Nov. 19, 2024
No More Turkey Gobbler: All Things Neck
Because the neck tends to reveal your age more clearly—and age faster—than your face, it is a key area to address when talking about facial aging.
Some people catch the early signs, like skin texture changes, and horizontal lines across the neck. For these concerns, skin treatments, like chemical peels, energy treatments for skin and dermal stimulating filler treatments can help. For minimal sagging or excess fat is approached with liposuction, or muscle tightening through small incisions. As skin laxity worsens, energy-based lifting treatments come into play.
But once you reach the point where there’s noticeable sagging or that “turkey neck” look, surgery is needed for real improvement.
The neck is just as visible as the face, so it’s crucial to include it in any rejuvenation plan. Don’t focus only on the face and neglect the neck—it’s on display every day, too.
Find out why the neck is so tricky to treat, how to pick the right surgeon for a neck lift, and why it’s often paired with a face lift. Learn what causes neck aging and how to prevent it and treat it.
Links
Learn more about neck lift and skin quality treatments
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to Park Avenue
Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery. I'm your co-host, Summer Hardy,
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a clinical assistant at Bass
Plastic Surgery in New York City.
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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
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educator, and technology innovator.
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The title of today's episode is No
More Turkey Gobbler: All Things Neck.
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I get the idea here
from the title Dr. Bass,
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but what is the scope of the topic
and why is the neck so important?
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Well, the neck tends to show
your decade of age even more
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clearly than your face and
age a little more quickly
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than the face.
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So it's a very important area
when we talk about facial
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aging. And if you have
that hanging wattle of
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skin under the chin,
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that definitively pegs you
in a certain decade of life.
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So typically in your sixties,
maybe in your fifties,
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but everyone's going to know for
sure you're not in forties or
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thirties. And the neck is a zone under the
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jawline,
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including that area under
the chin that's horizontal,
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but also the area from
the Adam's apple down,
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that includes the Adam's apple
and the neck skin going down
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to the collarbone or clavicles
and the top of the chest.
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And it generally includes the area
where the sternocleidomastoid muscle
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is, the strong muscle on either
side of the neck that creates a
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V or demarcation line for the front of the
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neck in the back of the
neck. It's behind that,
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but most people don't see the back
parts of your neck when you're
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talking to them or when
you're walking around.
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Okay, that makes sense. And then
given the title of this episode,
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can you tell me what is a
turkey gobbler Dr. Bass?
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So as I mentioned,
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it's that hanging wattle of skin
that hangs down from underneath the
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chin to just above the Adam's apple.
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Some people have vertical banding
even when they're very young.
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That's not a turkey gobbler,
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but when you really start to
have that hanging band of skin
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and fat,
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that's not muscle tenting up and that
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represents substantial excess of skin.
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That's a turkey gobbler that
puts you in your sixties,
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maybe in your later fifties,
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except for folks who have
lost massive amounts of weight
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that defines your decade.
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And most people really
hate it and feel it makes
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them look considerably less attractive.
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It's typically associated with
a bunch of other aging changes,
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and so it's something people really
want to chase and get rid of.
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Got it. What is the treatment
for a turkey gobbler?
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Are there nonsurgical options?
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So by the time you reach the
stage where you have that
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actual hanging band of skin and fat,
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you are past the stage where there's
any meaningful treatment using
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nonsurgical methods.
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And I do a lot of research and I'm very
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interested in new technologies
and I've tried all kinds of
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technologies on these things
and I've succeeded in taking
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a component, a percentage if you will,
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of the turkey wattle out.
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But if you have that hanging
turkey gobbler and I take
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20% of it away,
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which would be a really good result and
I've succeeded in doing that in some
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folks, you still have 80% of it present.
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You still have an obvious
visible turkey gobbler.
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You're still obviously in your sixties,
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you're not in that adult indeterminate
stage that we're trying to create with
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facial rejuvenation. So in
my view, that's a failure.
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And my experience with patients has
been that they're still unhappy with
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their appearance because they were
really looking to minimize that.
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We never get rid of a hundred percent,
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but if we got rid of 80
or 90% of what's there or
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95% if we were really lucky,
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you look definitively better and
the future is mild rather than
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being obvious.
