Hello and welcome. Dr. Stephen Mulholland here in Toronto, Canada on Plastic Surgery Talk. Our latest installment of our podcast series is on facelifts today. If you find this interesting, entertaining, informative, please subscribe and leave your thoughts on a review.
So, what is a facelift? A facelift is really a generic term for a series of surgical maneuvers that reposition the soft tissue of the face. Now, that could include just the jawline and neck. That could include the cheeks and the mid-face. Some people even use facelift generically for repositioning the brow, but in general, is reposition the soft tissue of the cheek, and jawline, and the neck to achieve a more youthful, rejuvenated, and healthy appearance following the aging process or weight loss/weight gain.
How is a facelift performed? Like what are the specific maneuvers and techniques? There’s the traditional type of facelift that you read about and you’ve seen on television, and Nip/Tuck, and Extreme Makeover, and on CityLine or Breakfast Television. We’re making little incisions hidden in the ear and the hairline, lift up the skin and the muscle, and pull. Now, you don’t want to be pulling too tight or too much tension. It looks bad. It looks overpulled, and you’ve seen many facelifts like that, so we add other tools and strategies to provide a natural rejuvenation.
We add volume if there’s loss of air in the balloon. Especially in the T-zone, we might add a little bit of fat grafting or a very subtle amount of filler so you don’t have to overdo the pulling. If you’ve got fine lines or wrinkles and sun damage, we add modern lasers and radiofrequency techniques to improve the color, the tone, and the wrinkle, so it’s often … Aging is in three Ds: deflation, descent, and deterioration. Facelift encompasses tension, volume, and wrinkle and tone improvements to create a much more youthful, natural, and attractive facial appearance.
Who’s a candidate for facelift surgery? Generally, these are going to be male and female. Males can be part of what I call a guy lift, a short scar hidden incision. You can do even bald guys, but they do get … We guys get little jowly and some loose neck tissue, and so for most guy facelifts, it’s going to be about creating a nice tension-loaded jawline, improving the jawline, but don’t feminize the mid-face or the cheeks. A good candidate, male or female, is going to be a patient who has soft tissue laxity. Meaning, that you’ve had some descent with time and your skin is loose, so when you grab it, you can pull extra skin of the face and the neck, and too much skin to be treated with non-surgical techniques, so loose skin.
You may have an amount of facial deflation, loss of volume, temporal hollows under the eyes, around the mouth, loss of volume. You may also then have some fine lines, deep lines froze and wrinkles from all that animating, smiling, squinting, laughing. With or without the use of Botox, you may develop permanent lines and wrinkles, and you may have tone and color issues, unwanted sun damage, brown discoloration, rosacea, and redness. Texture like enlarged pores. Add all this up. The summation of unwanted age and wrinkles, laxity, loss of volume, texture, and tone, and combination of those elements make you a good candidate for a facelift.
Now, you may have the indications, but you still may not be a good candidate because you aren’t realistic. You have unrealistic expectations. Now, we can do amazing work with facelifts. Not uncommon to have 55, 60, 65, 70-year-old woman looking 15 or 20 years younger and still natural, but you can’t be 18 again. Your expectations of the outcome need to be realistic. You need to be medically well. You can’t have medical illnesses that are not controlled like diabetes, smoking, liver diseases, kidney diseases, hypertension, high blood pressure.
You need to be medically well, realistic, have the aging indications that we can improve, and then time, and the commitment to recovery, and following the instructions so that this surgery designed to have you looking youthful, fresh, and natural has the time to recover and heal. So often, one, two, or three weeks, depending in the type of facelift that you require. These are the good candidates for facelift surgery.
What are the benefits of a well-done facelift? The first benefit is the visual projection of youth and freshness. As we age, we undergo the three Ds of growing old: deflation, descent, and deterioration, which we’ve already talked about. As a good surgeon, I’m going to bring the necessary Ds to your face. If you have descent, we’re going to lift. If you have deflation, we’ll add volume. If you have deterioration, we’ll smoothen lines and wrinkles, and so we’re going to provide a natural restoration of youth and beauty. You’ll look fresh and rested.
