients get bruising? Would you say it s almost every time they ll get one little spot here or there or hardly ever? I don t have any idea. Dr. Steven Struck: It s not that frequent, and it does seem there s some people who maybe just have some thinness of their blood and some platelet decreased counts or something. But they ll get bruises more. I actually take more time on their injections. I ve found that if you hold pressure longer I just did one before we came here who bruised, and we have come up with a system to stop it. I hold pressure longer. Interestingly I changed her from Radiance to Sculptrabecause I inject some Epinephrin in with the Sculpture, so that ll decrease your bruising. So the bruisers, I usually spend more time on them and we can get around that. But I d say a bruise, ten percent of the people are going to get some bruising with injections. Susan Bratton: So that s not bad at all. Dr. Steven Struck: It s not that bad. When it happens, it happens. Most frequent area to see the bruising is the lower eyelid tear trough injection, cause it s such thin skin. Those people, I tell them to expect a week, cause I you don t they re mad at you and they think you did, Why didn t he tell me? He must ve done something wrong. It s just that s an
area where that may be as high as 20 or 30 percent of people. So tear trough injection, big benefit, but definitely potential for bruising for even a week. Susan Bratton: What else can go wrong or has gone wrong? Dr. Steven Struck: With the fillers, you know, not a lot can really go wrong. Some people are a bit, they feel the filler a little bit and they weren t quite prepared for that. When they rub it they can feel it. I actually, I m a case study on letting lines go too long, not using the theory of Botoxing your line earlier to prevent them from getting deeper. So my forehead lines were quite deep and I had patients telling me, you know, How come you do anything with those forehead lines? So I finally did. I have Botox in there and Radiance, and I know for myself I can feel the Radiance at first. I can feel it when I palpate the forehead. No one sees it but I can feel it. So some people aren t ready to feel that injection while it s hearing, and a bruise is a little bit of a disappointment to them. With the laser, these lasers are safer lasers because they re fractional, so you usually don t see much. So the problems that I see with these are mainly maybe I touch up an injection, maybe they needed a little Botox in one spot, maybe one lip looks a little fuller than the other one. On all that stuff though you have to let the swelling go away before you touch it up. You don t want to inject around swelling because then the swelling goes away and you re dealing with another issue. You can always add more filler, but you can t really take it out. Susan Bratton: What is the maintenance schedule if you do this? If someone comes in and they do the liquid facelift, the complete non-surgical mini makeover, how long until they have to do what, and in what order do they have to typically do things? Like I know Botox doesn t last as long as Scupltra as an example, so what s the maintenance schedule look like for the typical woman? Dr. Steven Struck: Well again, we can kind of look at the skin surface, the lasers and then the injectibles because they re different from each other. The lasers really do deliver. I have a number of patients who, that depends on kind of their expectations and how much they want to do this stuff, because you can do the lasers, again, it won t damage your skin. It actually helps with photo damage. It corrects some pre skin cancers and things, so there s nothing wrong with doing more lasers. I d say a quarter of my patients would like to do a laser even once every two years or something like that. They get their baseline set and maybe once in a year or two years they ll do just one laser treatment to maintain that. So that s pretty standard on a laser. Some people will wait five years. With the fillers, you re right, Botox, the average patient s four to five months. A real fast metabolizer might be three months, but long, six months, usually four months. The Sculptra lasts 22 months once you build it up. So that s cheek volume, jaw line. If you spend the four treatments to gradually build that, that will hang around for 22 months and is nice. Radiance also, which I mentioned for the nasal labial folds, another one and a half years to a year. So the heavier weight fillers last longer. Those are Radiance, Sculptra. I tend not to, I think it s a big thing not to over inject people and have people look funny,
cause it just is, I know it as I have people say it everyday to me. That s why I will often do a 70 percent correction of a cheek or a nasal labial fold knowing that you can always add a little bit more. I think that s the beauty of keeping people, someone looking natural, youthful, having their friends wondering what they re doing instead of knowing, Oh, they just look like that cause they go to Dr. Struck. Some of my people don t want anyone to know what they re doing, and their friends really don t know. So a little bit on the side of under correction with the knowledge that maybe you ll inject at a year and a half instead of two years even though the product s still around. So that s just my personal philosophy. The lightest fillers, the [inaudible] acids Restylane, Juvederm, both very good products, lip volume, fine lines around the mouth