Behind the Scalpel: Plastic Surgery Trends and Tips with Dr. Marc E. Yune, MD

Maedeh Samimi

Welcome back to another episode of The Skin Coach in Georgia podcast, sponsored by Urban Skincare Clinic. Today, I’m excited to have a special guest: Dr. Marc Yune.

Dr. Yune is a triple board-certified Facial Plastic, Cosmetic, and Reconstructive Surgeon, with certifications from the American Board of Facial Plastic and Reconstructive Surgery, the American Board of Head and Neck Surgery, and the American Board of Cosmetic Surgery. He is also a fellow of the American Society of Cosmetic Breast Surgery. We had an insightful discussion about facelifts, the optimal timing for elective procedures, the differences between silicone and saline implants, and more. Without further do, let’s dive into the interview.

Welcome back to The Skin Coach in Georgia podcast, Dr. Yune. It’s a pleasure to have you here today.

Dr. Yune

Thank you for having me. It’s always an honor to talk with you, so I appreciate the opportunity to return.

Maedeh Samimi

We had a great conversation last time about injectables, facelifts, and blepharoplasty. I’ll make sure to link to that episode in the show notes so listeners can catch up. Today, I thought we’d dive right into some new questions. How does that sound?

Dr. Yune

Sounds great!

Maedeh Samimi

Is there a specific time that's best for considering elective procedures?

Dr. Yune

The best time to consider elective procedures is when something bothers you enough that you seek out a professional like myself to address it. As providers, our role is to educate rather than to sell. The key is to have realistic goals and to ensure that the surgeon or provider can achieve those goals safely and effectively.

Ultimately, we aim to provide what I call "happy medicine"—treating the issues that concern the patient, regardless of their age. It’s not about chronological age but rather anatomical and emotional factors. Elective procedures are exactly that—elective.

People choose to come to us because they want to, not because they have to. In a competitive environment, some practitioners might suggest procedures that patients hadn’t considered, which can be off-putting. I believe it’s crucial to maintain professionalism and objectivity, focusing on patient-led decisions rather than sales tactics.

Maedeh Samimi

I completely agree. When someone comes into my clinic asking what needs to be corrected, I always put the ball back in their court. If redness or sunspots aren’t bothering them, they don’t bother me. I focus on what they want to improve.

There’s a relatively new non-surgical injectable procedure on the market called thread lifts. Can you tell us more about this procedure? Is it FDA approved, and what are the pros and cons?

Dr. Yune

That’s a good question. I get asked about thread lifts quite a bit. The concept of thread lifting isn't new at all. In fact, the idea has been around for nearly 30 years, since I began my career. I experimented with various types of threads, including Gore-Tex and Prolene threads, aiming to lift the face without incisional surgery. Thread lifts aren’t fillers, but some threads, like poly-L-lactic acid threads (the generic name for Sculptra), can function somewhat like a filler. These stimulate collagen growth, but we don’t offer them anymore because they have inherent flaws due to material science issues.

Threads are not stretchy; they’re stiff, like fishing line. Since your face is mobile, over time, movement and animation can cause the threads to lose their effectiveness. Many patients report that they like the initial results, but problems like dimpling can occur because the threads need to hook into the skin. This can cause irregularities as the thread doesn’t stretch with the face. The ideal thread would be one that doesn’t create dimpling or break, like a rubber band, but such a product doesn’t exist yet. Consequently, thread lifts are often not a high-value treatment for patients. Those who have had thread lifts often find that the results diminish in six months to a year, which can be disappointing.

Maedeh Samimi

So, do these threads dissolve over time?

Dr. Yune

Yes, one type does. The poly-L-lactic acid threads, which are used to create collagen replacement, eventually dissolve. Historically, these threads were used to place under the nasal labial folds and even in the lips to provide volume. The idea was to shift from hooking the skin to building collagen. However, because they didn’t hold as well as desired, their application evolved over time.

Maedeh Samimi

We touched on facelifts last time, but let’s delve a bit deeper. Who is an ideal candidate for a facelift? When is the best time to consider one, and what’s the difference between a mini facelift and a full facelift?

Dr. Yune

Great questions. To determine the ideal candidate and timing for a facelift, it comes down to a few key factors: Does the patient have the right motivation and realistic goals? Are they healthy enough for surgery? Safety is paramount, so we need to ensure that the patient is in good health and that the surgeon can deliver a safe and excellent result.

