Skin Trade

By Author: ylift
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Unlike many plastic surgeons, Dr. Yan Trokel is getting a lift during the recession.

Beauty is supposed to be only skin-deep. But for Dr. Yan Trokel it runs right to the bone. The 39-year-old Manhattan cosmetic surgeon is pushing a new face-hoisting technique--called the Y Lift--that requires no nips, tucks or month long healing time. While traditional face-lifts can involve three to five hours of invasive surgery that results in stitches, swelling and bruising, the Y Lift is performed while the patient is awake and typically takes 30 to 45 minutes. "My patients can fly in, get the procedure done and go out to dinner, to a business meeting--anything they want," says Trokel. "They look amazing immediately afterwards, and in a day or two they look even better."
After analyzing a patient's bone structure, Trokel maps out the face and, with just a dollop of topical pain-numbing ointment, makes a number of small holes in different locations, say, on the forehead or jaw line. He inserts a thin titanium tube loaded with gelatinous filler (a common sugar found throughout the body called hyaluronic acid) into the holes ...
... that lifts the tissues and creates a space for the filler, which he often applies directly to the bone. Once cured, the filler becomes the new foundation for the face. By massaging the filler like clay, Trokel can accentuate cheekbones and jaw lines, and even smooth out wrinkles in the neck and around the eyes.
The Y Lift--named for the letter, which Trokel says is the ideal shape of the human face--has become so popular that his calendar is booked solid for the next six months with actors, executives and other physicians from around the world. That backlog may not be recession-proof, but Trokel is faring a lot better than his old-school, skin-snipping competitors. Americans spent $11.8 billion on plastic surgery last year, down 9% from 2007, according to the American Society of Plastic Surgeons. Since 2000 the number of invasive cosmetic surgical procedures, such as cheek implant surgery, chin plastic surgery and forehead lift surgery, is down 3%; meanwhile, the number of minimally or noninvasive procedures--hyaluronic acid treatments (that would be for wrinkles), laser skin-resurfacing and hair removal--leapt 81%. When it comes to vanity operations, patients prefer to pass on the knife if they can.
Born in the Republic of Georgia, Trokel immigrated to the U.S. with his parents in the 1970s. His father set up an art and antiques dealership, but Trokel knew early on he wanted to work on faces. That's why he went to dental school at Columbia University. "If you really want to understand the face, you have to know how everything works," he says. "The jaw makes up three-quarters of the face." Later he attended medical school at the University of Texas, Southwestern Medical Center at Dallas and spent eight years at nearby Parkland Hospital doing everything from cancer resections to facial-deformity reconstructions.
Trokel's quicker, cleaner approach is based on a fundamental observation. "As people age, they don't grow extra skin," he explains. "So we really don't need to be cutting the excess skin, because there is no such thing." Over time our facial skin gets thinner, the muscles atrophy and the bone diminishes; that lack of total facial volume results in saggy-looking skin. The Y Lift essentially replenishes the volume. Trokel likens it to making a bed: "You can't just throw on the duvet. You have to do all the layers to make it look really nice."
Perfecting his technique after four years, Trokel brought his show to New York in 2006. As word of mouth spread, his 2,000-square-foot office--now with ten other staffers (nurses, technicians and clerical folk)--was soon at full capacity, remodeling 8 to 12 faces a day. With the cost of his assorted procedures running $5,500 to $12,000 apiece, Trokel's business probably pulls in at least $2 million a year in revenue.
The assembly-line ramp-up isn't a good model in this business. "It is my brand and my name," Trokel says. But he is pondering slow expansion within the limits of quality control: training classes for other surgeons looking to learn the procedure--for a handsome licensing fee, of course. Even a healthy business needs an occasional makeover.