those are about six months. So the answer is probably at six months they ll do a mini liquid facelift. At a year to two years they ll do a little touch up of their laser. And as I said, those are my favorites patients, the people that people see in the lobby and say, That person looks wonderful, and this is their secret. That s what they do. They spend the time to maintain this beauty and they can often avoid surgery or minimize their surgical procedures by at least one or two procedures. Susan Bratton: So, and I m going to get to men and I m going to get to the costs, but lets keep going on women specifically. You talked about the groups of women who are the most likely candidates for this. What about age? When should a woman and I know, every woman s so different and their skin is so different, they re aging, they re genetics but in general, when would you like to see a woman come to you? If she s going to do the liquid facelift and she s going to get Botox in four to six months and she s going to have another mini facelift in a year and a half to two years, she s going to have these every year and a half to two years for a while until she either says, I m happy with this or I really want actual plastic surgery, not injectibles. What s that timeline? What s that horizon look like for the largest group of your clients age-wise? Dr. Steven Struck: Well from when we were young, age has definitely changed. Those things are true. 60 is the new 40. That really is true, at least from what I remember from when I was younger people who were 60 looked older than people who are 60 now. So I think that falls under the same thing being healthier, maintaining your skin, taking care of your skin. We all look a lot younger. So the timetables moved younger for sure as, you know, far as how we look. I think average patient is probably the mid 40 s when they start on something like this, maybe early 40 s. Someone who has been harder on their body, lived a little, more in the sun, a little more active, a little more changes in their diet, maybe late 30 s. But that s kind of the beginning of things. And then, but as I say, someone in their 60 s can look very youthful and they can even start at something like this and avoid a surgical procedure. So some of it just depends on the pallet we receive of the patient and how we re going to address it. Those are some good averages though. Susan Bratton: So if you re starting in you re, lets just say you start mid 40 s. How long could the typical 45 year old woman have liquid facelifts before she would probably from what you ve seen your customers do, when do women typically have their first surgical
facelifts if they ve been doing this more proactive approach to keeping themselves younger and more youthful looking? Dr. Steven Struck: Most start with the eyelids I think because eyelids show a little more aging earlier. They re a little easier introductory to surgery procedure for a patient. There isn t a lot of pain, there isn t as much downtime, the results are beautiful, and so usually people will start there. That s a procedure that can be early 50 s. Person who doesn t do much to maintain themselves, average eyelid age is probably only 45, 42. So if you maintain yourself you can probably buy yourself more towards 50 on that type of procedure. Susan Bratton: And wait, question on that Steven. Is the eyelid surgery just the top that comes over your lid or is it also the bottom that you re pulling up? What are you doing when you talk about that? And what is an eye job called? What s the technical term? Dr. Steven Struck: It s called a blepharoplasty Susan Bratton: Blepharoplasty. Dr. Steven Struck: is the technical name. Susan Bratton: Thank you. Dr. Steven Struck: Exactly. And a lot of people do uppers and lowers because the healing time is the same, the downtime from work is the same. It just creates a little more harmony of the face, better harmony. So I often do both, I d say at least 50 percent of the time I do both. If someone is to choose one, it s normally the upper that we do first, upper eyelids, hood a little earlier. They re also a very simple procedure with a lot of yield. As I mentioned, the lower, sometimes I buy some time injecting that into your trough using injections because in a lot of ways I think lasers and injections combined rival surgery on a lower lid. So probably within the last few years, a few more upper lids alone with some lasers and injections of the lower. Ten years after that you re also looking at the facelift group. You re maybe late 50 s for your first facelift if you ve maintained things, maybe late 40 s if you haven t. So the ages are younger, and the procedures are probably more natural than they used to be. When I was in my training, which is now 15 or 18 years ago, back then the facelifts were a little more of a Rambo procedure, aggressive, you know. The surgeons that did them were mans man surgeon and you went in and really did a number on them. That s changed now. More people want less aggressive mini facelift. They re willing to do maybe one more in their lifetime so that if we can snap a picture of them at 40, 50 and 60 there wouldn t be a huge change, and I actually have some of those in my own base and in my own book. I have one that I show her at age 74 after her third facelift and she looks good and she looks natural. So that s probably a philosophical change in plastic surgery that actually goes along with the concept of liquid facelift.
