Greetings Dr. Yang,
Your posts and your website or wonderfully informative. I noticed on your website that you use Surgiwire in certain instances. Are there generalities to describe the best patient canditates and outcomes for this instrument (e.g., deep lines versus deep folds, or, glabellar lines versus nasolabial lines)? I understand that Surgiwire is relatively new – are there any observations as to how long the results last? I noticed that the patients shown on your website didn’t have fillers and that they have very natural looking results. Do you have general recommendations as to whether or not a Surgiwire procedure is more effective or longer lasting when used in conjunction with fillers or fat grafts?
Thank you Dr. Yang.
Very good question.
When I offer treatments for nasolabial folds I give them multiple options. Surgiwire is relatively the most invasive procedure, even though it doesn’t require incisions. I do offer Radiesse, and Restylane if they need a faster recovery.
I don’t think that Surgiwire works for everyone. In order to understand that we have to understand what exactly Surgiwire does. Many people think that this is a thread lift or something that stays under the skin, which it is not.
Surgiwire is a type of Subcision, or cutting under the skin without making an incision. Some people will use surgiwire for cellulite to help release the collagen attachments under the skin to reduce the dimpling effect (I don’t offer that, I only focus on faces)
So the best candidates for Surgiwire are the patient who have a deeper creases. Usually these patients have tried other fillers with minimal improvement. I think of it as, the deeper the crease, the better it seems to work. Where as with fillers the shallower the crease the better it works.
If someone has a very fine wrinkle from folding of the skin, like a crow’s foot, this would not work well. It needs to have a deeper collagen attachment from the smile lines to the smiling muscles (Zygomaticus major and minor) This way when the surgiwire slides under the skin along the smile line, it is actually releasing something.
The main downside of this procedure is lumps, even though no fillers are used. The lumps tend to form on the lowest point of where the surgiwire cut under the skin. So for smile lines it occurs at the bottom of the smile line, and for frown lines toward the bottom of the frown lines.
The lumps that are formed are from pooled blood, and this forms a fairly hard lump which is usually not visible on the surface of the skin. It is scar tissue that forms from the clotted blood. Your own scar tissue is your own collagen. The area under the smile line will fill with your own collagen/scar tissue, with the most deposition of collagen towards the bottom. I have used fat, restylane and radiesse with this technique, and I prefer fat the most. If the patient is going to use restylane or radiesse anyway, they usually try to avoid the bruising that can last anywhere from 2-5 days to up to 2 weeks if the patient bruises badly.
I am still waiting on long term results, but so fat most are holding up for up to 6-7 months. The manufacturer shows up to a 14 month result which still looks good at 14 months, so the duration is still not established.
I have had one patient who I was pretty sure was a good candidate, with deep smile line creases, and I did a surgiwire alone and she had no visible improvement. She also did not bruise at all, so I wonder if some bleeding under the skin is helpful in filling the crease, which means that this procedure would have 2 weeks of bruising to be most effective.
I do have some ideas of how to improve the procedure, but since I don’t have any results to back up my ideas, I am reluctant to share them publically.
Very interesting procedure. I really like the idea of it, and I am currently trying to isolate which people are the best candidates, and how to make the procedure work well without too much bruising.
The more you bruise, the better it looks; the less you bruise if at all, the less the results. More bruising = more collagen deposition.
These are my general observations at this point in time.