Thank you for your question.
You’re 47-years-old and you’ve submitted several very good photos of your neck and
lower facial area.
And you state that you had Ultherapy with the plastic surgeon which did not work and
your plastic surgeon said it’s too early for you to have a facelift.
With that understood, you had some injectable fillers placed on your cheeks in an effort
to try and lift the skin and that, as you state, was not successful.
So you are looking for some guidance as to what your options are.
Well, I can certainly give you my perspective and certainly my opinion on how I approach
patients like yourself.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I’ve been performing facelifts from the very beginning and I have offered the full
range of different face lifting and neck lifting procedures as well as non-surgical options
and I can certainly explain to you a little bit about what your options would be if someone
like yourself comes to our office.
So when you look at the skin under your neck, there are certain issues that are relatively
straightforward.
You have some, what is called platysmal banding and so certainly, suggestions will come up
like using Botox® to relax the platysma and then when you discuss a little bit about or
you describe your question about the fillers to help lift, it does bring to mind an option
that is also with fillers but it is one way of helping this issue but necessarily the
only way and what I am talking about is called structural volumizing.
You see, regardless of the placement or the intention of adding volume in the face, there
is a real distinction on technique when it comes to using fillers to cause a lifting
effect.
When we do something called structural volumizing, we are actually placing filler such as Juvederm
as well as Juvederm Voluma at the level of the bone structure.
At a certain level of the bone structure, it actually restores volume where volume is
lost and it allows redefinition and some lifting of the skin.
Now it is not necessarily that it is the only thing that will get you to where you want
to be.
The simple challenge with thermal energy devices regardless of whether it is ultherapy, whether
it is a other radiofrequency devices, whether it is Nd:YAG laser device which what we use
in our practice.
I can tell you that skin remodeling which ultimately is really what’s happening and
I try to help people understand there is a distinction between skin quantity and skin
quality.
There’s a limited amount of overlap where skin quality creates enough tightening that
there is some degree of elevation but in general, the challenge really is the sagging of the
underlying tissue which limits the effectiveness of any treatment which involves non-surgical
skin tightening.
So when it comes to that question, there are a couple of different options: one option
is the type of limited short scar face lifting procedure.
With due respect to your plastic surgeon, I would say that there are definitely people
who benefit from a little amount of lifting where the soft tissue including the SMAS which
is the muscle layer and the cheek area on the face as well as the platysma, which you
would contribute to those bands when lifted, willl actually relieve the tension of the
skin and that’s a very important part of this.
The other procedure that we also recommend is something called the suture suspension
procedure and this is not a thread lift.
This is not the barbed suture technique which is basically a procedure where skin to skin
is being tightened in a way but unfortunately, a lot of times, there is a lot of regression
and that’s what gave thread lifts unfortunately a lot of negative press.
Suture suspension is actually a method of fixating the sagging tissue or elevating it
to a structure that is more stable.
In other words, what we are doing is essentially restoring tissue in a way where you don’t
necessarily have to open up the skin.
And the point of that is if your doctor or plastic surgeon feels you don’t have enough
extra skin to justify doing a face lifting procedure, well essentially, the concept of
suture suspension is doing this work that you typically do in facelifting surgery without
removal of skin.
And the reason it works is that the skin, depending on age of course and the general
resiliency of the skin, will actually retract when there isn’t physical weight on the
skin.
Now that also means that if there is re-suspension of the deeper tissue then you can also get
the opportunity to maybe visit some thermal energy device tightening procedure afterwards
to further enhance that.
A lot of times it is not necessary and again it has to be customized.
So, there are options for you and it is a challenging area and I certainly understand
the frustration.
And sometimes there are not enough things because unfortunately there is like disproportionate
amount of aging that happens in the neck relative to the face but in my opinion, it is often
the best solution as a combination approach and certainly you have been kind of visiting
some elements of this and hopefully what I am discussing with you in terms of Botox®
for the platysmal bands and suture suspension may give you some other perspective on options
So I hope that was helpful, I wish you the best of luck and thank you for your question.