The aesthetic medical profession is currently experiencing an exciting moment in history where the scientific possibilities available to plastic, facial plastic and cosmetic surgeons are rapidly increasing with new techniques and technologies that improve or even change established surgical protocols and safely deliver superior patient results. In this ground breaking interview with Aesthetic Insider™, Gregory Mueller, MD, a board certified plastic surgeon located in Beverly Hills, CA, discusses Ellevate™ a new and exciting minimally invasive lower face jawline and neck rejuvenation procedure he has pioneered. The Ellevate™ procedure is a completely new approach to address the underlying muscles and glands of the neck. To date no other minimally invasive technology exists that will treat the underlying neck structures percutaneously. The Ellevate™ procedure is a great adjunct to all technologies and approaches that either tighten the skin or remove/dissolve fat. Many of these approaches leave visible neck bands and droopy glands. Ellevate™ is the first and only procedure that allows the oversewing of these structures to support and shape the neck contours underneath the skin. Dr. Mueller invented the ICLED® light guided surgical system that is used to perform the Ellevate™ procedure. The ICLED® is also used in many applications such as brow lifts, brow shaping, facelifts, and breast reconstruction. To learn more, visit www.myellevate.com.
Dr. Mueller, as well as being a practicing plastic surgeon, how did you also become a pioneer in new aesthetic technologies?
I have been in practice since 1998 and over the last 20 years my practice has evolved into the inclusion of less invasive technologies because that’s what patients are demanding. At my practice in Beverly Hills, I perform facelift surgery, tummy tucks and body contouring, as well as radiofrequency skin tightening, laser treatments for sun damage and other similar procedures. My first invention was in 2006 when I developed the concept of light guided suture placement, which is now known as the ICLED® light guided surgical system. The ICLED® light guided surgical system received FDA clearance in 2009 and is an illuminated suture rod that allows the surgeon to deliver sutures underneath the skin to elevate and approximate soft tissue. We now use this system for brow lifts, facial and neck contouring, and breast contouring. It’s a great way to less invasively shape, contour and elevate soft tissue in cosmetic surgery. Over the years, using that light guided surgical system, I realized a great use of it which is a minimally invasive facial procedure I’ve named the Ellevate™ procedure which is a way to support the glands at the back part of the neck to refine the neck area and jawline. In 2011 I invented the oVio360 Dynamic Imaging System, which is a robotic dynamic image capture system that captures standardized before-and-after images in a 360 degree format in perfectly the same lighting. The oVio360 allows doctors and patient a complete and accurate 360 degree video capture that they review during consultations, and post-surgery to carefully evaluate results. So, both of these are my big innovations, but I have to say the one I’m most excited about is Ellevate™.
What is Ellevate™ and how does it work?
Ellevate™ is a procedure that addresses the glands and the muscles underneath the skin of the neck which has often been a neglected area by both patients and surgeons until more recent years with the introduction of sub-mental liposuction, injectables and Kybella. I had been treating this area surgically but since developing the ICLED®, developing a non-invasive permanent procedure became important to me. Ellevate™ enhances the neck and highlights the back part of the jaw line which is a very strong sign of beauty. Using the ICLED® surgical suture system which consists of an illuminated suture rod and suture system that is mapped out and placed underneath the skin to support and refine the neck and jawline area, patients can now see a much more defined and youthful lower face and jawline which is exciting. Ellevate™ is also a very complimentary procedure and for patients that require a little more enhancement, can be used in conjunction with other technologies such as radiofrequency laser, ultrasound and, as mentioned previously, sub-mental liposuction and Kybella®.
Is the Ellevate™ procedure specifically for lower face, jawline and neck revitalization or is it considered a facelift?
Ellevate™ is very different to a facelift. It’s not a facelift or a neck lift and is something totally new. Ellevate™ does not require incisions or removal of skin, can be performed under local anesthesia in about one hour in the office, and requires little anesthesia and almost zero downtime. That’s what is so remarkable about this technique. Ellevate™ is a method to support the foundation of the neck that the skin lies upon to really sculpt and refine the neck.
Does Ellevate™ require special training?
Yes. Ellevate™ is best suited to surgeons that are already familiar with aesthetic improvement of the face and neck and training programs are offered to board certified plastic surgeons, facial plastic surgeons and cosmetic surgeons that specialize in facial aesthetics.
How is the Ellevate™ technique different to a thread lift procedure?