The big benefit is the psychological pick-me-up, that sense of wellbeing when you just look good, and you know you look good, and you feel good. There is that sense of serotonin and wellbeing, and you project a youthful vital attitude, so the benefits may be you feel better. The benefits are that you will be interpreted and treated by people around you sometimes quite differently. I hear it from older patients all the time, particularly older women. As they go older in their late 60’s and 70’s, they become invisible. Our culture stop respecting elders and treating old people like they are somehow frail, feeble, and unable to be vital and active anymore, and we created that cult of youth, and now we’re getting old, and that same culture that values youth, no better way to have a positive impact than project youth, and vitality, and health.
You may actually find you’re treated with more dignity and respect when you look a little more youthful. You maybe able to hang on to a job longer. It shouldn’t be the way it is, but ageism is rampant. People who are elderly don’t tend to hang on to jobs or get jobs, and it may also help in your romantic life. If you look good, feel good, and you’re single, you’ll be more apt to attract an outgoing and act of an interesting partner, so there’s many, many benefits I’ve seen over the last 24 years of doing lots of facelifts, and they can be psychological and physical. Physically, you will look 10 or 15 years younger for the most part, and you’ll project that youth, and you may start incorporating that youth for the psychological benefits of that surgery.
What about the facelift scars? Patients are very concerned about visible scars, about the telltale signs of facelift, this facelift stigma of the 1970’s or 1980’s, and so gone are the days when you need to worry or be concerned about visible scars on front of the ear. They are hidden inside your ear. Whether you’re a male or female facelift patient, no visible scar. You can wear your hair short or behind your ear. It could be a windy or rainy day, and you should be confident there’s going to be no visible scar.
We also hide scars behind the ear, and so as long as your ears are set back far enough, and if they are a bit outstanding or Dumbo-eared, we’ll set back the ears over the scar, so in the ear, behind the ear, there should be no visible scar. I generally don’t put scars on front of the hairline up the forehead or behind the hairline behind the ears, so I use a short scar hidden technique, and so scar visibility should not be a concern.
Now, everybody heals differently, and so scars could be thick. They could be red. They could be raised, but we tenaciously treat the scar at no cost after your facelift procedure as long as it takes till they’re flat, white, and inconsequential. They’re always hidden, so while we’re healing, we can treat in-ear, behind-ear with different tactics and strategies with lasers, with injectable products to soften, flatten, and lighten your scar, but the first and most important aspect of great facelift surgery is proportion, technique, and tension, and a scar that’s not visible.
You hear a lot about mini-lifts and mini-facelifts versus a standard facelift. What are the differences? In general, a mini-facelift is designed to treat one small portion of an older face. It could be just a jawline and neck lift with an incision behind the ear. It could be a mini-lift of the mid-face, the cheek, and the jawline, which is incisions in the ear and hidden above the ear, and it could be just a brow reposition with short little incisions in the temporal hairline. Those are the mini-lifts: brow and upper lid, mid-face and cheek, or jawline and neck. They tend to have short incisions, well-hidden, and they provide a renovation of one small area of the host, not the whole basement, ground floor, and top floor. That’s a full facelift.
This is usually a basement lift, jawline and neck, mid-floor lift, main floor, cheek and jawline, or the top floor, brow. Minis are subsegmental repositioning and surgical rejuvenations of elements of the face, not the entire face. A more standard facelift is going to lift your jawline, your neck, your cheek, and the side of your brow, and that will have incisions that encompass behind the ear, in the ear, above the ear, and in the hair, but never visible, and those are generally the differences between a mini and a more standard facelift.
Now, so plastic surgeon that teaches and educates other physicians and specialists on the use of lasers and energy-based devices to deliver clinical outcomes. You’ll hear a lot about the non-surgical facelift, so what is a non-surgical facelift versus mini and standard open facelifts? The non-surgical facelifts generally do not involve excision of tissue. We’re not cutting tissue away. Non-surgical facelifts are using forms of energy, pieces of capital equipment designed specifically to lift and tighten skin of the jawline, neck, and face, but without a scalpel, and so you can divide those into the kind of energy.
The most common devices you’ll hear for non-surgical facelifts are going to be radiofrequency energy devices. These move on the skin, create a gentle heating, and after a series of six treatments, give a modest tightening effect. Some of the more common products would be InMode’s forma, BTL’s Exilis, Venus Freeze from Venus Concepts, TempSure Envi and Pellevé from Cynosure. These are the more common bulk-heating radiofrequency electric current devices that are very gentle and need a series of treatments for a modest tightening.