But if you only take 10, 20, 30% away,
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the future is still obviously there and
you're still obviously in that later
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stage of life.
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I didn't realize that once
you can really see it,
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surgery is one of the main options then.
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So what kinds of aging changes
are typical in the neck?
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So even though we titled
the episode about the
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turkey gobbler, we're really,
as we said in the subtitle,
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talking about all things
neck. So just like the face,
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the neck is an area anatomically
that that has a lot of
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complexity.
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There are a lot of different structures
under there in a very small amount of
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space.
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A lot of those structures are
really important things for your
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life and well being.
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So someone who works in the neck needs
to be intimately familiar with all of
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that anatomy and like
the face, unfortunately,
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there's not a single thing
that ages in the neck,
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a single anatomic structure
that needs to be addressed.
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But there are multiple components
and those components include
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skin quality things.
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So skin quality talks
about redness and vascular
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changes,
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pigmentary changes like age
spots and sort of bronzing of the
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skin,
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the turgor of the skin. Does
it look floppy and parchment
like or is it firm and
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springy like youthful skin?
And texture, wrinkles and
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crepiness has that skin texture
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declines.
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You show more and more aligns
wrinkles and irregularity.
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So those are skin quality
issues. Then there's skin laxity,
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which starts out as a little bit of
hanginess and progresses to the point
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where you really have the turkey gobbler.
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There are muscle changes like separation
of some of the platysma muscle,
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which is really a paired muscle and
that can show some vertical banding and
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other kinds of lines and also
contribute to dissent and blunting
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of the cervicomental angle. The angle
between the horizontal and the vertical
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glands in the neck can also show,
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so glands like the submandibular
gland that sit under the jaw,
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tucked up behind the jaw when we're young,
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start to sag and droop down
and they can show on the
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side of the neck just under the jawline.
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And finally fat,
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which can be excessive
in the neck, building up,
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contributing to fullness,
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contributing to blunting of
the demarcation between the
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jawline and the neck
and fullness of the area
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under the jawline and under the chin.
So those are a
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long laundry list of all of
the small things that can go
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together to create an aging
appearance in the neck.
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Wow, there are a lot of small
details that's really interesting.
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When do they show and what are
the big factors in this area?
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So of course aging is variable,
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so there's no single age where a
given feature is going to show,
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but we do age based on some
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controllable factors and some that
are not currently controllable.
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So sun exposure is a
big factor in skin aging
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and neck skin is really
affected by that as well
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as smoking. Those are our
two big controllable factors.
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And then there's also timing of
skin aging based on your skin type
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fair thin skin tends stage
more quickly than thicker,
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darker skin. So those
are some of the factors.
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But most people by the time
they're in their forties,
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will start to have some texture
changes in the skin of their neck,
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often even in the thirties
and some fair skin,
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people who get a lot of sun can
start to see these changes in their
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late twenties.
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There we're mostly talking
about skin laxity changes and
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laxity starts to creep in
and most patients in their
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fifties accelerate in the sixties.
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And for women menopause
is a watershed where
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again, skin laxity and other
skin aging changes can speed up.
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Okay. So we've heard about
a few of the problems.
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What is the approach to treatment?
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Well, this depends on what is
really showing and predominates
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in the appearance of the neck
and on when the patient shows
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up asking for help. So some
people come very early,
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they're starting to see
some skin quality changes,
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some lines going side to side
across the bottom of the neck,
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a little bit of sagging of skin or a
little bit of fullness or banding of
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skin. So at that point,
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skin quality treatments are going
to be the focus and sometimes
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liposuction or a little muscle
tightening just done through small
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incisions under the chin.
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As skin laxity progresses,
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we can come in with energy
based treatments for the skin,
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and these are ideally for people
in their forties and some people in
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their fifties who don't yet
need a surgical neck lift or a
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surgical facelift,
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if they just have a little laxity,
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those energy-based treatments
can give them what they need,
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which is just a little bit of tighten up.
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But if there's significant laxity
or the obvious turkey gobbler,
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those technologies are not going to
be able to contribute enough change to
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make a meaningful difference.
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I've heard that the neck is harder to
treat. Is this true? And if so, why?
