Smart Lipo Neck
CO2 laser resurfacing
The aging process in men and women causes distinct changes in the anatomy of the face and neck that create an older, tired, less youthful look. The aging look to the face begins subtly in both men and women as they approach their mid to late 40’s and progresses into the next few decades. Most of my patients are physically and mentally in very good shape and active professionally and socially. But often they will tell me that they look older than they feel. These patients come to me asking for ways to reverse this aged look, yet maintain a natural, non-surgical look.
Recent advances in surgical techniques and laser technology has made this goal much more achievable when compared to procedures done in the past.
First, let’s examine the aging process as it affects the face and neck and then let’s explore the newest options for obtaining a more youthful look without the telltale signs of surgery.
One of the first signs of aging process of the face, seen equally in women and men, is fullness and excess fat in the neck region, along with looseness of the skin and muscle in the neck. Some refer to this as a “double chin” or as it progresses, some call it a “turkey gobbler neck”.
In the face region, many of my patients start noticing a sagging or pouching of the jaw line or “jowls”. This progresses as we age due to loss of elasticity of the skin and underlying muscles. Additionally, the midface and cheeks drop and the nasolabial folds (cheek folds between the nose and sides off the mouth) deepens.
Thirdly, depending on one’s skin type and level of sun exposure over the years, the texture of the skin may show distinct signs of aging, such as deep wrinkles, more superficial lines and “etchings” on the skin surface, dark sun spots, dry looking skin, and a sallow appearance.
These it is these three progressive changes in facial features, happening subtly and gradually all at the same time, that cause the faces to look older as people progress through their 40’s, 50’s and 60’s. The lack of definition and progressive fullness of the neck, looseness and sagging of the skin and muscle of the jowls and midface, and finally, aging of the surface or texture of the skin surface itself, need to be addressed in order to reverse this older, tired, unattractive look to the face.
Traditionally, surgical correction alone with a traditional face – neck lift would be the only option offered to correct this condition. The face-neck lift techniques has distinct advantages in that is specifically addresses the loose skin and muscle of the face and neck. The most common facelift done today is a deep plane, two layered procedure that tightens not just the skin, but also identifies and tightens the underlying supportive muscle (the platysma muscle) of the neck and face). Incisions and subsequent scars can be well camouflaged with careful placement depending on the patient’s hairline and anatomy. As with any operation, there is a risk of scarring, bleeding and infection.
Component #1: Loose and fatty neck tissue:
There is a new laser option for treatment of the neck fullness and mild to moderate looseness of the skin in this area. It is SmartLipo. Many of my patients in their early 40’s to mid-50’s tell me they are “not ready” for a face lift. They want less surgery and less downtime. What are their options? Today the best option specifically for neck fullness and mild to moderate skin laxity would be SmartLipo of the neck. SmartLipo is a laser technology that heats and tightens the undersurface of the skin, melts the fat under the surface of the skin, and coagulates or seals small capillaries to lessen bleeding and bruising. Once the SmartLipo laser is used, the physician then preforms traditional liposuction to remove the excess fat in the neck region. This process involves three small incisions only – one in the midline of the chin hidden in a chin crease, and two small incisions near each earlobe. The recovery and subsequent scarring is much less than a face-neck lift. Patients need to wear a Velcro “Ace Bandage” around their neck and head for a week to promote proper healing. Patient selection is important. SmartLipo works best for minimal to moderate fullness and looseness, but not necessarily for patients with excessive looseness of the skin.
Component #2: Sun damage and wrinkling of the skin surface
Many advances in skin resurfacing have occurred over the last few decades. Facial plastic surgeons and patients realized that just doing a face-neck lift to pull and tighten loose skin does not always make someone necessarily look that much younger, if the skin surface still has a wrinkles, sun damaged appearance. For decades, chemical peels, laser treatments, infrared and ultrasound devices have all flooded the market to reverse the signs of aging of the skin surface. The tried and true options that have proven most effective over the years, in my hands and those of many other surgeons and dermatologists around the world, are chemical peels and laser resurfacing techniques.
People often ask me what is more effective, a chemical peel or a laser treatment? The question is very general and not so easy to answer, as there are many types of chemical peels and laser treatments and there are many different skin types. Each skin type, and each patient, responds differently to the treatment. However, based on years of experience with thousands of treatments, I feel that laser resurfacing gives a doctor more control of the treatment than a chemical peel. Most lasers have many parameters (energy, density, wattage, etc) that are selected based on a skin type and often based on a test spot. Chemical peels can vary based on how saturated the gauze pad is with the solution, the amount of pressure applied by the doctor applying the chemical peel, how and when the chemical peel was mixed in the lab, as well as the oil content of the skin.
For the last twenty years, I have resurfaced skin with glycolic acid, Jessner’s solution TCA (trichloroacetic acid) at varying percentages, Phenol peels,the CO2 laser, the erbium laser, as well as various ultrasonic and infrared devices. My most positive and consistent results have been with the CO2 laser resurfacing. The original CO2 laser required a week of downtime with the face covered with ointment followed by several weeks of redness to the skin. The laser technology was updated several years ago to a “fractional CO2 laser” and the downtime and postoperative redness is much less, usually 7-10 days, but the results are still very good.
So I can address the second component of the facial aging process with the fractional CO2 laser resurfacing technique simultaneouls with a facelift
Component #3: Loose sagging skin of the jowls and midface
This aspect of the aging face is best addressed with a deep plane, tow layered facelift. Incisions are carefully placed based on one’s hair pattern, hair style, beard (in men) and facial anatomy. The skin and underlying SMAS or platysma muscle are elevated and tightened appropriately. This will help achieve a cleaner jawline and tighter appearance to the midface and upper face.
THE THREE IN ONE FACELIFT
I believe, in properly selected patients, the THREE-IN-ONE FACELIFT can address all components of the aging face most effectively, simultaneously, with less scarring and less downtime. Each component of the aging face is addressed with the best and most appropriately selected technique, each of which have been used successfully individually for years with a proven track record.
Component 1: The excess fat and loose skin in the neck is addressed with SmartLipo using only one small incision in the midline of the chin in an natural crease and two small incisions near each earlobe .
Component 2: The sun damaged, wrinkled skin of the face an be treated with the fractional CO2 laser at a depth and energy appropriate for the patient’s skin type and level of sun damage
Component 3: - The loose skin and muscle of the face and jowl region is tightened with a deep plane, two layered facelift with careful placement of incisions to minimize scarring.
I think this highly selective and technically advanced approach is the best way to address the aging face. There are several options and an individualized approach is needed based on the patients specific needs. The best treatment selected is based on the patient’s anatomy, the patient’s desire for improvement, and what kind of downtime the patient prefers.