hi everyone I'm super excited to share my list of treatments and Trends in plastic surgery that I'm officially over I've had a lot of experience with this I'm not just throwing these things up here because I don't do them most of them I've actually done and I've learned the hard way and many of them I was smart enough to avoid doing make sure you watch this all the way to the end Empower yourself make good decisions and in case you don't know I'm Dr Mir carum I'm a board certified facial plastic surgeon I'm also the
founder and creator of caram MD skin today we're going to delve in and talk about some procedures that I've selected that in my opinion don't meet the expectations under delivering overex expectant ultimately not worth doing at all so I'm going to go through that list with you I'm going to share some stories and anecdotes about my own personal experiences with them how I arrived at this decision but ultimately why this is important for you is really because you're trying to make decisions about what's worth doing and what's not worth doing and there's a lot of
decisions and choices out there and frankly that's the number one reason why this entire Channel exists is to help people make good decisions for themselves Empower themselves so if you haven't already make sure you subscribe to this channel what I'm going to talk about today are things that I don't like there's a video coming up that's going to be talking about things that I do like so subscribe so you can follow along and make sure you don't miss the second segment of this concept all right without further Ado let's break it down so let's talk
first about how I make decisions so number one I am a facial plastic surgeon I'm very careful about things that I bring into my office it's been this way for the last 20-some years that I've been in practice so the way I decide whether a treatment belongs in my practice which means something I'm going to recommend ultimately is not ever ever because of marketing hype and a swell of interest that comes from from the community Etc it's always based on whether or not that treatment actually works and meets the expectation but most importantly would it
be something that I would comfortably do for myself or my wife that's a high standard so if it's not good enough for her or for me then it's not good enough for my patients that's how I hold every decision to because I feel I'm a steward of their trust in me and I have to deliver on that and therefore I'm going to be careful about what I recommend I look at each decision from a risk benefit point of view to me a good procedure has a high reward low risk not the opposite high risk low
reward and we'll go through each of these procedures with that in mind the other aspect that is equally as important to all of those is give the procedure some time in the world don't be the guinea pig in any procedure and anytime something has come into the marketplace I let it live for about two years out there and hear what people have to say about it see what the results are and then I pick up the phone and I start making calls to colleagues around the country who have that particular device who have that particular
procedure and I asked him frankly hey is this thing delivering is it worth doing and if the answer is no then I know it's it's not worth bringing in if they give me a strong blowing recommendation for it yeah this is groundbreaking this is awesome then I bring it in so those are the the ways that I decide on treatments and ultimately everything that's on this list has either gone through my own personal experiences or the experiences of trusted colleagues and the test of time all right so let's break it down the first item on
this list is threads I've been in practice like I said for 20 years and before that I've been you know a hardcore student of it for about 10 or 11 years so 30 something years watching this industry evolves right during my fellowship actually the trend of threads blew up there was a company that came out called Contour thread lifts it took everything by storm it was like the hottest concept they're putting in basically non-dissolvable Barb sutures to hold the face up the concept was they're Barbed when you slide the tissue above it this tissue can't
slide down so it's going to give you traction and hold the face into place so it was basically supposed to be a non-invasive non-surgical replacement of FACS and I'm literally in my fellowship for facial plastic surgery when this came out which excited all of the surgeons around the country including um non-surgeons but the bottom line is it was going to be okay we can open the door for a lot more people and and get a lot more treatments for them the people who are not ready for surgery or maybe who are not interested in surgery
an alternative we started doing this in my fellowship and I remember one case in particular this patient was in a candidate for surgery because she was a smoker she had a lot of excess skin she was in her 50s and so a perfect candidate not a a good surgical candidate and aging so we did this procedure on her it was shocking like in the moment we're doing it we lay the threads in you know he goes from the top down here and you put a multiple in then you hike the tissue over the threads and
then you walk you know let go and then the face is up so it's like wow okay the cheeks went up but then around this area there's all this bunching of skin all this stuff was bunching up up in that area so I was like well what do you do with that skin well I guess the concept is that with time it just sort of opens up again and it relaxes but it looks really weird and stupid while it's in that position not to mention the patient was in pretty excruciating pain as these Barb sutures
were sitting underneath the skin holding everything up I think we did one or two more of those treatments and it became very very clear that this was a pretty dumb idea frankly it didn't take that long I think within a year or two after that point the company completely went bankrupt and it disappeared everyone realized that this was a complete waste of time money and and risk not to mention all the deformity and infection and all the other things that that came with it it just didn't take off fast forward almost 20 years thread lifts