Facial plastic surgery is diverse. Some surgeons specialize in facial cosmetic surgery, others in facial reconstruction, and some focus solely on specific patient groups or conditions. It’s crucial to choose a surgeon who specializes in what you’re looking for.

As for the mini facelift versus a full facelift: Historically, the deep plane facelift has been considered the gold standard. This method, which elevates the deeper layers of the face, such as the muscles and fascia (SMAS), creates a more natural look and longer-lasting results. The tension is placed on these deeper layers rather than just the skin, reducing the risk of visible scarring and distortion.

In response to patient demand for less invasive procedures and shorter recovery times, many practices have developed mini facelifts. These typically involve shorter skin flaps and focus more on tightening the skin. However, the results of mini facelifts often last less time and can sometimes distort the ear. The Lifestyle Lift, for example, faced legal issues because its results did not match the marketing claims.

The mini facelift uses a similar incisional pattern to a full facelift but with less dramatic results. While it may offer a quick recovery and minimal swelling, it often falls short in terms of long-term satisfaction, particularly if it only lasts a year or less.

The gold standard remains the deep plane facelift. I was among the early adopters of the Botox-assisted facelift, which modernizes the deep plane technique by using Botox in the muscles that pull the face down (like the DAO and platysma). Administering Botox two weeks prior to surgery can help maintain the lift and improve results by 10 to 30%. This approach, combined with understanding how to use Botox post-operatively, can help maintain the lift longer.

So, while facelifts have evolved over time, the deep plane facelift remains the gold standard. Social media has helped educate patients, but it’s always wise to seek multiple opinions and be cautious of treatments that seem too good to be true.

Maedeh Samimi

I’m right there with you! Last time, we touched on botched plastic surgery jobs. I’m sure you encounter a lot of these in your practice. What is your unique approach or technique for "fixing" plastic surgeries that have gone wrong?

Dr. Yune

That’s an excellent question. During my fellowship, I had the opportunity to participate in and observe around 1,500 surgeries. I noticed recurring issues, particularly with over-resected noses, which are often referred to as “botched nose jobs.” This term simplifies the issue, but it essentially means that the nose is too pinched, short, or rotated.

To address this, I developed the Dart procedure during my fellowship. This technique involves using structural grafts from the patient’s own cartilage—either from the septum, ear, or rib—to create a supportive framework, or “tripod,” within the nose. By placing two cartilage grafts alongside the septum and one at the base, I could control the arc, rotation, and projection of the nasal tip. This approach allowed me to correct the projection and rotation of the tip in a controlled manner and restore function by opening the airway.

I first published the Dart procedure in 1997, and it has since gained international recognition for correcting over-resected noses. Before Dart, attempts to correct such issues often involved stacking cartilage grafts, which could weaken the nose further and obstruct the airway. My technique not only improves the aesthetic outcome but also maintains or enhances the airway function.

Another contribution came with the ICE procedure, which I developed in 2016. This technique addresses malpositioned breast implants that appear too low, too far to the side, or with excessive cleavage. Traditionally, this involved removing the implant and suturing the patient’s tissue to the ribs and sternum, which could lead to complications like dimpling. I found that using the patient’s own natural healing process could be more effective. By applying fractionated cautery inside the capsule along the bottom of the implant and then using a sports bra to define the new curvature, I could reposition the implant with greater control and predictability. This method, which I call the “trap wrap,” leverages the body’s natural scarring process to achieve a more natural result.

Both procedures—Dart and ICE—represent significant advancements in their respective areas and have helped differentiate our practice. It took several years to refine these techniques and gain acceptance in the medical community, but they have proven to be effective and well-received.

Maedeh Samimi

Speaking of breast augmentation, what is the difference between silicone and saline-filled breast implants?

Dr. Yune

I’m glad you asked that question. For me, safety is always the top priority. Long-term successful outcomes and patient satisfaction are crucial, but safety comes first. I’m somewhat unique in that I’m one of the few breast augmentation surgeons who doesn’t offer silicone implants. Early in my career, I noticed that many women experiencing complications had a history of silicone implants and capsule contracture.