The next level of device would be using focused ultrasound where ultrasound beams are focused under the skin along the deep tissues to cause a thermal contraction. This is done, again, without surgery or scalpel. It’s a little more uncomfortable. You need some topical anesthetic cream or like in my center, SpaMedica, we use nitrous oxide to make this kind of treatment more comfortable, and that’s called Ulthera or Ultherapy, which is use of focused ultrasound beams to get a modest lift of the brow, the cheek, and the neck.
The next level of treatment will be using coded needles to be inserted into the skin and deliver heat in the deeper parts of the skin or the deeper muscles of the face and the neck through radiofrequency, energy, and coagulation, and tightening. The first generation of this was Syneron’s Profound, and that was a good entry into the market for non-surgical contouring of the jawline, neck, and face.
The most recent entrance into the field has been the Morpheus from InMode, and the Morpheus gives you variable depth needles into the platisma muscle of the neck into the deep tissue of the neck into the skin of the neck, or the under-eye muscle, or the jawline. The Morpheus has become probably the gold standard of non-surgical facelifts. All of these devices work, but they’re modest. They are less expensive than a surgical facelift, but you need a series of treatments between one with Morpheus and several with bulk-heating radiofrequency devices for a very modest, but noticeable improvement.
The last level of non-excisional, non-cutting lifting surgery is using threads, suture suspension threads. There’s a number of different threads. You can divide them into absorbable or non-absorbable, fixed and tied to the support skeleton with lifting soft tissue, or bi-directional and insertional threads, or threads for volume. Threads are a big part of the non-excisional facelift experience and often are combined with energy-based devices and injectables such as Botox and volume.
As a facelift surgeon, a very busy facelift surgeon, I’m quite amazed at how well we can do without a scalpel, but it never replaces a good facelift effectively executed on someone who is modestly aged. The non-surgical are good I think for your entry-level facelift patients in their 40’s, early 50’s with reasonable good skin tone. I hope that answers a complex question, the difference between a non-surgical facelift and a mini or standard surgical facelift.
What is the age requirement that we see for true surgical facelift surgery? Well, as we just talked about in this podcast, there’s been a huge explosion on non-excisional, non-scalpel-based lifting. That means a lot of women in their late 30’s, early to mid 40’s that would have previously had mini-lifts may actually be doing a thread lift or a Morpheus, or a Profound, or an Ulthera, or a Forma, or a Thermage, or a Venus Freeze. Any one of these devices may help those younger women in their 40’s, early to mid, escape the more aggressive lifting techniques.
With the advent of suture suspension thread lifts, again, mid to late 40’s, we can often suture suspend and improve a jawline or a neck. We’ve got a tremendous radiofrequency devices we can put under the skin and create contraction and tightening. With the advent of a product like FaceTite and the MiniTite from InMode and NeckTite, we can put these electrodes under the skin, heat up the soft tissue to 69 or 70 degrees under local anesthesia just like wisdom teeth in a dental office so with freezing, and we can get significant contraction with no scalpel. FaceTite, NeckTite, suture suspension techniques can all help the 50- to 55-year-old get a really lift effect without a scalpel. That covers off a large group of patients. Let’s say 35 to 50 with products like FaceTite, NeckTite, thread lift, and then all the non-surgical techniques we started with with the outside-in approach.
What’s the best stage for a true mini or excisional facelift? Too much loose skin for all the techniques I just mentioned, so you can be 45 years old. I grab the skin on the side of your jawline, and I pull. If it just keeps going and I can’t see your earlobes, you’ve got 2 centimeters or more of loose skin, we are not going to get a great result with FaceTite, or MiniTite, or NeckTite, or a thread lift, or any one of the devices that are non-surgical. If you’ve got too much loose skin when you do this, you got to throw it away, and you need to look at a mini-lift or actually lifting, pulling, and removing extra skin, and hiding the seamstress work inside and behind the ear or a more standard lift.
The question becomes, “When are you an indication for a deeper-plane lift?” Some surgeons will do little skin pinch mini-lifts. Some will lift the skin up and tighten their plicate, the underlying muscle called the SMAS and platisma. Other surgeons like me generally favor a deep-plane facelift where I lift up the skin and the muscle together as one flap. Very robust. Very healthy, and I put all the tension on the muscles, so the skin doesn’t look pulled, and that lift in my hands tend to last a lot longer than little mini-lifts or skin-pinch lifts that rely on a tensile load on the skin because when you put skin under tension, it tends to relax like pregnancy. You get bigger, it relaxes. You get bigger, it relaxes. If you put skin under … on the face under tension, over a few months, it will relax back a bit. You put that same tension on the deep muscle, that lift is going to last.
