Question: I have some loose, crepey skin on my neck. Is this better treated with neck lift surgery or a laser procedure?
Answer: I would have to personally evaluate your neck to determine the best mode of treatment but depending on where it is on your neck a laser procedure is most likely not the best treatment option since we cannot deeply laser the skin of the neck the way that we can on the face due to the fact that it has a much higher risk of scarring in that location. There are other options though including Ultherapy, which is an ultrasound based tightening device that has absolutely no downtime and at Quintessa Aesthetic Center we have been using the 1.5 mm transducer now for several months and have had some very impressive improvements in crepiness of the neck skin. All this with absolutely no downtime.
Question: Are skin tightening procedures an effective alternative to the neck lift? How do you know when you really just need surgery instead?
Answer: Overall, skin tightening procedures really are not an effective alternative to a neck lift but Ultherapy, which is used to treat the layer of the face deep to the skin, can be very effective at improving a neck. Ultherapy uses microfocused ultrasound to create small thermal injury zones 3 and 4.5 mm below the skin surface and the new transducer can provide these zone at 1.5 mm under the skin. A combination of these treatments across the neck and face all create new collagen, which tightens and lifts. It is actually the only nonsurgical device ever to be given a lift indication by the FDA. It is, however, most effective in patients with very early signs of aging as it is not going to be able to lift nearly as effectively as a surgical procedure. If you can lift several centimeters on each side of the jaw then you would be much better off with surgery, but if you can only lift a few millimeters on each side of the jaw and this improves your concern then you may be a candidate for Ultherapy.
Question: Is a standard neck lift considered minimally invasive surgery?
Answer: You can certainly say that a neck lift is minimally invasive due to the fact that it is less invasive then a standard facelift but it still involves making some incisions in and around the ear, going under the skin and then lifting up the deeper layer called the SMAS to provide a very nice esthetic improvement in the jaw and neckline. I personally performed these procedures under local anesthesia in the office setting and the procedure itself takes about an hour. I would highly recommend seeking out a very experienced facial plastic surgeon to provide your neck lift so that you end up getting the results you desire without any untoward side effects of surgery.
Question: At 52 years old, I am a very physically fit male and take pride in my appearance. I am starting to get the telltale signs of jowls and a little double chin. No matter what I do I cannot get rid of them. Would facial liposuction be an appropriate procedure for me or do I need to have a facelift along with it?
Answer: More than likely at 52 years old liposuction is not the best procedure for you. As we get a bit older and our skin loses its elasticity it simply does not bounce back and we therefore end up with some laxity. Liposuction alone will only reduce some of the volume, but will not improve upon laxity and can actually sometimes make laxity look worse. More than likely what you would need is at the very least a necklift, but you may want to consider a full facelift as well depending on your particular anatomy. A necklift or mini-lift can be performed in the office setting using strictly local anesthetic or as more sophisticated facelift techniques, such as what I perform in the operating room which is called and extended SMAS or high SMAS deep plane facelift can provide much more rejuvenation and longevity, but does require going to the operating room. Ultimately, I recommend a consultation so that we can discuss your desires and then I will discuss the specific details regarding each possible treatment so that a customized treatment plan can be created just for you.
Question: I want to smooth out my jowls and laugh lines, but do not want surgery. Do you have injectable fillers that can be used in this area of the face?
Answer: Yes, we can use injectable fillers such as Juvederm Ultra or Restylane or Perlane, as well as Radiesse in these areas of the face to help smooth out a jowl and fill in laugh lines. These products typically last for 9 to 12 months or even longer, and can be easily placed by an experienced injector in a spa setting. If you have a significant amount of jowling that the injectable fillers are just not going to be able to completely camouflage, then you may want to consider a mini-lift in the office, which is a minor surgical procedure performed under local anesthetic, still in the spa or office setting. The results from a mini-lift can be quite dramatic, extremely long-lasting, and the whole procedure takes just over an hour. I would recommend a consultation with someone who can not only provide you with the injectable filler option, but also one who can provide you with a minor surgical option, just so that you can fully understand the options that are available to you before you make a decision.
Question: I am 58 and I feel I look pretty good for my age. Everyone always thinks that I am younger. However, the past year or so my neck has begun to get really saggy. What are my options for improving the contour of my neck?
Answer: I think you have several options regarding trying to improve the contour of your neck. The most effective of which would be a surgical option of a form of face or neck lift. This involves some incisions around the ear that are hidden in the creases of the ear, and the saggy neck tissues are essentially lifted and some excess skin is removed and sutures are placed to close the incision. These sutures are removed in a week and there is typically very little down time. I personally perform 2 completely different forms of face or neck lift; one being what I call a mini lift, which is performed in an office setting under local anesthesia, and the other is called is an extended SMAS deep plane face lift with platysmaplasty, which is a much more technologically advanced lift, which will provide not only a more natural appearance, but a more significant rejuvenation which then allows for a much longer lasting improvement. Ultimately, I would recommend a consultation to discuss these options. If you are interested in a nonsurgical option, then I would highly recommend the Ultherapy device, which is an ultrasound-based device that creates heat in the deeper tissue, which then causes new collagen deposition and tightening of this tissue, which can lift brows, cheeks, jowls, and improve the appearance of a saggy neck. I personally feel that the best candidates are ones that have very early signs of aging. So again, a consultation at Quintessa Medical Spa would be appropriate.