came up again now they're dissolvable sutures this is what you guys are all probably aware of these pedo threads these dissolving sutures that are made of basically like a suture material that goes away the concept I me I looking at I was like wow why is this coming back up you know we really tested it in the most hardcore way and it turned out to be a bad idea why is it coming back up well things in our field do that all the time you know things go away marketers think okay well people have forgotten
about it let's rename it bring it back again as a New Concept and let's get another ride of of sales from it terrible terrible thing trust me I hate that aspect of this profession I did a whole video on this topic before but basically it's what's happened of course this time around you know I didn't get involved in it there's been a number of of studies that show the risk of infection Contour irregularities nerve damage blah blah blah but every procedure has those risks right I mean anything you do has a risk of infection and
all that kind of stuff question is what's the benefit remember we're looking at this from a RIS benefit point of view the results generally last about 3 to 6 months now every time I say that I get a ton of people who agree with me because their own personal experience and then once in a while we get someone who says no it it did really well for me well that's great if it does really well for you but in general the actual reality is especially for people who are looking at this as an alternative who
are a little bit older in their 50s Etc it's not going to replace surgery you're not even going to get a sufficient level of correction from it to it now if you're like in your 30s and you're kind of playing around with it maybe those are the people who are responding this way 40s whatever but it'll never give you the the magnitude of change but it also won't give you the durability so you say all right fine well it costs so much less you know I'll do it over and over again go ahead I mean
if that's how you want to approach your aging process then go go ahead and do it that way but most people want to kind of get control of it and stay ahead of it and the reality is everything costs money everything does I mean threads cost money and if you have to do it every six months to a year or whatever it is I mean you can just extrapolate that fee out and eventually it'll be what a faive would cost but more importantly I don't even think people are getting that much durability out of these
procedures not from what I've seen not what from the reactions for these videos Etc so to me that's a trend that needs to go away it just doesn't have a place in it and those are the the reasons why high risk low reward really doesn't doesn't make a lot of sense facial fascia is sagging you need to get it back up into position and you need to get it back up with a high quality surgical procedure like a deep plane fa lift vertical restore something that's going to really keep it there and give you some
mental Liberation not to have to thinking about your aging process you know month after month year after year really at the end of the day that's kind of the part of the big goal right to look as young as you feel all right so let's go on to the next one next category is this idea of using fillers again as an alternative to a facelift for almost 20 years as a practicing facial plastic surgeon I've been seeing new ideas come up every other day about where to put filler to basically Contour the face in a
way that it doesn't look as aged my own personal experience and I've done tons of filler I even used to be basically a trainer for Allergan you know the makers of juviderm and Botox I don't want to say I drank the Kool-Aid but how would I know the difference right I mean I was a big volume loss person I realized that volume loss was an important part of facial aging and you can use fat transfer which I have always loved but some people want to do something a little quicker a little bit less invasively so
I would do fillers for them it did not take me long embarrassingly it took longer than it should have it took me 10 years 12 years 15 years whatever it was for me to realize that the fillers that we're using on these faces when the cheeks and you know along the jawline Etc were not really making people look younger they were you know maybe camouflaging some of the laxity along the jawline maybe they were making the cheeks look a little bit better but really at the end of the day there's a couple important points here
sagging continued necks continued to Sag Etc jawlines became bigger and bigger cheeks became wider and wider the face started looking different and once I realized that pretty much if you're in the facial sagging phase of your life which is like 50 and above in that way is not a treatment you want to do why because a it doesn't stop you from aging B it starts to make you look weird and we've definitely have seen lots of celebrities and we've even talked about it on this channel Courtney Cox Kristen Davis who say they're dissolving it you
know is the worst decision they made etc etc and you know we've learned from them we learned from our own experiences we learned from our friends who go through this but fundamentally the use of filler in that way is a dumb idea almost every patient I operate on has had a 5 to 10 year run with before they come in for their surgery and their biggest regret frankly is when they pull up a picture of themselves when they're in their 30s their face is just a lot Fuller looking than it ever has looked unless you're
in a situation where you're going to go and like try to dissolve all of it which takes multiple multiple treatments under ultrasound guidance and this and that which frankly I personally don't have the patience to do that's just not my thing I mean there are some doctors that that are doing that type of stuff but that's a lot of needle Pricks and a lot of this and that I don't even think you can really get it all out of there cuz there's a transition from fibrosis that occurs that really becomes more scar tissue and we've