The indication for a lift is when you have enough loose tissue. The indication for a deeper-plane lift versus a skin lift is when you have the need for a long-term lift and repositioning of the muscle themselves. When you think about a facelift, and the scars, and the incision, and the recovery, and the cost, it’s one of the more expensive procedures. Is it worth it? That can only be answered by you or the patient. Is it worth it to the patient? Is it worth spending that kind of money to look 15, 20 years younger, essentially a four-hour fountain of youth that has you looking like you did 15 years or 20 years before?
Clearly, for women and men that want to look rejuvenated and youthful, there’s a real value in looking 15 or 20 years younger, and that’s why facelifts generally need to be the most expensive of the procedures because it’s delicate surgery. It’s around dangers, areas where there’s facial nerves and facial structures. If something goes wrong with your facelift, there ain’t no hiding it. Something goes wrong with your tummy tuck or your breast surgery, you can hide it while it gets repaired, and so it’s delicate surgery. It’s exposed, and it’s out there for everyone to see, and there’s a huge social value and business value often to looking 15 or 20 years younger.
Let’s say you hang on to a job for another decade than you normally would have or you get a job because you look not 55 or 60, but 45, think about your earning capacity over the time that you’re enjoying that facelift, or relational advantages if you’re dating and you find the love of your life because you happen to be a little more youthful-looking. It’s not right, but it often happens. There’s huge emotional and relational benefits, so how do you value youth and rejuvenation? There’s no way to give it a dollar value, but in general, it’s a very popular procedure.
There’s more than a hundred thousand facelifts done every year because enough women and men out there feel that that $10,000, $15,000, $20,000, or $25,000 is better spent on looking 15 years younger than buying a Ford Prius or a mid-range Dodge production van or a Dodge Caravan. If you value your face more than the car you drive, then you have the relative value of what a facelift will bring. You might drive your car for five years, hand in the keys, and it costs you $18,000 to $20,000. You keep the face for the rest of your life, and your out of pocket about the same.
Do you need a risky anesthetic to do a facelift? With modern techniques now of sedation, the vast majority of facelifts I do, minis, extended, standard, thread lifts, volumization, I do under local anesthesia so like you’re going into a dentist getting a root canal. We’re very good at now what? Freezing and numbing entire areas of the face, providing this during laughing gas and nitrous oxide. Once the freezing is in place and you’ve got some oral medications, some intravenous medications, and you’re dozing away, the facelift is usually performed without general anesthesia.
Without general anesthesia, the risk of any operation go way down if it’s effectively administered, and so what are the risks of a facelift? Well, without general anesthesia, they tend not to be life-threatening. Yes, there’s a whole host of extremely rare things that could happen that have very bad adverse outcomes, but that can happen with a simple laparoscope of your ovaries or an endoscope of your knee and arthroscope, so a small procedure can come with big risks, but it’s measured one in tens of thousands to one in millions in terms of probability.
The main risk with the facelift or not that you can have something serious medically go wrong because it’s just skin and muscle outside your body. The real risks are that your expectations won’t be achieved, so manage expectations. You need to have a contact with a good physician with lots of experience that shows you in the mirror or a 3D computer imaging the kind of outcome you might expect.
Risk number two, a wound healing problem. You want to avoid and minimize small infections, unwanted abnormal scars, small blood collections, and all these need to be managed as part of your perioperative care, and we as surgeons want to minimize that risk, so no smoking, diabetes needs to be under control, and follow the surgeon’s instructions.
Some of the risks that you read about that are extremely rare, not life-threatening, but horrible are a facial nerve injury. There’s a number of nerves that go to your muscle that move and give you animation, and if you injure those nerves, you can’t move that part of your face, so you could have a Bell’s palsy look or like you’ve had a stroke.
