Thank you for your question.
You submitted several photos and you state in your question that you underwent CO2 laser
as well as Botox®, and some Juvederm for your parentheses lines and your jowls and
now you’re focused on your neck and you’re making an interesting observation of what’s
the point of having improvements in those areas while the neck appears to be saggy or
as you described, having crepey skin. And you want to do something that doesn’t involve
a neck lift.
Well, I can certainly give you some ideas of how I approach my patients in my practice
in a similar situation as yourself. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years and helping people with
facial aging is a real core of my practice and my daily practice.
So certainly, the challenge of course is an ongoing challenge for someone like yourself
where you start to do things in certain areas that draw your attention and then you start
to look at other areas and this is very typical. You know, we have so many options these days
that it is not unusual that once we look at the hierarchy or the priorities of a patient’s
needs, once one thing is taken care of or two things or three things, then basically
you get another perspective on your overall appearance. Now that being said, I think it’s
important to first recognize the anatomic issues and then the possible options or alternatives
to the surgical option of neck lifting.
So to begin with, let’s look at what you are describing. When you look at your photos,
you see the facial sagginess along the jawline that is responsible for that jowl and the
amount of skin that’s under the neck. Now if you were to do what is often referred to
as the mirror lift where you lift everything and you look at the mirror and you like what
you see, you understand that the major issue is relative descent or change of position
of the soft tissue of the face. So it’s both facial element to the neck skin as well
as the sagging of the neck skin.
As a surgeon and someone who provides comprehensive solutions in my practice, everything from
surgery to volume augmentation, fillers, non-surgical procedures as well as lasers and energy-based
devices, essentially, I customize a program for every patient based on what their desires
and understanding what the outcomes would be for every procedure. So that being said,
I would say that the most ideal procedure for you in dealing with the descent of facial
skin and neck is a procedure like a surgical face and neck lift. Now surgical face and
neck lift is based on the principle of repositioning tissue that has sagged. And so, in a face
and neck lift, in a surgical approach, everything is being lifted.
Now, you just had two procedures which address the other elements that we approach. The other
elements are volume loss and that’s where Juvederm played a nice role or the injectable
fillers play a nice role in restoring some volume in areas where there’s volume loss
and then skin texture and quality and that’s where the CO2 laser was a value for you. So
if you don’t want to undergo a surgical procedure, for whatever reason, for a lot
of our patients, there is a timing issue where they want to do it but they want to do something
for an upcoming event or a wedding or something special and they want to do something that
doesn’t have anything close to the downtime. The downtime for a face and neck lift surgery
is about a week to 10 days so it’s not exactly that inconvenient but if you don’t have
that time or if you don’t want to have surgery period, I’ll share with you some of the
options that we offer to our patients.
When you are dealing with this sagging tissue and you’re willing to accept a certain compromise
and that’s very important, if you’re willing to accept a compromise, you can’t get neck
lift results without a neck lift. As many devices and concepts are all around us that
claim to be alternatives, they’re not necessarily alternatives but they are really complementary
to the procedures that are more definitive. Now there are alternatives if the patient
is willing to accept an improvement to a certain level beyond which they can’t achieve without
a surgery and this is about making an informed decision.
So for a patient like yourself, I actually offer procedures such as suture suspension
neck lifting and this is a procedure where we’re basically using the same principles
of what we do in surgery such as suturing and lifting and tying muscles to tighten the
tissue and then overlapping the skin and trimming the skin. In this procedure, we’re basically
passing the sutures through the skin without opening the skin. So it’s kind of a blended
procedure. And what are we doing? We’re basically supporting the muscles and helping
define the neck. I’m not removing skin but unlike surgery, basically it’s a little
local anesthetic and then passing of sutures in a strategic way. Now this is not a thread
lift. A thread lift is a very different procedure where they’re using barbed sutures to try
to lift the skin and from my experience, for someone like yourself, a thread lift won’t
be very effective. However, suture suspension does have a potential role in your situation.
Now the other side of that, from the external approach, the skin quality, texture and tone
approach, there are options such as thermal energy devices or energy-based device as well
as, in our practice, we use laser that basically heats the skin and causes skin tissue contracture
but it does not ablate or take away the top of the skin like your CO2 laser experience.
This is based on the concept of delivering thermal energy to the deeper tissues to cause
some tightening and remodeling of the skin. Now one can argue that it depends a lot on
the capacity of the skin to generate collagen and that’s absolutely a limitation and it
requires several sessions in order to achieve a result. So there’s a time investment as
well involved but it is an alternative. So the way I approach something like this is
basically suture suspension to bring the skin up, the tissue up and then energy-based device
to shrink the skin and improve skin texture and quality. It’s an option, it’s an alternative
but as a surgeon, I would say that if you want to get really the results that you probably
ultimately really want then surgery is worth considering.
In our practice, we do face and neck lifting surgery under local anesthesia with LITE™
sedation which means basically you’re avoiding general anesthesia which is often a disincentive
for many patients. They don’t want to have a tube in their throat. They don’t want
to be put under general anesthesia. And doing it under local with sedation, we are also
able to expedite recovery. And so being in practice for over 20 years and developing
my style, I’ve been able to get people back to work in a more expedited way. So although
there are alternatives, you shouldn’t close the door completely on the option of surgery.
I found that, especially in the early to mid-2000s where there was a rising popularity of short
scar procedures, short scar lifts, people wanted the results of a more extended face
and neck lift and although they would say that they would be willing to compromise with
the results, even though there was improvement, they always wanted more. So it was kind of
a basic understanding that, yes, improvement is possible and as long as you and your doctor
communicate effectively and you can come to compromise and get a result that might be
a bridge before you do a more definitive surgery.
So I hope that was helpful, I wish you the best of luck and thank you for your question.