Reality Check

Dr. Caniglia talks the simple truths about plastic surgery

By Kimberly Hundley • Photography by Adam Moreno

ADM_1297Who doesn’t want to look as young as they feel, if for no other reason than to project vibrancy in a competitive workplace? Cosmetic surgery advances have made that increasingly possible. But despite the media hype on “new and revolutionary” procedures, there is no such thing as a one-size-fits-all facelift, says Dr. Ronald Caniglia, a specialist in facial plastic surgery.

Caniglia, whose Airpark practice has earned numerous accolades over the last 20 years, built his reputation on the tried and true. Media hype and clever branding about miracle short-cuts don’t change the facts, he says—and consumers need to be careful.

His top concern is the misconception of what a facelift actually is. “Everybody thinks a facelift is everything, when in reality, it just addresses the aging changes in the lower part of the face; it has nothing to do with the brows and eyes,” he says.

To minimize the extent of the procedure, marketing campaigns brand the facelift with monikers such as “mini lift” and “lunchtime lift,” but a facelift is a facelift is a facelift. And that means surgically tightening the internal layers of the cheeks, jowls and neck, and then removing the extra skin.

Those who opt for what Caniglia calls “corporate-sponsored” facelifts—heavily marketed pitches that often involve 1-800 numbers, watching a video and assignments to surgeons that patients may not have met beforehand—forgo the process of being evaluated by a physician, a step Caniglia considers vital. It’s during his face-to-face consultations that he determines the best way to proceed with each client. Maybe they don’t need a facelift, for example, maybe it’s the eyes or brows that are bothering them, which require totally different procedures. Caniglia also looks at factors such as skin elasticity, volume loss from age, asymmetry caused by trauma and whether there is muscle weakness on one side.

“The truth is, no one procedure takes care of everything,” Caniglia says. As part of his comprehensive approach, he uses a lot of mid-face implants, and sometimes injectables, to plump hollows where the fat pads below the eyes have shrunk and descended down the face.  He also looks at the chin and pre-jowl, to see if those areas would benefit from small implants along the jawline, enhancing the facelift effect by subtly adding volume.

After evaluating the lower and mid face, Caniglia considers whether a brow/forehead lift would be beneficial—“The important thing to remember is it lifts drooping brows for a more youthful look, it doesn’t get rid of wrinkles,” he says. And finally, he and the patient looks at upper and lower eyelid surgery; the former addressing heaviness of the eye by removing excess skin, the latter reduces puffiness or wrinkles below the eye through internal surgery.

Trends Tend to Fade … for Good Reason

Caniglia likes to tell his patients, “Do what is proven, do what’s effective, do what works.” Curious clients often ask him about the latest “next best thing” they’ve seen hyped in magazines and TV shows.

“Trendy procedures are trends, and they tend to fade away very quickly,” he says. One that comes and goes, for example, is the ‘thread lift,’ where doctors thread barbed sutures through the face and use it to pull up the tissue. “It’s absolutely awful—I’ve seen the worst complications,” Caniglia says. “First of all, it doesn’t work, and another thing is it doesn’t remove any extra skin.”

Now making the rounds, particularly in med spas drawn to the treatment’s noninvasive aspect, is the use of radio frequency and ultrasound to counter aging. The idea is to put heat into the skin to get the inside layers to contract and tighten, an approach that costs about $2,000 to $3,000, explains Caniglia. “It’s very difficult to see consistent results. Typically the results are at best subtle.”

The so-called “vampire facelift,” also attracting a flurry of media attention, involves injecting growth factors from one’s own blood, sometimes combined with hyaluronic acid fillers, into the face to add volume. “You’re adding volume, which is OK, we need to do that,” Caniglia says. Injecting fat is regaining popularity in the media. It is often marketed as new and revolutionary, when in fact it is old technology. “In reality, a good majority of the fat melts away, and you have to do it again.” Weight fluctuations will also have an impact on how the injected fat waxes and wanes in the face, risking an uneven look that isn’t a factor with pharmaceutical fillers such as Juvederm.

“And you can’t inject fat to tighten tissues that have sagged,” he adds. “You have to tighten the internal layers and then remove excess skin, in addition to adding volume. So you have to look at the face in its entirety.”

Caniglia cautions that surgical procedures promising to lift just the neck and not the cheek often fail. “It just doesn’t work,” he says, pulling up the skin around his neck with one hand to demonstrate the pleat formed below the ear. “You can’t pull up just one area. The cheek and neck tissues need to be tightened together for best results.”

Consumers should also be wary of buzz about a procedure that “only one doctor in New York or California” is doing. “You have to take a step back and say ‘Why is he or she the only one doing it?’ It should be a red flag, because if it’s an effective procedure, we are all going to adopt it.”

Speedier Recovery

In Caniglia’s practice, which includes an onsite outpatient surgical facility, facelift patients no longer must wear a compression wrap the first week after surgery. In fact, Canigilia has speeded up recovery time through his adoption of TISSEEL, a natural tissue glue sprayed underneath the skin, allowing layers to quickly re-adhere with minimal swelling and bruising. Drains are also avoided, enhancing recovery.

“It’s fabulous. It gets our patients looking much better, much quicker, and there are much fewer incidents of bleeding,” Canigilia says. “It’s expensive, but I find the benefits outweigh the expense.”

TISSEEL is commonly used in vascular surgeries, but Caniglia has used the glue in 800 plastic surgery cases. He’s now preparing peer presentations about his success as well as a paper for review to the Archives of Facial Plastic and Reconstructive Surgery.

Cost

Cost for procedures varies, depending on a patient’s needs—though Valley residents are fortunate they will pay substantially less for top-notch doctors than in parts of New York or California, Caniglia says.

The thing to remember is there are three fees: the surgeon, the anesthesiologist, and then the surgery center/operating room costs. Upper and lower eyelid surgery at the Caniglia Center can cost close to $5,000 total. A facelift can run $10,000, but if combined with additional procedures such as eyelid and forehead lift surgery, laser skin resurfacing or facial implants, the bill can reach $25,000.

When searching for a qualified surgeon, look for those who specialize more in the procedures you’re looking for, Caniglia advises. If it is the face you are looking to rejuvenate, he recommends visiting with a plastic surgeon who specializes in plastic surgery of the face only.

“If you want a breast augmentation or reconstruction, find someone where that is their specialty,” he says. “Try not to get caught up with what you see on TV or magazines. Go visit with the doctors and make sure you see the doctor himself or herself. Make sure you are comfortable with the surgeon and his office.”

Dr. Ronald Caniglia offers consultations Mondays through Fridays. Cost is $50, and that is applied toward a scheduled surgical procedure.