Now, in the hands of a well-trained surgeon that’s done appropriate training and years and years of experience, there should never be a permanent facial nerve injury. There should be something that’s reported on the internet, but the surgeons never seen it, so facelift injury is a risk. There’s also a risk of some hair loss. The stress of the surgery can sometimes induce stress hair loss called telogen effluvium, so for women who have thinner hair, I’ll often put them on a program of non-surgical hair enhancement before the lift using things like PRP, Platelet-Rich Plasma, low level of light therapy. We make the scalp hair more healthy before we do any stressful lifting around it.
Then, last but not least are the risk of the stigma of bad facelift surgery: visible scars, earlobes pulled too tight, the skin too tight, the hairline elevated. These are the stigma of old school facelifts gone bad. In the modern era, these stigmata of facelifts should just not be there. You should have a very natural look and no one should know that you look 15, 20 years younger because you had a facelift. They assume it’s because you lost weight, eat well, and exercise. When in reality, you might do that, but it’s the facelift that got you there, and nobody needs to know.
Is there any after-care after a facelift? Absolutely. There’s two phases. There’s the initial, “Let’s get you healed,” phase, and then you’re healed and looking great, and there’s the, “Let’s protect your investment phase,” so let’s start with phase one. First phase is the recovery phase. In general, you need to plan on about one to three weeks recovery depending on the type of lift you’re doing. Suture suspension thread lift, the mini-lift, or standard facelift?
It also depends on whether you’re adding energy-based devices such as fractional lasers like the fractional CO2 or fractional RF to smoothen lines and wrinkles. That will add some crusting, weeping, and oozing to the central part of the face, and that might be a three-week recovery. If it’s a mini-lift, you might look acceptable in two weeks, so you need to know the type of lift you’re doing with the other added elements, and sit down with your surgeon, and just say, “What kind of recovery do I need to plan for?” Because we surgeons, we tend to minimize and underestimate, so whatever the surgeon says, generally, add two weeks. If they say, “Oh, you’re going to look good in a week,” you’re not. You’re going to look okay in three. If they say you’re going to look good in three weeks, you’re not. It’s because you had a laser, some other things where they’re more realistic. Plan on four, maybe even five weeks.
Recovery is substantial because there’s swelling. There’s often crusting, and redness, and discoloration from laser. There’s often volume increases, which add plumpness to the lips and eyes, which need to go away, and there’s often bruising along the sides of the ear, so in general, you’re going to come back to the surgeon’s office about three times over two weeks. Most surgeons are going to keep you overnight and observe you overnight till the next day.
Three more visits over two weeks for the little sutures in the ear, sutures behind the ear. Clips, or staples, or sutures in scalp will come out on each of those three visits, so at the end of two weeks, all your stitches are out. Generally, during that time, some Arnica Montana or anti-bruising supplements like bromelain to help speed up the resolution of bruising. By the end of two weeks, all the sutures is out, a lot of swelling is coming down, but you still don’t look normal. You have to make like an excuse if you go back to work in the third week. You had your wisdom teeth worked on, or you had some gum surgery, or you’ve had some gum surgery or sinus surgery.
All these things could give you that sense of swelling at three weeks that’s gone by the sixth week, so by the sixth week, you start to look actually pretty good. You look really good by 12 weeks, but by six months, you settled into your face. There’s still some numbness. That’s going to take some time up to one year to come back, but if you have a big event like a wedding, a reunion, an important family event, do not do it six weeks … your facelift or mini-lift six weeks before that event. Give yourself at least 12 weeks is my advice.
That’s the early perioperative care. Suture incision care. Make sure that is healed and there’s no separations or infections. Make sure there’s no fluid collections, and then once all the sutures are out and the bruising is managed, you can have a little bit of a break, and then I see my patients back about week eight, and we start phase two.
Is there any maintenance treatments, any treatments you can do after your facelift that either improve the result or extend and maintain the result? The answer is unequivocally in this era of 2018 and beyond, the answer is yes. All those great devices that I talked about for non-surgical lifting, color correction devices like IPL Photofacials, PicoFacials, fractional infrared lasers, energy-based devices for wrinkle reduction and tightening, the Ulthera, the Profound, the Morpheus, all these devices can be added to your recovery time, increasing the collagen content, improving the color and tone, and improving the look of your face.
We use these devices during week eight to about week 24 or six months to optimize the outcome while you’re healing to improve upon collagen content, to soften the scar tissue, take the red out, to even out your sun damage and rosacea, to smoothen lines, wrinkles, pores, and texture, and tone. That all happens after the surgery.
