Episode 9: NoCut Facelift with Exosomes or Stem Cells

Foreign. Whitfield in Austin, Texas. And welcome to my podcast, Dr. Rob Solutions. Today I'm going to discuss my no cut facelift with exosomes or with stem cell enhancement. So let's get into it. So how did I come up with something called the no cut facelift? Facelifting has been around, you know, for over 100 years. And traditionally it's a excision of tissue, and many times it's removal around the anterior portion of the ear and lower portion of the neck. So when people do the natural kind of tug on their cheek and show me they want to tighten that area, I tell them that's really obviously not the direction that came from, because gravity makes things come downward. So when we age, and we're talking about facial aging specifically, we can lose bone in our face, which is over time, just almost like a resorptive thing. The second thing we can do is we can lose fatty volume. And so the third and final thing that we see commonly that, you know, disturbs us a lot is skin laxity. So many people will tolerate volume loss, and that can be addressed in other non autologous ways and autologous ways either with facial fillers or with fat grafting. But the skin laxity has always been, you know, the kind of thing that drives people to seek counsel about, you know, what can actually be done to correct this. And for the longest time, we had excisional surgery only. And then with the advent of radio frequency devices, first monopolar devices where energy would come out of the tip of the device just like the tip of an apple pencil. And that could pass under the tissues and heat the tissues, and you would get tightening. The problem with that is when it comes out of just one tip, it gets dispersed in a not the most efficient manner. So that didn't solve the issue in, you know, we'll say two thirds of the patients, and it can be painful. So we, you know, we want to provide obviously the most reliable and efficient treatments with the least amount of downtime and recovery and discomfort. So as those devices evolve, then, you know, there's radio frequency devices, there's lasers. Lasers work on the top layer of the skin. They don't do deep tightening. There became, you know, more of a movement to use what's called the bipolar radio frequency. Now, bipolar radio frequency is similar to what I would use in the operating room to control bleeding. Think of a pair of electrified forceps or tweezers. Tweezers, like you poke your eyebrow with those tips, are where everything happens. So between those two tips, all Energy is being dispersed. So in device that I use for facial tissues like face tight, which I've had since 2017, really, and it was available before then, I just, I got it in 2017. That has a tip that goes below the tissue so you can heat the deeper tissue. And then it has a head that's above on the skin. Skin's prosected with ultrasound jowl, and this is done sterily. And those tissues can be heated and so you can apply heat, you can apply radio frequency. And those things will shrink what's called the fiber septal network down towards the muscular or the fascial layers. And in addition, you'll build collagen. So over time, we'll say plus 35 years, we're losing collagen and we're losing a substance called elastin, which is what makes the skin tighter, have snap, if you will. That was a great device in terms of providing skin tightening. And then in 2018, in the summer, same company put forth a product called Morpheus 8. Morpheus 8 is a microneedling product. And there had been microneedling products from the company in the past and other companies that were basically either monopolar or didn't have energy or in this instance, they have bipolar radio frequency energy. In the instance of Morpheus 8, you could change the needle depth from 1 to 4 millimeters. So I started employing that and I had been doing this for a period of time and it really worked to help tighten the facial tissues. It worked so well at a point that I had a case where someone had a band in their neck and it gave them a bad profile appearance and they wanted the neck skin tighten. And I said I could do that. But these techniques didn't treat the bands. So it actually exposed the band because the skin tightened around it and it made that band look worse. So for a period of time, we had to be very careful with people who had the platysmal bands which were needing some sort of therapy. So you could do botulinum toxin, you could do dysport, you can do, you know, revans as a filler, I'm sorry, a toxin called Daxy Botulinum toxin, which you can use now to relax the band. But that's obviously going to work depending on the product from three, three months to six months. So that's not a solution that fixes this. So I was doing all this work and these were my, basically I labeled them my smart treatments because they're really just leveraging technology. We're not using, you know, any knife or anything to create excisions. But we needed to address these bands. And so there's a suture suspension lift that's come along affectionately. I call it the Zoom lift because it became prominent during the pandemic. And the product is my Elevate. It's a suture that's on a fiber optic light that can be woven through the neck tissues underneath the jawline to enhance the jawline. After dividing those bands, almost like think of a band as a wire cuts through