Capsule contracture occurs when the breast forms excessive scar tissue around the implant. This scar tissue can become calcified and hard, causing the implant to become constricted in a tight pocket. There are different levels of capsule contracture: Level 3 is hard, and Level 4 is hard and painful, which is the most severe. Correcting this often requires a procedure similar to a partial mastectomy. In nearly 30 years of practice, I’ve never encountered capsule contracture with a saline implant. The industry claims that both types of implants can have this issue, but based on my experience, I’ve only seen it with silicone implants.

When silicone implants leak, the silicone infiltrates breast tissue and lymph nodes, leading to ongoing inflammatory processes. I believe that this residual silicone contributes to the formation of capsule contracture. The initial data that supported the re-approval of silicone implants by the FDA—around 2007—indicated a 8-15% chance of grade 3 or 4 capsule contracture, which I consider too high a risk.

Saline implants, on the other hand, are simpler and safer. If they leak, the saline is absorbed by the body like IV fluids, and the implant simply deflates. The newer silicone implants use cohesive gel, often referred to as “gummy bear implants” because they maintain their shape even if cut. This gel is less likely to leak compared to the old, more fluid silicone, which is a positive development. However, even cohesive gel implants can leak slightly and cause capsule contracture. Silent leaks are particularly problematic because they can’t be detected by mammograms or physical exams. Monitoring requires expensive MRIs, which can be a hassle for patients.

Because of these issues, I choose not to offer silicone implants. I’m likely in the minority, as most surgeons do offer both options. My stance is that if I wouldn’t use silicone implants for my own family, I won’t use them for my patients. I know this is a controversial opinion, but it’s one I stand by with great conviction.

Maedeh Samimi

Well, as you mentioned, safety always comes first. Now, where do you see the future trends in plastic surgery and aesthetics?

Dr. Yune

You know, patients are always looking for less downtime and less invasive procedures, so the trend is definitely moving toward non-surgical options. For example, in my office, we offer a variety of advanced treatments. We have over a dozen devices that address various concerns: from reducing discolorations and unwanted hair to tightening skin with heat through ultrasound and radiofrequency—kind of like non-surgical facelifts.

We offer CoolSculpting, which reduces fat by freezing without the need for liposuction, and CoolTone, which uses magnetic muscle stimulation to enhance muscle tone in the abdomen, buttocks, and thighs. It’s a great device, though it doesn’t replace regular exercise—it just complements it.

Another treatment is Thermage, which uses radiofrequency to rejuvenate the skin and also helps with female rejuvenation. One of the more popular treatments among my patients is Thermiva, which can reduce stress urinary incontinence in women. It’s a fantastic option that addresses quality-of-life issues, even if some may find it a bit embarrassing to discuss.

We also have a cutting-edge technology called Cleovana, which uses sound wave technology. Invented by an orthopedic surgeon for his family member, this technology regenerates nerves and enhances blood flow. Originally used for bone issues and tendinopathies, it’s now being applied to the clitoral area, significantly enhancing orgasmic potential after just a few treatments. It’s a non-invasive, 10-minute procedure that patients can even perform themselves.

In addition to these treatments, my wellness clinic focuses on bioidentical hormone replacement therapy (BHRT), which is a great complement to cosmetic practices. Wellness and preventative medicine are integral to overall health. We address various aspects of aging with good nutrition, supplementation, and bioidentical hormones, which are synthesized to be very similar to your own hormones, unlike synthetic alternatives. BHRT helps manage menopause and andropause and reduces risks associated with synthetic hormones, like certain cancers and cardiovascular issues.

The specialty of wellness is growing rapidly, paralleling advancements in cosmetic medicine. I believe it’s crucial to address not just superficial appearance but also overall health.

Looking ahead, there’s an exciting new product coming out that uses platelet-derived growth factor (PDGF). This FDA-approved growth factor, derived from recombinant DNA technology, has shown to be up to 30,000 times more effective than traditional PRP (platelet-rich plasma) in boosting wound healing, skin rejuvenation, and hair growth. I’m eager to try it myself and hopefully offer it to my patients soon.

While our gold standards like Botox and fillers remain essential, it’s been fascinating to watch the evolution of non-surgical treatments.

Maedeh Samimi

Absolutely, it’s been great. I could listen to you for hours, but we’re out of time. Thank you so much for joining us. I’ll include all the links in the show notes so people can connect with you and come in for a consultation.

Dr. Yune

Thank you, Maedeh. It’s always a pleasure. I appreciate you having me.

Find Dr. Yune here: https://asc-psd.com