Ellevate™ is quite different to a thread lift for several reasons, the most important one being the long lasting ability of Ellevate™. The suture material we use to create the support sling underneath the jawline is a permanent braided polyester suture, and where it is placed also differs from the thread lift (PDO threads or absorbable threads) in that we place the thread a little bit deeper and we place it right over the muscle and beneath the skin using the ICLED® lighted Suture Rod. This is what allows us to travel in the exact location, so that we’re not too close to the surface or too deep, to actually permanently support the glands and muscles of the neck. With the ICLED® light guidance it makes Ellevate™ much more accurate and with the permanent suture material, it is also much more long lasting. Also, the structure of the Ellevate™ suture is much different to PDO threads or absorbable threads which are single strands sutures that are placed to sort of elevate skin. The Ellevate™ suture is actually a continuous loop that goes underneath the entire area of the jawline and really supports it over the long term. It is also non-absorbable, thereby making it more permanent.
How long do the results of the Ellevate™ procedure last?
I began developing and performing Ellevate™ in 2011 and now have patients that are seven plus years out and with strong results, so far I consider the results to be very long lasting with a five to seven year plus success rate.
How does that compare with durability of Thread Lifts?
Time will tell and Ellevate™ may even last little bit longer, but just like when I’m doing a facelift or a neck lift we always tell patients we are essentially going to reset the aging clock and then it’s going to start marching forward. I feel the same thing is true with Ellevate™. The nice thing is it really supports the glands and also supports and smooths the muscles, so the patients obtains an immediate new refined neck and it’s long lasting. At best Thread Lifts can lift tissue for a short period of time before they are absorbed. Absorbable sutures are not long lasting enough to hold the glands and muscles in a new position in the way that Ellevate™ can.
Who is the ideal candidate for the Ellevate procedure?
The ideal candidate for this procedure is a patient who is hesitant about going under the knife in the traditional invasive sense, with minimal skin laxity and who is just starting to show early signs of aging. If you look at someone’s profile and see that their neck line is looking like a ski slope, rather than a nice right angle underneath the chin, those are the most ideal patients. Also, patients who have glands that are prominent underneath the neck line, which happens to a lot of people genetically and are not even age related, those are patients that also experience a great result with Ellevate™. The list goes on, as even a patient who is thinking about having a skin tightening procedure may also need Ellevate™ as the technology may tighten the skin, but it does not do anything to address the underlying muscles and glands which are causing the neck to look aged. Ellevate™ is the only procedure that is percutaneous and addresses these problem areas.
Does Ellevate™ improve the jawline?
Yes. The two strands of the Ellevate™ system extend from behind each ear all the way underneath the chin, and underneath the back of the jawline to support and shape the neck as well as suspending the glands. This provides an accurate shaping of the neck and jawline. Most patients say they feel as though this is the first time in their life that they actually see that they have a defined jawline.
Is it possible for Ellevate™ to improve the back of the jawline and give it definition in the same way you see many model faces in beauty magazines?
What many people are unaware of is that when they have their skin tightened, or have a little fat removed or undergo a Kybella® treatment, the glands and muscles in the neck have nothing to support them and they are actually heavier than the skin. So, they might have a little less heaviness or improved tissue but the neck and jawline is still not defined due to the weight of the glands and muscles. The way Ellevate™ works is it accurately passes right over those areas and when we evaluate each patient we mark those areas where they have the least desirable neck contours and place Ellevate™ in those areas to support and shape that part of the neck line. The same considerations are used when we use Ellevate™ to define the back part of the jawline. Not everyone can have a model face, but with Ellevate™ they can definitely have a more defined back jawline which carries with it the look of youth and beauty.
How long does Ellevate™ take to perform and what is the downtime?
What makes Ellevate™ so exciting is that it is an in-office procedure that only takes about one hour to perform which patients really appreciate as it is a procedure that gives instant and permanent results that they can have performed on a Thursday or Friday and literally be back at work by Monday. The patients go home wearing a chin strap and when they return the next day for their post-operative check-up they are just amazed to see their results. Most of them have very little bruising or swelling and could actually go to work the next day with minimal signs of a procedure. We do, of course, recommend no heavy lifting or heavy workouts at the gym which is normal with most procedures. Also, there are no stiches or incisions so there is very little in the way of post-procedural care. Patients can shower the next day, although as mentioned previously, we do tell them not to work out at the gym for a couple of weeks, because people who work out too soon will get more swelling.
What is required for a surgeon to be able to perform the Ellevate™ procedure?
We only train doctors who are experienced in surgery of the head and neck, preferably a plastic surgeon, facial plastic surgeon or other surgeons who are trained in this type of surgery. If a surgeon knows how to do liposuction of the neck, then they would also be qualified to perform Ellevate™. We have an instructional video that I made for this technique in addition to many of the techniques that we do with the ICLED® system, but Ellevate™ is the one I’m most excited about. Those doctors that choose to train in the Ellevate™ procedure will watch an instructional video which demonstrates the marking and the sequencing of the skin and how we pass the ICLED® Lighted Suture Rod underneath the skin to accurate place Ellevate™. Then the doctor will come and observe either myself or another doctor in their area who is trained in the Ellevate™ procedure and view the procedure live. This is important as the surgeon can watch the procedure live and ask questions. The third step is for the surgeon to go ahead and perform a procedure. Most surgeons trained in facial anatomy and liposuction find Ellevate™ to be a procedure they become comfortable with very quickly especially as the ICLED® light guidance makes it easier for them to see where they are placing the Ellevate™ double strand loop underneath the jawline.