Yes, there are certainly options for patients that are not healthy enough to undergo general anesthesia specifically regarding their lower face. Standard facelifts or certainly extended SMAS deep place facelifts are typically performed in the operating room setting under either deep sedation or general anesthesia. Options for patients that are not healthy enough to undergo these types of anesthetic care would be mini facelifts, which can be performed under local anesthesia in the office and I have certainly performed these on patients that are not qualified for procedures performed in an operating room setting. Though this treatment is compromised compared to the more sophisticated and technically demanding extended SMAS deep plane facelift, they nonetheless get a very significant improvement in the lower third of their face and these patients are quite satisfied with the results of this type of surgery. A more advanced and newer technology that is available now for patient that are showing the early signs of aging would be Ultherapy, which is an ultrasound device that can target the deeper layers of the skin and this ultrasound energy is then focused on the deeper layers thus heating up the collagen and causing new collagen deposition, which in turn results in tightening of the deeper tissue and lifting of the facial structures. This can be performed in the area around the eyes to cause a nonsurgical brow lift. This can also be used to treat the midface, jowl, and the area under the chin to create the lift of a miniature facelift. There is no need for any anesthetic and there is absolutely no downtime as this is performed in a medical spa setting and the patient’s own healing creates the lift over a three-month period. This would be an excellent alternative for any patient with early aging that is not a good candidate for a standard facelift.
Yes, mini facelifts definitely cost less than your standard facelift for several reasons. One reason is that mini facelifts are typically performed in an office setting under local anesthesia and therefore there is no need for the cost of a surgical center, hospital, or anesthesia provider. Secondly, a mini facelift is exactly what it sounds like, which is a miniature version of a standard facelift and as such typically takes much less time, is less technically difficult, and is not nearly as sophisticated as some of the more advanced techniques that I personally can perform in an operative setting. As such, the cost of a mini facelift is approximately half of what I charge for a facelift in the operating room. With that said, I personally feel that the more advanced techniques that I perform in the operating room, specifically the extended SMAS deep place facelift with platysmaplasty not only create a more rejuvenated look, but also last much longer than a mini facelift and as such, overall, is a much better value than a mini facelift. With that said, many patients find it advantageous to undergo a mini facelift due to its lower cost and the fact that they have slightly less downtime and do not have to undergo any sort of anesthesia in an operating room setting and certainly for patients with early signs of aging, I think this is a perfectly appropriate option for them and I personally perform mini facelifts on a very regular basis.
In experienced hands, jowl liposuction has very little risk; however, in inexperienced hands, jowl liposuction can cause irregularities or depressions that would be extremely difficult to correct. When performing jowl liposuction, one has to be very judicious regarding the amount of fat that is removed and one has to feather the fat removal along the edges of the proposed fullness to prevent any sort of a visual depression. There is very little risk to any sort of injury to major blood vessels or nerves as long as the liposuction is performed in the appropriate level, which is just below the skin. I find that many patients that feel they are a good candidate for jowl liposuction really are not as the majority of the jowl is not due to subcutaneous fat, but due to laxity of the midfacial structures over time. These patients obviously would benefit from a more surgical approach such as a minilift or extended SMAS deep plane facelift for adequate correction of this concern.
Overall this generalization about injectables is true. Botox, for the most part, is very effective in the upper portion of the face including the forehead, glabella or area between the eyebrows, as well as the crow’s feet area where as fillers are more effective down in the area of the smile lines and lips and marionette lines. However, there are some patients that would benefit from fillers in the upper third of the face as well as Botox in the lower third of the face such as patients that have very deep creases between the eyebrows. These creases can be filled with hyaluronic acid fillers though one has to be quite judicious in the amount that is applied to these areas due to the fact that significant complications can occur when performed inappropriately. I therefore recommend patient seek someone with a significant amount of experience using fillers in these types of areas. Furthermore, fillers can be used in the lower eyelids quite successfully, but again, this area is fraught with complications when performed by an inexperienced injector. Furthermore, Botox can be used in the lower portions of the face such as into the depressor anguli oris that can help lift the corners of the mouth and prevent the downturned look. Furthermore, it can be placed above the lips in the levator labii superioris to prevent a gummy smile. Botox or Dysport can also be placed in the bands below the chin, which are caused by the platysma muscle and the relaxation of this muscle will visibly diminish these lines or bands. In summary, Botox typically is used in the upper portion of the face and fillers are typically used in the lower portion of the face, but when highly skilled injectors evaluate patients, we can use these products in areas that cannot only enhance one’s appearance and significantly rejuvenate the patient, but can also be used in an extraordinarily safe manor when compared to a more inexperienced injector.