cheese. You can just divide the edge of the band, relax the tissues and it'll become less visible if not completely absent in most instances. If people have too much neck laxity in terms of the skin, it won't completely resolve that. And I let everybody know that because radio frequency skin tightening, facial tightening with face tight and neck tightening with the same product will enhance but not completely eliminate the collagen production, but not remove the skin laxity completely. So face tight Morpheus 8, a zoom lift will give you a really nice change along the jawline, the facial tissues and the neck tissues. But it didn't really remove any skin. Right. So the, the hallmark of a facelift, if you've followed along is it removes tissue. So obviously that looks tighter when it's completed. The issue is it can have you appear as you have, you know, a pulled appearance, a fish hook in the mouth, a windblown appearance, however you want to describe it. If you watch award shows, you'll see many, many celebrities with very kind of odd looking faces, they've been pulled very tight or if you've seen people have had typically a revision that just doesn't look natural. So I don't ever revise a facelift that sent to me and I don't revise my own. I have these options. Plus what we've added is a new product called ellacor. Ellacor removes 0.5 millimeters basically of skin in a area. So think of it like a hollowed out microneedle. So it's 0.5 millimeters. If you take that out, it'll heal without a scar. So now if we do that on the lower third of the face, which is its FDA approval, we further enhance the tightening effect of those tissues. So that is a portion of what we do. But fundamentally I want to treat the whole face and neck as a unit to give the best harmony. So I approach it this way. I use basically my own approach to separate layers of tissue initially. And this is all done under local in the office you can have oral sedation and we have nitrous, we have music, and most people do extremely well. Just I'm taking it easy and almost going to sleep during the process. It makes it easier for us if you're not under anesthesia because of the way we need to move your head and work around the face itself. So it's much easier if this is done in an office based setting. You talk about doing this, all these techniques combined, plus adding exosomes or adding stem cells, and we'll get to that. This is what I call my no cut facelift. Because we're not ever using a knife, we're not excising any tissue, but we're going to remove tissue. And when I recently did these, basically I took out 2 square inches of skin on the face using the Ellacor device. And it's on label for the lower third of the face, off label for forehead, around eyes and necks. But you can get some really dramatic changes both with respect to skin laxity and then really lines. So fixed lines, the 11 lines, the lines around the eyes, which are the crow's feet, the laugh lines, the marionette lines, all these can be dramatically affected using this technique that removes skin without leaving a scar. So to do the no cut facelift is one thing, but as a stepwise process, what we want to do is as soon as we've, you know, completed our separation of layers through the fluid, we've done face tightening, neck tightening with our probe, the radio frequency probe. Then we, you know, if we're doing the neck, we're going to tighten the neck at that point. And then the final step on the way out, we're going to work from outside in. So everything else is done internally. All that's complete. Now we're going to work to remove skin without leaving a scar. So taking the device, which is much larger than a handheld microneedling device like Morpheus, and then working diligently under loop vision, which is magnification, using a special glasses, you can see and line up rows as the device takes out the cores. You can see them, they'll come out, we'll wipe them out. We have epinephrine, our solution. So there's very little bleeding. When we do this, the keys are to get the material, or the skin material out of the actual opening. If you don't, you'll have more redness. So as soon as we get done, we have a hydrafacial machine that we use to further cleanse and remove debris from the area. So we're doing once again basically multistep process in terms of local anesthesia placement, separation of layers, face tight. We would do the neck procedure. If someone needed or needed or wanted submental liposuction or neck liposuction, we would do that prior to doing the zoom lift. Then we would do the zoom lift and then conclude by doing the ellacor treatment. Once that ellacor treatment is complete and we feel like we've maxed our removal of skin from the face and neck areas, then we'll take our hydrafacial machine and we'll basically not infuse product in, but we'll really use suction and fluid to remove debris out of the treatment areas of the face and neck. So once that is all complete and we're comfortable with that process, then we're going to talk about what, you know, what do we add to make this better? So we use exosomes in pretty much the majority of the cases because we want to enhance wound healing as much as possible. So we'll get exosomes either atomized or droplet placement. But now we have something that really is truly exciting to me. As personalized as you can make it, it's actually using your own