Susan Bratton: So I promised we d talk about men because they ve probably been patiently waiting for us to get around to them. So is your treatment of a man different in any way than your treatment of a woman? Dr. Steven Struck: It usually is different. I see a large number of husband and wife combinations now, I will say that, which is that they come in together and they do Susan Bratton: The wives drag their husbands and they re like Dr. Steven Struck: them together and that Susan Bratton: I can t be with you if you re going to look like an old guy, right. Dr. Steven Struck: And they stay in their hotel together afterwards and they have their plan. I think men, interestingly the biggest one that comes up usually is they don t want to look like Kenny Rogers looked after his. I hate to say that, you know, publicly, but it is what men say. Susan Bratton: At least they didn t look like Dolly Parton. Dr. Steven Struck: That s true. So, but with men, I tend to take a little bit less skin from the upper eyelids. I would say upper eyelids are the most common thing men do. Makes a huge difference. They can wear some sunglasses to hide it and still be pretty active. It only takes five days. That s by far number one on men. Probably love handle liposuction is also. So those are the two surgical things. Men tend to like Botox a lot because there s not surgery, there s no signs. Guys definitely have the crow sfeet and the forehead lines. Botox is a great product for men. Also if I were to define a men s only liquid facelift, it would probably be the lasers that we discussed cause for some reason them really respond well to laser. I don t know if it s because they really haven t done much to their skin so their skin really responds because its been treated so poorly for so long. Or if it s just because our dermis or deep layer of our skin is thicker, but guys tend to respond well to the laser. So a men only liquid facelift would probably be a laser treatment and at the same time some Botox. That would most likely be what they would do. Susan Bratton: Interesting. So you don t get a lot of guys going for the full liquid facelift. Dr. Steven Struck: Not that much. Men don t tend to focus on the lips as much. They don t want the lip volume as much. Nasal labial folds, those lines, I ll get some of those, which I ll do with the filler. Cheek volume, I don t know if it s necessarily a sign of handsomeness or manliness to have more cheek volume, so there definitely is a different approach to that. So I think it is, it s mainly Botox and lasers on the guys. A little bit of liposuction under the chin too, cause we tend to Susan Bratton: Yeah.
Dr. Steven Struck: our facial aging s a little lower than women, so we have the big thick necks on the men are definitely something that So in a way you could almost look at it male mini makeover, as in I have one of these that I just saw yesterday that I m doing next week, eyelid surgery in the office, not under anesthesia, tighten up that upper eyelid in the office, do the Fraxel in the office, do the Botox in the office and maybe even a little liposuction to their chin. Healing time isn t a whole lot different, then they re looking good within seven days. So even though it s not non-surgical, it s mini surgical, and that would address most things a guy would want to do. Susan Bratton: Wow! That s amazing. I m sending my husband in. So that was a good question too was do you do everything in your office? When we re talking specifically about the liquid facelift, is everything done outpatient in your office or do you have to go to the hospital? Dr. Steven Struck: That s all done in the office. So those are all office based procedures. Surgical procedures I do in a state certified operating room as an outpatient. But these procedures are almost all done in the office. Susan Bratton: Yeah, sounds like it, especially with the one you were just talking about with the guy, that he can come in and you can do all that to him right in your office is awesome. All right, so talk to us about pricing. Now that we know that we need to come in every 18 months to two years for kind of the full facelift, and we do need to have some maintenance between times, what are kind of the minimum and maximums in the range right now? Dr. Steven Struck: I would say for the initial treatment liquid facelift, you re in the early group we discussed, a little bit of early aging, not in need of quite as much. It can be as low as $2,000 to $2,500. If you re wanting to see a little more, if you re willing to do the three to four Sculptrainjections to reestablish cheek volume, jaw line volume, if you want to do the Botox to get your eyes and forehead and you want to do some lip work with the Restylane, maybe $3,000 to $4,000, probably in that range. And that s about as high as I like to go on a liquid facelift, cause I like the results to match what I m delivering. If someone wants to see more than that, they may just be better for a surgical procedure and it may deliver more. If you try and get a surgical patient to do a liquid facelift cause they don t want to do surgery, in a way that s where you kind of have to be the guidance person for this patient and say, I know you really don t want to do surgery, but I think you re going to spend $6,000 or $7,000 and you re really not going to see that much, because if you have a lot of deep lines, a lot of aging you re going to eat up so much product that it s going to be hard to deliver. So in that group I ll usually just be honest and say, Maybe you re more in the surgical group. But in the non-surgical group, $2,000 to $4,000 ballpark for the liquid facelift. The maintenance, Botox can range from $350 to $500 or $650 each time they come in, and then the fillers can be about the same. So you might be looking at between $600 and $1,200 every half of the year to maintain things.