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The neck skin is significantly
different from our
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face skin,
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even though the neck skin is only
a few inches away from the face,
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blood supply is different, the
thickness of the skin is different.
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And most importantly,
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there are things called
adnexal structures in the skin.
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So these are sweat glands,
oil glands, hair follicles,
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things that are in the
skin that are not skin
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material, skin fabric themselves.
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And that's a source of
healing and regeneration in
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part for skin when it's wounded.
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And just in terms of its
regeneration and turnover,
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skin turnover declines as we age and
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our neck skin has a thousand fold fewer
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adnexal structures than our face skin.
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So that skin is going to
show aging changes first.
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And it also tells us why it's going
to be harder to treat because its
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ability to heal and
regenerate is significantly
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less than that of face skin.
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00:12:26,920 --> 00:12:31,000
That's really interesting. Here's
something I've always wondered about,
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what is the difference between
a facelift and a neck lift?
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00:12:35,260 --> 00:12:39,280
So that difference means
a lot more to patients
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semantically than it
does to plastic surgeons.
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There are some procedures
that focus on addressing
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lax skin in the neck or addressing
deeper structures in the neck.
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And these are sometimes done in early
stage of aging where we make an incision
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just in front of the ear
or just behind the ear
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to lift the skin just in the neck in a
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more focused fashion.
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But most of the time we're
making a more extensive
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incision that's both in front of
and behind the ear and back into the
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posterior hairline.
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And we're generally resetting in harmony,
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a lot of the tissues in
the face and neck because a
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key element of what both
a facelift or a neck
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lift are aiming to correct
is hanging skin in the
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neck and a sharpening of the jawline.
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And the jawline is that demarcation
between the face and the neck.
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So in either a facelift or a neck lift,
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that has to be made as sharp,
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defined and youthful
as it possibly can be.
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And that means that all the adjacent
structures both above and below are going
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to require a little bit of
tinkering so that everything
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remains in harmony.
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So there are just facelifts
and just neck lifts,
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but most techniques are going to
involve at least some work in all or
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both of those areas.
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00:14:23,020 --> 00:14:27,430
And that doesn't really
modulate the recovery,
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which is part of the reason why some
people are focused on getting just a neck
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lift or just a facelift because they don't
want to mess with more than they have
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to.
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And you get more or less the same recovery
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if you have a proper
neck lift or facelift.
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Just the area where that bruising
or swelling may occur is slightly
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larger,
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00:14:53,900 --> 00:14:57,530
but it doesn't necessarily
last any longer.
227
00:14:58,670 --> 00:15:02,480
If you're adding a bunch of other
procedures, it may last a little longer,
228
00:15:03,620 --> 00:15:07,520
but not between the
facelift and the neck lift.
229
00:15:07,940 --> 00:15:11,390
Okay, that makes a lot of
sense. Thanks for explaining.
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00:15:11,870 --> 00:15:16,730
So then more recently, I've heard the
term deep plane neck lift mentioned.
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00:15:16,790 --> 00:15:20,120
What does this mean and how is it
different from traditional neck lifts?
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00:15:20,810 --> 00:15:23,630
So deep plane techniques,
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00:15:23,750 --> 00:15:27,200
which is really a better way
of putting it than neck lift,
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00:15:27,680 --> 00:15:32,450
is sort of a marketing term that
a lot of people who are promoting
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00:15:32,450 --> 00:15:34,670
deep plane facelift are using,
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00:15:35,120 --> 00:15:39,920
but it does have some
significant medical meaning to
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00:15:39,920 --> 00:15:41,870
most of us in plastic surgery.
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00:15:41,870 --> 00:15:46,850
And the important thing here is
that there are a bunch of structures
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00:15:46,850 --> 00:15:51,740
in the neck that need to be addressed
in a patient who has a significant
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00:15:51,740 --> 00:15:55,310
amount of aging besides just the skin.
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00:15:56,090 --> 00:15:59,120
And so deep techniques,
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00:15:59,360 --> 00:16:04,100
deep plane techniques in the neck mean
addressing things that are under the
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00:16:04,100 --> 00:16:06,860
skin and under the platysma muscle.
