Thank you for your question. You're asking how long has Ultherapy and Pelleve been around,
and the safety for the neck. What you want to address is some crepiness and skin quality
of the neck, but you are concerned that people have expressed that they lost fat from these
treatments, and you want to know whether or not it's technique-dependent.
Certainly I can help you with this question. I'm a Board-certified cosmetic surgeon, practicing
in Manhattan and Long Island for over 20 years. I have used a lot of technology in these 20
years. I own Pelleve and I certainly can give you some guidance as to the modalities, the
technology, and some other alternative options.
So to begin with, what we want to first define before you look at these modalities, because
these modalities, and as a general rule, the technologies are oversold; the claims are
disproportionate to what they can really deliver. The photos are questionable and it's very
very difficult for a consumer to make a rational choice when there is so much aggressive messaging.
A lot of these new devices show up on different talk shows, and then become so hyped that
when you go to professional meetings, they become so dominant in their messaging, and
then before you know it they become obsolete and you wonder, if they work so well then
why don’t people keep using them.
So when you talk about crepiness, or when you talk about loose skin, you have to understand
that there is a difference between skin redundancy, skin laxity, and skin quality. As we get older,
when we look at the crepiness of the skin, we assume there's laxity that needs to be
tightened. A lot of times, people just pull on their neck and think “oh I wish it would
look like this”. But we know from surgeries that part of the limitations of face lifting
and neck lifting surgery is in the intrinsic elasticity of the skin.
So along come these thermal energy devices that claim that you can heat the skin and
get the collagen to contract and tighten. To a degree that is true, but there is a limit.
Unfortunately, a lot of overuse of these thermal devices results in loss of fat, and this is
one of the things that I have observed a lot, patients are coming in looking for solutions
for volume loss. Just think of a younger person, is a young person tight? No, they have volume,
they have glow, they have healthy skin.
It is my conviction that the fat layer under the skin is not there just for padding, but
also has a very functional contribution to skin quality. We have confirmed this to many
levels because we have a solution for hair loss where we inject this material under the
skin into the scalp, and we’re able to treat thinning hair, we’re able to treat with
platelet rich plasma and extracellular matrix. So we’re able to improve the skin quality
of the scalp, and provide a solution for hair loss.
What we do in our practice, if we actually use platelet rich plasma, instead of heating—and
we do use Pelleve, but we don't use it as a first line, especially in people who have
very thin skin—we actually use platelet rich plasma, which is derived from your own
blood and we’ll inject it into the dermis, into the backbone of the skin, as well as
under the skin, and we’re able to improve skin quality. If you think about aging, you
can understand that there is loss of collagen, there is loss of blood supply. What does platelet
rich plasma do? It stimulates collagen, it stimulates blood supply, at no risk to the
fat—in fact it makes the fat healthier. This has been shown in published studies in
peer-reviewed journals, showing the fat cells looking better after platelet rich plasma
treatment.
So I think that I would avoid a thermal energy device, because the frustration that patients
and practitioners have leads people down a very dangerous path. They pay a lot to have
a treatment with a thermal energy device, the treatment gets done, they don't like the
results, so what does the practitioner do naturally? They go up on the energy, they
heat even more aggressively. The patient feels it’s hotter, it must be working better.
But the skin can only tolerate so much heat, and invariably, there is loss of fat.
There is always conduction of heat, even though the device manufacturers will claim the ability
to really be specific, you're looking at structures that are very very thin and it is very easy
for the heat to be transferred. I feel that people are literally getting their skin cooked
with these thermal energy devices. We use Pelleve but we use it very conservatively
and very specifically. We use it under the eyes for fine lines for people with darker
skin who are good candidates for laser, but when you are doing your research, understanding
redundancy, laxity, and skin quality, then you'll also understand why these devices have
a limit.
People try to avoid a facelift by going for different thermal energy devices and simply
does not work, it's just not enough. People who have a lot of volume loss will actually
add volume and do something called a Y Lift™, where we’ll place fillers at the structural
level, above the bone and below the muscle, and we’ll actually create the effect of
a facelift by adding volume. We’ll improve skin texture with platelet rich plasma. So
instead of trying to cook the skin to get it tighter, remember a younger person doesn't
look tight, they look healthy. Think about a healthy quality to your skin, rather than
just tightening the wrapping. So I hope that was helpful and I wish you the best of luck.
Thank you for your question.