Is the ICLED®device integral to this procedure and is additional training required?
Yes, it is essential. The ICLED® suture system kit consists of a puncture device that makes precise punctures in the skin, followed by what we call the dermal clearing device that is inserted into each puncture to clear the dermal attachments around each puncture. The light handle and the Suture Rod are used to construct the suture matrix underneath the skin using the LED light guidance. The suture rod is illuminated as its tip, so that light transilluminates through the skin. Everything comes in the kit that the doctor will need, and during the Ellevate™ demonstration we show how the kit works. The nice thing is that the suture rod is not sharp, it’s blunt and the surgeon just attaches the light to one end and inserts the other end underneath the skin allowing them to watch the light as it passes under the tissue. The user will want to keep the trans-illumination light a soft yellow hue which indicates they are not too deep and that they are in the fatty layer which sits right underneath the skin and over the muscle. This allows the user to pass the ICLED® suture rod and attached suture from one pivot point to the next, creating a suture suspension system over the underlying muscles and glands.
Does Ellevate™ require general anesthesia?
When I meet with my patients I always assess and ask them would they be more comfortable with local anesthesia and there are few who say oh, no I’d rather be asleep. So, for those patients we would use general anesthesia. However, I estimate that 80 to 90% of my patients prefer and are comfortable with local anesthesia.
How does Ellevate™ compare to surgical neck procedures?
Although they are not the same as Ellevate™, older invasive techniques such as the open corset platysmaplasty were great procedures to use if a patient is undergoing a neck lift or a facelift, or if the patient is older and they really want their neck defined. Many of today’s cosmetic surgery patients do not want an invasive procedure as it carries risk, as well as significant time off from work. They prefer the Ellevate™ procedure because they are not interested in invasive surgery, but want effective results that last a long time, and that’s where I think the sweet spot is for Ellevate™.
How does a patient generally feel after an Ellevate™ procedure?
Most patients report that within a few weeks they feel great. Any swelling or bruising, should dissipate within the first week. After that, patients are going to feel a little bit of tightness where the Ellevate™ suture strands have been placed especially when they look down towards their toes because that’s when it really does its maximal supporting and shaping underneath the jawline. They may also feel a little pressure behind each ear as the suture loop circles around before it comes down to underneath the chin, so when they look down it pulls a little bit behind the ears. That sensation is pretty much gone by 2 to 3 weeks and after that they’re usually not aware of the pulling sensation. When we review them one, two and up to six years out, we ask them to look downward and we can still see that Ellevate™ is still doing its job supporting, refining and shaping the back part of the neck.
What advise do you offer to a surgeon that is new at performing the Ellevate™ procedure?
With any new procedure there is always a learning curve and so with new doctors to Ellevate™ the first thing I tell them is to select an appropriate patient. Patient selection is everything, with every technology and every approach that we do. Finding the right patient, finding the young female or male patient who is just starting to show some signs of aging, with a small amount of skin laxity are ideal as they will have a great result and feel more confident about their appearance. Learning how to comfortably pass the ICLED® Suturod underneath the skin and how tight to tie the suture may take time but once the surgeon learns it, there is no looking back. The second opportunity I would offer is to consider how Ellevate™ can enhance other procedures surgeons may already offer such as laser and RF skin tightening, liposuction or Kybella®. Our surgeons are finding that these procedures when combined with Ellevate™ ‘are creating a beautiful harmonious appearance of the lower face, neck and jawline of their patients.
What other types of procedures or technology does Ellevate™ compliment?
The most exciting technology is the FaceTite® technology by InMode. InMode also offers another application called BodyTite®. Both applications work by using radiofrequency which is bipolar meaning that it is very focused and very precise. It’s a great technology that tightens the skin. So, with my patients now who normally would have required the old traditional neck lift of facelift with all the invasiveness and the incisions and down time, I now use FaceTite® to significantly tighten skin without any incisions. I have found that whenever I am using a device to tighten the skin or to reduce fat I combine them with Ellevate™ to insure the absolute best and long term results.
To learn more about Ellevate™, visit www.MyEllevate.com.
To learn more about Gregory Mueller, MD, visit www.drgregmueller.com
To listen to Dr. Gregory Mueller’s interview at Aesthetic Insider™Radio, CLICK HERE!