Now, once you’re done, six months, you’re looking great. You then have a choice. “Doc, had fun. Look great. I’ll see you in 15 years when I need another one,” or, “Doctor, what can I do to protect this investment? I love the way I look. I don’t want to age from this 15, 20 years younger starting point. What do I do?” I sit down with the patient. I say, “If you’re so inclined to optimize and protect your investment, here’s what I would do. I would do Botox twice a year, brow, frown, crows. I would do a little bit of filler in the T-zone, under eye, cheek, around the mouth.” Not too much. You don’t want to look like filler face, but you don’t want to look too tight either, so add 10 central volume once a year.
Once the fat grafting settled, you might use Juvederm Voluma in the central T-zone, a little bit of Botox in the brow. What about the neck and jawline? That’s where we add energy-based devices, bulk-heating RF devices, fractional infrared lasers, and fractional needle-based devices, or ultrasound devices to keep the neck looking firm and tight. With that simple maintenance program, and that might cost you $2,000 to $4,000 a year to protect that 20 years of youth you just paid for, but you will not age. You just won’t age from that setpoint, and you’ll look 15, 20 years younger than your chronological age forever.
Is there a maintenance? If the patient wants to protect their investment, absolutely yes. Do you need maintenance to look good? No. Some patients, I would say a minority, maybe 10% say, “Dr. Mulholland, I’m happy. It looks good. I went from 75 to looking 55, and now I’m going to age gracefully. The clock is going to start ticking, but I’m going to age from 55 now, not 75.” In those cases, those patients are content aging gracefully, no maintenance needed, but the vast majority want me to give them a plan to protect their investment and look great forever.
How much does a surgical facelift cost? Well, it depends on the kind of surgical facelift, a mini or more extended traditional. It depends on the surgeon. It depends on the city. It depends on the market. It depends on the patient, but having said all that, in a large urban market like a Toronto, a New York, a Miami, a Chicago, an Atlanta, a Dallas, a Houston, a Las Vegas, a Los Angeles, a San Francisco, the average facelift, standard facelift is about $15,000.
Now, you might find some less expensive. You might find in those cities some of the top facelifters that get some of the most renowned patients might charge $25,000 to $50,000, and in some rarefied atmospheric environments, you might be paying $100,000 for a complex facial lift procedure, but the average price across the board in a city of a million people plus in North America, $15,000.
Now, what if you add on things like blepharoplasty, eyelid surgery, volume, nose reshaping, other variables and factors? That price of a standard $15,000 goes up to about $25,000 to $30,000. Another way to look at it, you are paying about $1,000 to $2,000 for every year of youth that you are purchasing, so if you’re going to look 15 years younger, that’s going to cost you about $15,000 to $30,000 depending on the surgeon. If you buy 20 years of youth, that might cost you $20,000 to $30,000 or $40,000 depending on the surgeon and the market, so $1,000 to $2,000 for every year of youth or an average selling price of $15,000 in North America is what standard facelifts go for. Mini-facelifts, maybe slightly less, and certainly, the non-surgical facelift prices are about half the price of the surgical options.
Now, what about paying for your facelift? Well, it could be cash, certified check. It could be a money order. It could be a Visa transaction, or more commonly, I’m seeing a lot of patients financing their facelifts through third-party financing institutions basically getting a cosmetic surgery alone, and like a car, paying for it over five years rather than immediately, so at the end of five years, you own your facelift.
Why is that advantageous to some patients? Well, it doesn’t hit their cash flow. It means that they can have a monthly payment like a car payment installment, and 60 months later, they own a result that’s going to last the rest of their life. They don’t have to hand in the keys. There’s no repossession, but it’s an affordable way to spread out the payments, and preserve your cash flow, and not have to save all that money upfront. So, financing. Much more common. There’s lots of companies that do that. iFinance Canada and Medicard in Canada is one such entity, where for a reasonable interest rate, depending on your credit score, you can expect to finance your facelift over 60 months with favorable monthly terms.
Thank you for joining me. Again, Dr. Stephen Mulholland in Toronto, Canada on Plastic Surgery Talk for our latest podcast installment, facelift. I hope you find it interesting. I hope you found it engaging, and if you did, please share on all your social media channels and be sure to subscribe and leave your thoughts in a review.