Susan Bratton: Okay. That s perfect. And that s completely reasonable and actually surprisingly low for the incredible I don t know, it just seems like it changes you. It makes you feel more confident I think as a woman to know that you look younger. I know that one of the things I really enjoy the most is when people, I can tell they re actually surprised at my real age, and I was wondering if there were other things that, other reasons that women are motivated to do this besides just looking younger and beautiful. Are there other things or is that pretty much what we all want? Dr. Steven Struck: I think that s mainly what they want. Susan Bratton: Yeah. Dr. Steven Struck: I think you hit the nail on the head. They want to look natural. They want to look beautiful. They don t want their friends to necessarily know. They want the harmony. And people love to have people compliment them and tell them they re looking happy. I mean maybe it s not their beauty, maybe it s their happiness that they re radiating out there to other people. Susan Bratton: They re happy beautiful. Dr. Steven Struck: Yeah, internally I guess that s the same. I feel good inside and I look good outside, and all that stuff together. Susan Bratton: Yeah. Dr. Steven Struck: So that s what I enjoy. They come in and tell me about it. I ve heard all kinds of stories about things that have happened to people that they ve enjoyed, so that s really the nice thing for me about it. Susan Bratton: Yeah, I think it gives a woman more confidence when she feels like she s young and beautiful. She just has a willingness to take more risks and do more things. So we re going to get back together again I hope and talk about your complete facelift and do this level of conversation on that. You have an idea for three different things that you do in a facelift, is that what we re going to talk about next? Dr. Steven Struck: That s correct. I call it the Complete Facelift. I use the harmony word a lot Susan Bratton: Yeah. Dr. Steven Struck: and maybe I use it too much, but I love that harmony thing Susan Bratton: I don t think you do. Dr. Steven Struck: And I think it s the same concept with the face. You re dealing with the skin s surface, laser; you re dealing with the deep structures, facelift; you re dealing
with re-volumization of the face, fat grafting. So that s a new thing that we didn t talk about. Susan Bratton: Uh huh. Dr. Steven Struck: Those are the three main components: lifting structure surgically, injecting fat to create youthful foundation, and then creating that youthful skin over the top. So that s the complete facelift in three parts. Susan Bratton: Cause of the facelift, what about the neck too? We ll have to talk about that because you don t really get to the neck when you re doing the liquid lift, right? Dr. Steven Struck: Not much. A liquid lift, I can inject some Botox into the neck muscles and get some improvement, but Susan Bratton: Mm hmm. Dr. Steven Struck: usually it is more of a lifting procedure. Susan Bratton: All right, so we re going to do that next. Dr. Steven Struck: I m looking forward to it. Susan Bratton: I am too. All right, you have had an opportunity to hear Dr. Steven Struck, and I hope this was beneficial for you. I ve seen his work, I ve had his work, it s really amazing. And thank you for answering so many good questions. I really appreciate it. Dr. Steven Struck: Well thanks for the great questions. It made it easy. Susan Bratton: All right. Have a great day and I hope you will feel beautiful today yourself. Take care.