The Ellevate™ minimally invasive facial rejuvenation procedure is currently attracting massive US and international attention from plastic, facial plastic and cosmetic surgeons, as it is the first non surgical procedure to offer long lasting rejuvenation to the neck, lower face and jawline. In this interview with Aesthetic Insider™, Professor James D. Frame FRCS, FRCS(Plast) who is internationally recognized for his academic leadership in plastic and reconstructive medicine as well as a pioneering early adopter of Ellevate™ at his UK medical practice, shares an international perspective on how Ellevate™ is rapidly becoming the procedure of choice for patients and surgeons. To learn more about Professor Frame, visit www.professorjamesframe.co.uk. To learn more about Ellevate™, visit www.myellevate.com.
How did you learn about and become interested in the Ellevate ™ procedure?
For the last 8 years I have been a professor of aesthetic plastic surgery at the medical school at the Anglia Ruskin University in Chelmsford Essex. In 2008, I was visiting San Francisco for a medical conference and I received an invitation to observe Dr. Gregory Mueller, who was demonstrating a new facial rejuvenation technique that used a new technology called the ICLED®. I became interested because Dr. Mueller was demonstrating how to lift up the hanging part of the neck under the submental (or below the jowl/neck and lower jaw) and to say the least I was very impressed. I then thought, ‘we’ve got to use this in the United Kingdom’ and I invited Dr. Mueller over to our hospital in the UK where he demonstrated on a number of patients in a very expert manner. We then used the ICLED and what has now become the Ellevate™ procedure on approximately 50 cases with excellent results.
What has changed since then?
Originally we had an early version of a tool now called the ICLED® which is a fiber lighted rod containing a long suture. The ICLED® tool has been modified as well as the Ellevate™ technique which has been simplified and adapted to fit virtually all patients. Previously Ellevate™ was only the Trampoline Plastysmaplasty which Dr. Mueller still performs on more advanced patients and still trains on, but what has changed is that the original procedure has been modified and adapted for more widespread use and to meet the demand of a younger patient.
Can the Ellevate™ procedure be used in conjunction with other treatments?
There are certain people that need adjunctive treatments. It’s not just all about the neck, sometimes you have to include other procedures such as little mini face lifts or facial tightening, fillers and fat graft or energy tools to tighten the skin. We can adapt the technique to suit our patient needs and I’m really quite excited about incorporating it into my practice in the United Kingdom.
How long did it take you to learn the Ellevate™ technique?
It’s quite easy for most surgeons, you just follow one line to the next line and the suture is easy to tie. It’s a better, more simplified procedure than when it was first developed. You can actually see the way Dr. Mueller has studied and analyzed the anatomy and worked out the direction of pull that is going to make the lower neck pull up nicely. The problem with virtually all surgeries on the neck is that we cannot necessarily solve the lower part of the neck itself and Dr. Mueller’s Ellevate™ technique does that.
What are the drawbacks with a surgical approach to facial rejuvenation?
If you just do a facelift, the neck doesn’t always come up with the face as well as we (both doctor and patient) would like. In fact the evidence is that the face stays up well, but the neck drops back within three to six months. The muscles and glands in the neck are heavy and are what makes it hang. So we needed to develop something to keep it in place. Surgical options include extensive undermining and high risk surgery, to just work on the submental area. It includes an incision underneath the chin and releasing of tissues, taking out fat, tightening the muscles of the neck and the platysma muscle and then suturing it in place. This can often leave the patient with a significant amount of lumpiness and irregularities that take a long time to settle down. With Ellevate™ we don’t need to be so aggressive and the results are very good. One drawback is the quality of skin on the patient. If the skin is aged and not able to retract, then it may hang slightly but most patients see this as a minor issue.
How is the non surgical Ellevate™ procedure different?
The idea of putting the skin into a position where it’s higher and tighter attains a very reasonable result with a good angle. Ellevate™ is actually doing something quite simple. As surgeons we are always attempting to provide a great patient result with the least downtime and very low morbidity. Ellevate™ is a low risk procedure with very high reward, whereas surgery is a high risk procedure with high reward. Most patients prefer the low risk option.
What makes Ellevate™ a notable procedure?
The day after the procedure the patient is up and about and, apart from a little bit of tightness in the neck, they are able to immediately resume normal life as long as they follow post-operative instructions. There is very little downtime and no scars. The needle holes used to insert the suture rod disappear within days and you can hardly see anything.
How does the ICLED® tool help perform the Ellevate™ procedure?
