Thank you for your question.
You had a facelift 6 years ago with some CO2 laser.
And then, you said three years later, you had a profractional Erbium laser, which you
felt did nothing.
Now you’re looking at yourself, and you’re noticing some platysma bands, and your question
is about doing a skin-only necklift with CO2 laser, and you ask can you get away with that.
Well, I can certainly give you some guidance, in the absence of a physical examination,
of course.
I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and
reconstructive surgeon.
I’ve been practicing in Manhattan and Long Island for over 20 years.
I perform every type of face and neck lifting surgery, and this is a big part of my practice.
I can give you some guidance based on the photos you’ve submitted, which you’ve
submitted several.
To begin with, the idea of what’s called a skin-only neck lift can be interpreted in
many ways.
Let me tell you how I interpret it.
When you say something like a “skin only” neck lift, basically what you're saying is
lift the skin, but don't do anything with any of the support structure underneath, that
includes the platysma, that includes the SMAS, and just pull the skin and then do a laser
to then improve the skin texture and quality—that’s how I'm interpreting it.
Well, that being said, the thing to look for when I see someone like yourself, is first
has there been any softening or regression of the facelift part.
Your face overall looks very good but is there any part of this sagging below the jawline
that could be benefited from maybe a little bit of elevation of the face.
A lot of times, facelifts on people with skin that is very elastic, no matter what technique—deep
plane, high SMAS, or whatever you want to call it—the skin is often the weakest link
and the skin can stretch, particularly in people who may live in areas where they have
a lot more incidental sun exposure, as well as people who have genetically, relatively
very thin skin and very elastic skin.
So my first thing to consider when I look at your neck is that you have these platysma
bands.
Although Botox maybe helpful, right now, with the photos that you submitted, those bands
look significant.
Sometimes in surgery what I do is I look for these bands below the chin and I either repair
those bands by doing what is called a platysmaplasty, or I release those bands so that you don't
see these continuous bands, because they're almost like a bow and arrow, like a bow where
if you release the band or the muscle, it separates.
Sometimes it heals and it comes back, and that's called “recurrent bands”.
That’s kind of the idea, because if you pull the skin you may get a temporary improvement
in the bands, but the bands will most likely stay.
So in addition to this, there may be some value to pulling the platysma upwards, and
superiorly, and laterally.
Again these are more technical aspects of doing the surgery and much of it I always
think of is like being a sculptor where while you're doing the surgery you actually get
a sense of the response.
Of course I have several assistants and they often give me feedback while I'm doing the
lift on how they like they way the face is looking when I move muscles in a certain way.
This is truly an art form.
I would probably also caution you about more heat to your skin.
Doing this for over 20 years, I was one of the first people or early adopters of the
CO2 laser in 1994 and 1995, and around that time it was very aggressive but it was considered
quite a miraculous treatment, but we've learned over time how the skin can get thin, and if
you really are aggressive then the skin can get very thin as you get older and lose its
integrity.
You might actually benefit from something regenerative like what we do in our practice
using platelet-rich plasma, but that's a separate issue.
I think, more importantly, you need to come up with a strategy that's most likely to give
you back structure that you want and then work on the quality of the skin.
So I caution you about the aggressiveness of the laser.
So again, meet with doctors, you know the routine, meet with the original doctor or
other doctors if you feel like you want more opinions and come up with a strategy.
But again I would say be cautious about doing the co2 laser too aggressively.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.