Thursday, March 31, 2016

Neck rejuvenation

By: Dr. Marian Northington with Shelby Dermatology

One of the most important concerns for patients interested in facial rejuvenation is the aging jawline and neck. We now have more tools to improve the aging neck ranging from injectables to surgical options. When selecting which treatment is best for your patient, it is important to identify if texture and dyschromias are an issue or if it is skin laxity, excess adipose tissue or a combination. It is also important to identify patient expectations, concerns and what their tolerance is for social downtime. The most effective way of improving skin laxity is a surgical lift. However, some patients do not want the risk or downtime associated with surgery. It is exciting that we have nonsurgical effective options for these patients.

One subtle and easy way to improve the neck with little to no downtime is with botulinum toxin. Botulinum toxins can soften platysmal bands and relax the downward pull of the platysma by injecting along the platysmal muscle. This is known as the Nefertiti lift. Additionally, soft tissue fillers are effective in adding volume and recreating a defined jawline by injecting along the mandibular angle and along the jawline and chin.

Energy devices are another tool we have to improve the appearance of the aging neck. Lasers can be used to improve the discoloration of the neck as well as texture. A variety of lasers are available to address these issues. Noninvasive tightening devices include radiofrequency devices such as thermage or microfocused ultrasound such as ultherapy. It is important to emphasize that these devices will not eliminate skin laxity or remove excess fat like surgery, but they will improve skin laxity and give a natural improvement which improves over time due to wound healing processes. These are excellent options for people who do not want the downtime or risk of surgery. I recommend noninvasive tightening procedures to be done on an annual basis for maintenance and for preventative purposes and like these as an adjunctive treatment to other procedures like liposuction. I also advise patients to start treatments with early signs of laxity to attempt to prevent laxity as much as possible. Cyrolipolysis is another device which induces apoptosis of the fat cells with cold temperatures. A new neck applicator is available to eliminate unwanted neck fat and improve laxity through the wound healing process. The treated fat cells are permanently destroyed. Kybella is another permanent removal of unwanted fat and is an injection of deoxycholic acid in the submental area. Again, the fat cells are permanently destroyed and laxity improves over the next few months. This treatment does have some downtime such as swelling for a week and possibly temporary numbness in the treated area.

Neck liposuction with the tumescent technique is my favorite procedure for neck rejuvenation. The tumecscent technique takes away the risks of general anesthesia. Patients are awake and comfortable. The adipose tissue is anesthetized with a dilute form of lidocaine. It is the most predictable procedure for fat removal and tissue tightening occurs as the area heals. Downtime with this procedure includes bruising, swelling, tenderness, and patients wear a neck strap/garmet for a week. Many patients wonder if they should lose weight before the procedure, but neck fat is not an area that responds well to weight loss and so is not necessary. first. Neck rejuvenation is important part of improving an aging appearance. It is exciting that there are so many options available for our patients.

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