Thank you for your question. You submitted a photo and you described some of your thoughts
as to making this decision on whether or not to have a neck lift versus a CO2 laser to
address the appearance of your neck, and you also state that you would not want a facelift.
So certainly I understand why there may be some conflicting ideas between neck lift versus
CO2 laser, but I think I should be able to help clear that up for you. I'm a Board-certified
cosmetic surgeon and a Fellowship-trained oculofacial plastic surgeon, practicing in
Manhattan and Long Island for over 20 years. I've been using the CO2 laser for that long
and have a lot of experience with all kinds of lasers, and I perform face and neck lifts
a lot in my practice.
So when I have consultations with people like yourself, I always try to make a clear distinction,
because I think a lot of the confusion comes from the very aggressive marketing of lasers.
So let's understand something. A face and neck lift—whether it’s facelift alone,
face and neck lift in combination, or isolated neck lift—what are we dealing with? We’re
dealing with redundancy and malposition. That means that as we get older, the soft tissue
sags. So what we want do is define that as redundancy. Now that also means that there
are other things, there is the muscle or the tissue underneath the skin called the SMAS,
referred to as the superficial muscular aponeurotic system, and in the neck, we refer to it as
the platysma, this muscle also sags, it separates, it weakens.
So with the photo that you submitted, I would say that it's reasonable to conclude that
the jawline loss of definition and the sagging in the neck partially is contributed by the
sagging in the face, and simple way to determine that is to go to the mirror and do a mirror
lift—lift your face ever so gently and see what happens to your neck. I think you'll
see that your jawline will improve.
So understanding that a neck lift or face and neck lift is about redundancy and structure.
So what do lasers do? Lasers improve quality, skin texture, defined by fine lines and wrinkles
and discoloration.
There was a time particularly in the mid-90s where people believed, especially Doctors
who didn't do facelifts, would advise their patients not to have a facelift but rather
make the skin smoother with aggressive lasering. And patients believed that they could actually
avoid a facelift by tightening up their skin so dramatically. Of course that doesn't work,
because you can only heat up the skin so much. We're seeing the same thing with a new coat
of paint on it with the thermal devices where it's not ablative like a laser, but they’re
heating up the skin, imagining that they can tighten the skin as effectively as a facelift.
Can't do that, think texture and quality.
So in our practice we will often combine both. We'll do the surgery, the lift and the laser.
Of course we make adjustments in the laser based on the type of lift we do, but you can
get both issues addressed, but you have to understand one does not displace the other.
So you have to think to yourself, if the texture quality is more bothersome and you don't mind
sagging, then you might be okay with doing just the laser alone. But my gut feeling is,
like many people who go for these treatments where they think they can avoid the neck lift
or facelift, you'll be disappointed if you don't get the dramatic tightening that is
naturally expected when you go through the trouble of having the laser and then the trouble
of dealing with the after care.
So I think you should meet with some doctors, meet with them some cosmetic surgeons. Surgeons
do both, they do both surgery and lasers, as opposed to non-surgeons who do mostly non-surgical
things and will maybe dissuade you based on their limited scope of practice.
So understanding that and getting opinions you'll become more educated when you push
your skin like this and you get a real improvement, you can’t get that with the laser alone.
With that being said, I hope that was helpful I wish you the best of luck. Thank you for
your question.