The Ellevate™ technique sutures are placed in an anatomically defined area by using the ICLED® tool. The ICLED® tool has a light source at the tip generating a white light creating visibility to guide the suture rod through and into the plane of the neck between the skin and the muscle, the platysma muscle. If we go outside of the muscle by elevating that muscle, we are actually pulling it in behind and that includes the submandibular glands and all the lateral parts of that. The neck is moved up into a position that’s suspended between the two mastoid processes, which creates a basic suspensory sling, but it’s not one line, it’s actually two lines of thread which draws it and pulls it all together giving a nice definition. Generally we will have liposuctioned the tissues above it, so we are basically closing off space so therefore there is less risk of a hematoma or a seroma, and less risk of infection. The ICLED® tool uses a fiber light that glows white yellow when it’s in the right plane, but if for any reason the rod moves behind the muscle it will show brown or red and that is the signal to the surgeon that they are in the wrong plane. The ICLED® gives the surgeon a great advantage over any other techniques as they are not doing a ‘blind’ surgery, they are able to easily see and place the sutures in the correct anatomical position.
What is the difference between the suture technique used in the Ellevate™ procedure compared to PDO Threads?
Threads are quite thick, are fairly rigid and the suture material has little semi-cuts made into them that we call barbs. The idea is to insert this suture thread through the tissues in the right direction so that the barbs are not anchoring anything. Then when you pull the thread from the other end, it actually catches the tissues by anchoring the barb and pulls the tissue back. There are certain tissues that the barbs won’t hold and in other cases when they do hold, sometimes on very thin people, they can actually tent and distort the whole facial anatomy. In addition, you never really know what plane you are putting the PDO thread suture and to suspend the thread lifts to try and lift up the neck they are not able to go across the neck in the way Ellevate™ can and if they did they could actually be garroting the tissues. Also, PDO Threads and the barbs will dissolve and will give way in the tissues (anything under tension gives way) so they are a temporary phenomenon. I don’t know any surgeon that’s experienced good long term result with any barb type of facelift, virtually always the effect is gone, if there was any effect at all, at 3 months. Compared with the Ellevate™ procedure where a patient can expect a result that will last a lifetime because the sutures we are using are non-dissolving, non-barbs solid suture material that is expertly placed to hold the weight and remain well hidden. There is really nothing that compares to it.
Who would be the ideal surgeon to perform this technique in the UK?
There’s a turf war that has been going off for the last 30 years which is absolutely unnecessary. Plastic surgeons by and large don’t own the right to do cosmetic surgery, and I think we will have to accept that In Australia, England and in the United States. The junior surgeons have recognized they’re not being trained in cosmetic surgery. If we take the fact that most newly qualified plastic surgeons are inexperienced and they’re going to learn ‘on the hoof’, the best advice is to go and see somebody that actually does this type of technique and actually receive training. It’s incumbent upon surgeons like me to say ‘look, I’m not just going to train plastic surgeons, I’m willing to train head and neck surgeons, oral surgeons, anybody that is interested in doing safe surgery that I think is competent enough to do it.’ I happen to have trained such surgeons in all sorts of techniques over the last ten years and I can tell you some of the general surgeons are as good as the plastic surgeons.
To learn more about Professor Frame, visit www.professorjamesframe.co.uk.
To learn more about Ellevate™, visit www.myellevate.com.
To listen to Professor Frame’s radio interview on Aesthetic Insider™ Radio, CLICK HERE!
To read the Aesthetic Insider™ news article “The Next BIG Thing In Aesthetic Surgery” featuring Dr. Gregory Mueller, the inventor of Ellevate™, CLICK HERE!
To read the Aesthetic Insider™ news article “The Next BIG Thing In Aesthetic Surgery” featuring Dr. Adam Rubinstein, MD, CLICK HERE!
The Ellevate™ procedure and the ICLED® light guided suture system is a new minimally invasive and advanced option that, when used in combination, will tighten sub dermal ligaments to better define facial features. Ellevate™ is not a facelift, necklift or threadlift. It is a minimally invasive procedure that addresses the muscles and glands of the neck and uses a clear uncomplicated method that allows a surgeon to tighten the neck by effectively placing sub-dermal sutures using the innovative patented ICLED® light guided Suturod® system which easily identifies not only location but also the correct depth of suture placement. When combined with the ICLED® suture system, Ellevate™ safely and easily delivers exceptional patient outcomes with precise accuracy, reliable and reproducible results. For patients who want to improve/rejuvenate neck contours, the lower face and jawline, Ellevate™ takes approximately 1 hour and is easily performed under local anesthesia. This procedure can be effectively combined with energy based technologies that tighten skin/dissolve fat/ remove fat and can also improve facelift or necklift results. By smoothing out the targeted treatment area and effectively sculpting in and around the neck, Ellevate™ can dramatically enhance results. For more information visit www.myellevate.com, or call 310.498.2102.