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00:16:08,150 --> 00:16:11,180
So in addition to taking
out subcutaneous fat,
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00:16:11,180 --> 00:16:15,890
often there is fat under
the platysma and that
246
00:16:15,890 --> 00:16:20,390
fat needs to be reduced
to create the shape in the
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00:16:20,420 --> 00:16:24,470
submental area or the area
under the chin that we want.
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00:16:24,800 --> 00:16:27,680
Some patients, if you just
take the subcutaneous fat,
249
00:16:27,710 --> 00:16:31,340
they'll still have some
bulging under the chin
250
00:16:32,480 --> 00:16:37,400
that has to be done in proper measure
because if that's over aggressively done,
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00:16:37,400 --> 00:16:42,260
you can get concavity and hollowness
under there what's called the cobrah neck
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00:16:42,260 --> 00:16:47,060
deformity, which is undesirable.
There are also muscles there,
253
00:16:47,060 --> 00:16:51,110
the anterior gastric muscles that
sometimes contribute to fullness,
254
00:16:51,500 --> 00:16:54,830
and sometimes these are
at least the anterior
255
00:16:57,080 --> 00:17:00,560
leg of that muscle is debulked.
256
00:17:02,150 --> 00:17:06,620
The submandibular gland, which
we talked about previously,
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00:17:06,620 --> 00:17:08,480
which can start to sag down,
258
00:17:08,480 --> 00:17:12,530
can either be tugged up in some
techniques or more commonly debulked.
259
00:17:14,780 --> 00:17:19,070
And there's a lot of
different kind of effort,
260
00:17:19,070 --> 00:17:23,990
more extensive effort being
expended on how the platysma muscle
261
00:17:24,260 --> 00:17:29,210
itself is handled separate
from the skin draping that
262
00:17:29,210 --> 00:17:32,780
takes place in the neck
to tailor out the laxity.
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00:17:33,320 --> 00:17:38,210
So controversial which techniques work
264
00:17:38,210 --> 00:17:41,780
best for the platysma and It's probably
different in different patients
265
00:17:41,780 --> 00:17:44,270
depending on what their
neck shape is like.
266
00:17:44,810 --> 00:17:49,800
And so examination and
customization of the for any
267
00:17:49,800 --> 00:17:54,360
patient is important
when you're chasing more
268
00:17:54,360 --> 00:17:57,630
advanced techniques as
part of an neck lift.
269
00:17:58,410 --> 00:18:01,950
Can you tell me a bit more about
the approach to procedure selection?
270
00:18:02,040 --> 00:18:04,680
What is the best option
and how should I choose?
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00:18:05,490 --> 00:18:10,350
So in terms of which procedure for skin
272
00:18:10,350 --> 00:18:13,380
lifting, as I was just explaining,
273
00:18:13,830 --> 00:18:18,600
we need to customize based on the shape
of the neck, the shape of the jawline.
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00:18:18,600 --> 00:18:22,590
Some people have a very long
jaw, a very projecting jaw,
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00:18:22,590 --> 00:18:23,940
other people do not.
276
00:18:24,390 --> 00:18:28,440
Some people have a jaw that's angulated
very much up and other people have a
277
00:18:28,440 --> 00:18:30,090
much more horizontal jaw.
278
00:18:30,090 --> 00:18:33,780
That's all going to
affect how things drape
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00:18:34,650 --> 00:18:39,300
with the skin, the fat, the
other structures in the neck,
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00:18:40,440 --> 00:18:44,460
people have different
positioning to the hyoid bone.
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00:18:44,460 --> 00:18:48,750
It's a little bone that sits again
at the cervical mental angle.
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00:18:49,110 --> 00:18:53,280
The intersection between the
horizontal and the vertical
283
00:18:53,790 --> 00:18:58,410
above the Adam's apple and
how low or high that bone
284
00:18:58,410 --> 00:19:02,850
sits is going to affect the shape
of the neck, how much fat is there,
285
00:19:02,850 --> 00:19:04,350
how much skin laxity.
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00:19:05,040 --> 00:19:09,900
So what all of that means as a bottom
line is there's no one procedure
287
00:19:09,900 --> 00:19:13,650
that's the right procedure.
And
288
00:19:14,610 --> 00:19:19,470
also different surgeons have
different approaches using
289
00:19:19,470 --> 00:19:21,120
the same basic techniques.