stem cells from your own fat. So the process follows like this. If you want to have a no cut facelift with a stem cell enhancement, then you would see us about eight weeks prior to having your no cut facelift. So many of my clients come from out of state, so it's not difficult to get to Austin. So we would have a brief, you know, preoperative discussion about doing a no cut facelift with stem cell enhancement. And that day on site in Austin, at my office, under local anesthesia, we would take fat. So how does this all work? So the fat is taken through basically under local anesthesia, of course, through a syringe technique. And we want to get between 30 and 50 cc's of fat. And then we have a device, an act device that separates into layers what we need to then use. Now, some things we could use that day, and one's called the stromal vascular fraction. This is a very, very powerful tool which has angiogenic factors in it and some of the cells that will stimulate healing. Very powerful product, more powerful than prp. And so I know for a fact this works extremely well. I've had it injected in my neck. I'm getting old after, you know, operating since 1996. So we can do an SVF injection that day. So if someone wanted their fine lines or something treated that day, we'd do a simple microneedling session. Either with one of the either the Skinpin device or Fractura or Morpheus and inject the SVF in the areas of treatment. Typically we would want to do lines like the lines of the forehead around the eyes. These would be common treatment areas and we'd inject this at that time. Now what do we do with the rest? Well, there's some material you discard and then the fatty layer we would send to the stem cell bank to have your stem cell line expanded. So initially this process takes about six weeks. We'll buffer ourselves a couple weeks so that we clearly have what we need. And then we would set your appointment for a no cut facelift with stem cell enhancement if that's what your desire was. I feel like this because it's your own. Zynal. Stem cell enhancement is an incredible advantage to my clients. So provided we had that opportunity, once the material has been cleansed and we've got all of that debris off the face, then we would do the application of stem cells and we'd also give you an IV of your own stem cells back. So once that is complete, then you get to take advantage of all the other options I have in my office, including hyperbaric oxygen, red light therapy with joovv lymphatic massage, gua sha, facials, things like that. But in this particular setting we're going to leverage a couple things. We're going to have you do you a red light therapy once you're complete with the other treatments and then we have a upright hyperbaric chamber that you can sit in. So we like to get as much enhancement of wound healing right off the bat with hyperbaric oxygen as possible. If anybody's dehydrated from travels, we have IV therapy in the office. So we really have all the tools in the office to make this a great experience and one that doesn't require any visible scarring. So people will ask like, how much time do I have to stay in Austin? What am I going to look like in terms of being able to go back on camera? I have a lot of folks in the media industry obviously are interested in this. So in terms of downtime, you got to give it about four or five days to heal. So there's products that we supply for application. And so once that skin healing has been between, you know, that four and five day window, typically you can apply makeup on and much of what's visible will be covered. Now these treatments are outside in, so you will have visible tiny little kind of healing areas. Some will be lighter, some will have a little bit more pigment. But day over day, week over week, all of that really dissipates relatively quickly. The thing for us is we want to leverage the ability of the device to take skin out, meaning alcor, with removal of the skin. Everything else we do is to really promote wound healing as soon as we're done with cleansing of those areas. So if you plan on, you know, coming and visit me in Austin, you're going to be here at least four or five days. And so people, you know, they obviously like to come to Austin. We'll make sure and see you frequently after that treatment so that we're taking care of any of your needs regarding the wound care, et cetera. But it's actually relatively simple. I do have complementary hyperbaric oxygen therapy for patients. After this, we do a couple sessions of that. We just want to get things moving forward as quickly as possible. And then if you're flying in, which the majority of my clients are, and of course, I have a lot of local clients in Austin, but we do everything afterwards in a virtual manner. Much of this is just a matter of time and healing. But it can be a great standalone treatment, or you can make it part of a treatment protocol that you want for the, you know, management of skin laxity. I've done this for faces. I've done this on the breasts. I've done this on the arms, abdomen, buttocks, thighs, so a knees. Each of these areas has their own kind of nuances to treatment, but you are truly getting closer and closer where tech is providing solutions that were once only surgical. Well, thank you for listening. Look forward to having you. On my next episode, we'll discuss something new regarding no cuts.