talked about this on this channel also that fillers in the mid face and the cheeks especially if later you're going to do a deep plane facelift can cause some fibrosis and scarring in that delicate plane which will make surgery more difficult now again I'm used to working in that space I do six of these vertical stores a week I you 20 years of experience I'm used to it and I can get through it and I can do a great job with it I always worry about a surgeon who's newer to it or who's not doing
the the volume that I'm doing and doesn't have the experience how they're going to find it to be sticky and stuck in there and they're going to potentially either back out or not do a great job or even worse Nick a nerve or do something like that so for me fillers in the midf face and the Cheeks is a big no no now in the upcoming video he going to talk about where you can put filler that is actually a useful and good part of the facial rejuvenate so I'm not totally anti- filler it's just
you got to use it the right way but as a general Point cheeks and jawline big no no in my opinion the next category is this idea of Sur surgy that addresses partial parts of the face at the same time for example mini face lifts lower face lifts neck lifts totally dumb idea first of all your face doesn't age in segments it ages together this entire fascia from the top of your temple all the way down to your neck is literally one thing it's one fascia and with age that fascia becomes longer and longer so
you see the crowding around the corners of the eyes the mid face comes down deepening in the nas laal folds a little crease in the middle cheek area jawline starts to Sag you start to see jowling as the cheek hangs over the jawline and of course finally the neck starts to Sag so all of that is a connected fascia sheet that gets longer with age it literally elongates so when somebody comes in and for example asks for a neck lift tightening this area and leaving jows looks stupid frankly it's a dumb idea it doesn't look
natural it doesn't look normal plus the reason your neck is sagging is because your face is coming down you don't believe me just do this if you have neck laxity grab a hold of your face right here literally right here and pull up look what it does to your neck your entire neck moves up it's because the neck muscle the platisa muscle is intertwined and attached to the facial fascia which is called the smaz that area comes up now look what happens if you keep going up well look you get bunching here well that's because
this temporal area is connected to the lower part so all this is generally connected to each other so when you go and do a partial face lift like a lower face lift so you tighten your lower face well what happens to your mid face this part comes down this part looks weird neck doesn't get addressed all these aspects look imbalanced and they look nonh harmonious and more importantly they look unnatural I actually went the opposite direction after 10 years I went more aggressive the vertical restore which is based off of a deep plane which is
the most aggressive style of lift you could possibly do is completely the opposite extreme of a mini facelift it's the most call it invasive or whatever you want to call it and the reason I I did that was because even though I had really natural looking results in the past cuz I always would go up with in a vertical Direction the results weren't lasting as long as I would hope and what would end up happening is patients would come back after five or six years and that's actually pretty good and they would start to look
a little worn a little tired looking so maybe 8 9 10 years you do another lift well deep planes in the vertical restorer which uses a deep plane in this upward vertical Direction incorporates the lateral brow mid-face jawline and neck that's what makes a vertical restorer unique deep plane allows it to be durable because it releases all of the ligaments that are basically pulling against it so you get this complete comprehensive look with the vertical restore that addresses all aspects so the whole result looks normal and natural and you get durability so the idea with
these partial lifts is lack of durability you don't want to go through surgery too many times I mean in addition to again the risks rewards not worth it but it makes surgery harder for the next surgeon who wants to do it plus you have to go through a whole another downtime and a whole another expense do it right the first time next category is this whole umbrella of energy devices everyone's trying to avoid having surgery scarring expense downtime etc etc every other year you have a new device that comes out that promises to be the
the answer and this cat there's too many names to mention but the big ones are morpheus8 all therapy they all work slightly differently but they're all trying to deliver energy into the deeper tissue which is that SM you know that fascia that I talked to you about to contract the smaz because when you put heat on tissue it shrinks you can do do that to like you know a piece of chicken that you're cooking so the idea is that you deliver heat into that elongated fascia and it's going to shorten it I mean it makes
perfect sense from logic's point of view but the only thing that was never really fundamentally understood is as you're going from the outside to the inside the fascia is actually below the subcutaneous fat which is the fat under your skin it's a very thin layer and below that is nerves you can't be that precise with this and you're going to air on the side of not hitting a nerve because if you hit a nerve in the face well the person has facial paralysis and they're going to be very really upset if they can't smile or
you know raise their forehead or whatever it is so you're going to go a little bit more shallow but deep enough to get through the skin cuz the skin is a millimeter or two so you're going to shoot for like three four you know sort of 5 millimeters in that range well guess what's in that range it's your subcutanous fat and we've done videos on this and you know if you look at the comments and you hear about it I mean I used to think this was complete BS when people would contact our office say
hey I did a you know Morpheus 8 and my face looks older than it did this and that I thought but then it just got too over whelming of people saying it and then when you really start thinking about the physics and the science behind it it actually makes a lot of sense but I see patients all the time unfortunately where they've lost so much of their facial and neck fat that is irreplaceable you cannot do a fat transfer and replace the fat underneath the skin that's what gives the face that suppleness that fullness when
