Is Awake Radiofrequency Skin Tightening, Buccal Fat Removal, and Liposuction the Best Procedure?

Dr. Zelken, do you have a” bread and butter” procedure?

Note: for a 2 month before and after, wait until the end. This patient is not close to her final result, and has had 2 treatments of Morpheus 8 and filler to the jawline and chin as well.

I get asked this all the time: do you have a “bread and butter” procedure? To answer this question, first we need to define “bread and butter”. When I think about this, it conjures up ideas of my most popular operation, the most common procedure I perform, and my favorite operation. All have different answers (blepharoplasty, facelift, and rhinoplasty, for example). Since all these definitions have different answers, I will leave it at this: my bread and butter operation is facial contouring, not otherwise specified. Since my YouTube presence showcases mostly wide-awake operations, let us discuss a popular choice of radiofrequency skin tightening with liposculpture (FaceTite) + buccal fat pad removal (bichectomy).

This video demonstrates why this procedure is so sought after by patients near and far, and allows me to discuss the science and rationale behind the procedure, and the reason it is so successful. As a classically trained plastic surgeon, I do feel as though I relinquish some control when I am not directly removing skin and directly pulling on soft tissues with sutures, for example. However, not everybody is ready for a facelift, not everybody is excited about the risks, expense, and downtime of more traditional aesthetic surgical procedures, and so “scarless” facial tightening procedures are very popular.

Unlike a “lunchtime lift” that was so popular years ago, this procedure leaves no scars in front of the ear or behind the ear with exception of 2 or 3 strategically placed pinholes. In addition, a small incision inside the mouth is not visible. Although minimally invasive energy-based procedures give a surgeon less control (and perhaps accountability) over the outcome, the results do speak for themselves- and more than 90% of my patients are satisfied. In addition, buccal fat pad removal has been discussed in many previous videos on this channel, and one of the most important messages is that it is not an obvious result, especially in 2 dimensions. Having said that, the subtle changes that arise from this combo of procedures can truly change the way a person looks, feels, and is perceived by others.

In this video, I use a machine called BodyTite, with a FaceTite handpiece. This is one of many commercially available options (Renuvion, J-Plasma, laser lipo, Smart lipo) that allow me to apply energy to the deeper tissues of the face. By causing a very carefully controlled thermal injury to these deep tissues, the body responds with collagen deposition, followed by remodeling of the deposited collagen, leading to a shrink-wrapping effect. In this video, we can see that I do have some direct surgical control over the liposculpture of the jowls and the lower face. This artistic component does allow me to reshape the face instantly and visualize a long-term result on the table. This is gratifying and attributes to the results that I can achieve. Choose a skilled provider to ensure that energy is administered safely and effectively. The buccal fat pad removal is a very straightforward procedure in most cases.

In addition, performing wide-awake surgery allows me to chat with my patients and have an enjoyable experience with not only my patients but my staff. As we perform dozens, if not 100s of these operations, the flow becomes very enjoyable, and this can be appreciated by the patient who is awake to experience the efficiency and comfort of wide-awake surgery firsthand. If you or a loved one are interested in facial sculpting, consider this combination of energy-based skin tightening, liposculpture of the lower face and neck, and buccal fat pad removal. The results can be very impressive, and can be further enhanced with filler injections, fat grafting, and other procedures. Do not be afraid to ask if what you seek can be performed awake.