THE TRIUMPHANT RETURN OF THE FACELIFT I have always been fascinated by facial contour. For more than 20 years I have used a technique that combines lifting in a natural direction and the restoration of facial volume with fat transfer. When fillers emerged as an option, I traveled to Europe so I could learn about their possibilities before they were approved in the United States. I have enjoyed working with fillers, not just to reduce lines, but to restore missing volume. I am lucky to have a team of expert clinicians who have high-level skill with injectable fillers and of course I love working with the fillers myself, especially since there is now a much better selection of filler options in this country. What doesn’t make sense is to blow up a face like a balloon with fillers when the real problem is a loss of tone of the facial structures. You see people who no longer look like themselves and whose faces don’t move naturally. People are catching on to the problem of “filler face.” It’s really quite simple: people who need a facelift, need a facelift. The facelift operation is here to stay, especially since we can usually do this under local anesthesia. It certainly is the number one procedure in my practice. The goal is always to make you look more like you, not a different person. This is true of both surgical and non-surgical treatments.
LOCAL ANESTHESIA SURGERY
In our practice more and more surgeries are being done under local anesthesia. This is less frightening to the patient and reduces risk. It is not for every patient, so we always offer the choice of IV sedation or a light general anesthetic for those people who prefer to have absolutely no recollection of the surgical experience. We are able to accomplish local anesthesia surgery for 85 percent of our facelift patients and over 90 percent of our liposuction and BodyTite patients. The patient can eat a light meal before surgery, so there is no starvation effect and an IV is not required. We give our patients an oral sedative and put a topical anesthetic on the skin, then allow them to relax in a quiet room. Once they have reached a state of tranquility, we administer local anesthesia with a special device which makes the injections almost imperceptible. The patient then walks to the operating room where we carry out the surgery in the usual way. Another advantage is that the patient has a very easy recovery since there is not a foggy mind that can occur after a general anesthetic and there is less nausea. It takes quite a bit of dedication to create a protocol that enables local anesthesia surgery, but our patients absolutely love it.
VIRTUAL PATIENT CONSULTATION AND POSTOP VISITS
When our practice was closed due to the COVID-19 epidemic we were able to stay in touch with our patients and have consultations with new patients using virtual technology. This new approach continues now that we have been back to seeing our patients since June. Of course, we love to see patients in person, but it is wonderful to offer patients who have had recent surgery and are doing well, the option of seeing me online. This eliminates the need to block out the time for driving to and from our office. It is particularly useful for patients who come to us from a long distance. We offer new patients the option of a virtual consultation as a first step. It is nice because no one needs to wear a mask, so we get a better sense of each other. Also, I can outline the possibilities for treatment and my coordinator can give the patient a quotation, and if this seems to make sense, the next step is an in-person consult. It really can be a great communication tool.
VIRTUAL SKIN CARE
I enjoy figuring out how to solve people’s problems. That’s one of the things that attracts me to plastic surgery. Many people would like to obtain medical-grade skin care products and advice, but can’t make it into our office. Just picking out random products from a website usually doesn’t work well. In the COVID-19 era, many people are put off by going to a department store and some are even reluctant to go to a medical office. I put a lot of thought and energy into solving this particular problem, and the result is the creation of SkinShopMDTM. On this site, you will find the SkinShopMDTM Quiz, an expert algorithm we developed that provides a selection of individualized products for each person’s needs. You answer a series of questions about your skin, select a priority, and right then and there you will find a combination of products that are designed for you. If you want even more detail, you can set up a virtual aesthetics consult. The products are the same ones enjoyed by our patients at the Whole Beauty® Institute. This includes our own line plus other innovative products that I think work well for particular needs. It took me many years to develop this great portfolio of products.
REMOVING FAT AND TIGHTENING
Liposuction with any technique, be it classical, ultrasonic, or laser, will work great if the surgeon has a good eye, and the patient has tight skin. The challenge is when a patient with looser skin desires liposuction. If you remove fat, the skin may hang even looser. I have been working with the BodyTite technology for several years. With BodyTite, the surgeon uses a pair of probes to deliver energy to the skin at deeper levels. This melts the fat but also tightens. It is not the solution for everyone but in the right patient, it really can make a nice difference. I love what it can do in the waist area. There are also some nice tightening options for non-surgical fat reduction. We have been working with a system called Evolve which allows us to reduce fat, tighten skin, and tone the underlying muscle and fascia, all with the same machine. It is relatively new, but so far, the results have been good in the right patients. The problem with other fat melting systems has been a tendency to leave the skin loose in the treated area. With any of these fat reduction devices, it all comes down to patient selection and realistic goals. They work best for a person who has good nutrition and exercise habits but who has one or two areas that just won’t respond to all their effort. As long as they understand that the result is not as powerful as liposuction, they can get a worthwhile change.
MORE SUBTLE LIPS
For a while, it seemed that all you would see at parties were people with overdone lips. This has never been my personal aesthetic. The lip has an amazing 3-dimensional contour, and it is important to keep this in mind when you are injecting filler. There are some newer techniques of injection that make this easier to accomplish. My entire team adheres to my naturalist aesthetic.
KEEPING SAFE WITH COVID
Since we are a practice that has its roots in plastic surgery, it is natural to emphasize safety. Everything that is done in the operating room depends on adhering to a safety protocol. This mindset applies to our aesthetics practice as well. We have developed a protocol, which we continue to modify as new information becomes available, to maximize safety for our staff and patients. We pay particular attention to the air that comes into our practice with the ventilation system. At the Winnetka office, we have installed a state-of-the-art needle-point bipolar ionization system. This technology injects positive and negative ions into the air that comes through our ventilation system. If bacteria, viruses, or mold are present, the process removes hydrogen atoms and the viruses, bacteria, and mold will die. The building that contains our Chicago office has numerous safety features, including self-cleaning elevator buttons, measures to limit social contact, and high-security parking. The ventilation system includes Merv-13 filtration, increases air turnover, and increases fresh air mixed into the circulation. Our patients frequently remark on the attention that we place on their safety.
Dr. Cook’s Winnetka office is located at 118 Green Bay Road and his Chicago office is located at 737 N Michigan Ave #760, 312-751- 2112, johnqcookmd.com.