you're doing a fat transfer you're putting in the Deep tissues you're not treating the subcutaneous fat so once that fat is dissolved it's done so in addition to the risks what I just mentioned there's literally effectively no upside to it you're not going to going to get your face to respond you're not going to get your JS to come up the way it does with a facelift it's just not who in the world would be happy with like a 10% improvement over a heavy jawline and neck I mean no one I've ever met wants a
you know a little correction if they have heavy jaws and necks they want to get in front of it and they want to correct it wipe their hands free from it continue doing skincare do Botox and call it a day live like a 30-some year old this whole category very low reward very high risk the balance is completely off to me never have I ever even thought about bringing those treatments in because every single time I even considered it I got on the phone talked to my colleagues around the country and every one of them
said even though they have it and they're using it every one of them said it doesn't work it doesn't do anything and now you're starting to see people catching on I've been talking about this literally for years I think there's a bit more consensus and Community coming together expressing The View on this so I'm not a fan never will be we've tried all different types of Technology none of them have been able to adequately resolve laxity and shape change of the face this last one I think it's on its way out was super popular in
the 70s and then had a Resurgence it's Buckle fat removal in 2023 this was a big Trend a lot of models and actresses and stuff were doing Buckle fat removal I've always been an anti- buuck fat removal person especially for young people there are select cases obviously where you should do people with like really heavy heavy faces but people have been doing it to like I don't know look a little bit more sculpted Etc the same reason that the models and actresses and the public was doing it back in the 70s but what they found
was you can easily overdo it you can end up looking really gaunt and and hollowed out in this area but also with age you're going to lose volume in this region anyway so taking this area out making everything really hollowed out is not a good look it's not a healthy vibrant youthful look so I'm happy to see this trend is almost gone but I was surprised to see it come back and it what always amazes me and I again I hope you're not one of these people but I'm sure there's a lot of people listen
this Who who' Fallen for this stuff but I can't imagine how easy it is for people to allow themselves to undergo certain types of plastic surgery procedures that basically have permanent results like that foxy Trend these are like real operations that have permanent effects I'm always amazed at how easy people are with their faces and doing things to me it's the most precious thing and it really deserves a lot of caring consideration before doing certain things and trust that you're making the right decision again this is what this entire channel is about give you perspective
hopefully you feel like you can trust but yeah this trend is on its way out and I'm happy to see it gone one of the final points here is be careful be mindful everyone these days has a platform to talk to you if friends send you a Tik Tok video an IG reel YouTube video Whatever whatever don't fall for that I'm trying to set the stage for you to evaluate these decisions yourself and you can use this to your advantage to make smart decisions but don't fall for Trends every day somebody has a different thing
they want to sell you understand the reasons behind it understand how it all plays out so now let's talk about where the state of the art is so every industry has a stage where things really really evolve and then they kind of plateau and that's okay if it's not broken why fix it the field of plastic surgery definitely had problems one results were looking unnatural there's obviously a huge variation of surgeries etc etc I look at my own outcomes I mean because I've been evolving right as a surgeon I've been practicing for 20 years tweaking
and getting better the vertical restore the fat transfer upper lid lower eyelid combination with a lip lift in some cases you can't get better than that how can you look better than the before and afters that I share with you guys I mean they look 100% natural the results last a very long time it's a 2 3 week recovery and then you're done I I really I'm struggling finding a way to make it better so to me now it's about kind of we're at a steady state with the results so my opinion is this is
what the state-of-the-art is everyone at any age you treat your skin with sun protection and the actives that I talk about that are in the trifecta the results we with the trifecta frankly cannot get better people's skin are always improving how do you get better with Supple glowing bright Flawless looking skin so you can't speed it along with with certain lasers which I'm going to talk about in the next video so make sure again you subscribe and watch skin is taken care of at home by you so there's your skin the other half is shape
at the end of the day it's going to be a solid facelift deep plane vertical restore comprehensive treat the neck treat the lateral brow treat the eyes get some volume back in fat transfer that's how you're going to rejuvenate the face do a little bow talks take care of the skin after a surgery I don't see really any room for anything else that's the state-ofthe-art this entire spectrum of of Trends need to go away there you have it all right folks I hope you enjoyed this video I hope you learned something make sure you subscribe
to this channel make sure you watch the next video that'll complement this particular video and if you want more information on this subject sign up for the caram MD Journal as well as check out our two websites I think you'll find a lot of good information there and examples of all this all right folks until next time Dr Mir carum