290
00:19:21,540 --> 00:19:26,100
So what's most useful is to work
with someone who's an experienced
291
00:19:26,100 --> 00:19:30,330
plastic surgeon, knows what
works well in their hands,
292
00:19:31,230 --> 00:19:35,850
looks closely at which
features and what layout is
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00:19:35,850 --> 00:19:37,380
present in your neck,
294
00:19:37,860 --> 00:19:42,120
listens carefully to which
features bother you the
295
00:19:42,120 --> 00:19:45,630
most and make sure that they
work that into the plan.
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00:19:46,320 --> 00:19:49,830
So that's in terms of
skin laxity and surgery.
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00:19:50,370 --> 00:19:53,460
In terms of skin quality treatments,
298
00:19:53,730 --> 00:19:57,870
there's really a big range of treatments
and there are a lot of different ways
299
00:19:57,870 --> 00:20:01,080
to push the skin quality
and get it to improve.
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00:20:01,530 --> 00:20:06,300
These treatments are going
to vary depending on how
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00:20:06,330 --> 00:20:09,990
extensive the finding
is, how severe it is.
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00:20:10,680 --> 00:20:15,450
So even if you pick the exact
same laser or the exact same PRP
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00:20:15,450 --> 00:20:15,870
treatment,
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00:20:15,870 --> 00:20:19,920
you're going to do it differently
based on what the stage of aging is,
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00:20:19,920 --> 00:20:22,980
what the skin type is,
how severe the finding is,
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00:20:22,980 --> 00:20:25,410
what other associated findings are there,
307
00:20:25,950 --> 00:20:28,530
and how many treatments
you're willing to have,
308
00:20:29,930 --> 00:20:33,210
and how much recovery time
you're willing to have.
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00:20:33,720 --> 00:20:38,040
So you pick something that's a
good intersection of all of those
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00:20:38,040 --> 00:20:42,300
factors and it should be pretty
clear from that discussion. Again,
311
00:20:42,300 --> 00:20:46,110
there's no one right answer
or one best technique,
312
00:20:46,410 --> 00:20:50,740
but it depends bothering you and
how much effort you're planning to
313
00:20:50,740 --> 00:20:54,760
expend to chase that feature
and get it corrected.
314
00:20:55,930 --> 00:20:58,810
Got it. And what are
your takeaways, Dr. Bass?
315
00:20:59,470 --> 00:21:04,300
So the neck is a really
important area to include in
316
00:21:04,330 --> 00:21:06,700
any rejuvenation plan.
317
00:21:06,700 --> 00:21:11,440
It's just as important as the face
because people see it all day every day.
318
00:21:11,440 --> 00:21:14,350
It's not an area of
the body that's hidden.
319
00:21:16,510 --> 00:21:21,220
So don't chase away aging changes
on the face and forget to treat the
320
00:21:21,220 --> 00:21:25,030
neck. That's really important as a first
321
00:21:25,030 --> 00:21:29,980
step. Recognize that it's going
to take more treatments to get
322
00:21:29,980 --> 00:21:34,630
a given amount of correction
on the neck than on the face,
323
00:21:34,630 --> 00:21:36,730
so it's more treatments.
324
00:21:37,000 --> 00:21:41,410
It's a slower and more limited
response when you treat the
325
00:21:41,410 --> 00:21:45,610
neck. because of that
difference in the skin biology,
326
00:21:46,450 --> 00:21:51,400
that means you really ought to
plan early and get a jumpstart on
327
00:21:51,400 --> 00:21:56,140
things before they're really
set in cement and difficult to
328
00:21:56,140 --> 00:21:59,710
undo. So working on skin quality early,
329
00:22:00,310 --> 00:22:05,290
certainly with sunscreen in your
twenties and starting to look at skin
330
00:22:05,290 --> 00:22:10,090
products and protection and
moisturizing in your thirties and
331
00:22:10,090 --> 00:22:14,560
maybe even some in-office
treatments is really important,
332
00:22:16,690 --> 00:22:19,840
especially skin quality things.
333
00:22:20,020 --> 00:22:24,310
The laxity comes later,
typically late forties,
334
00:22:24,610 --> 00:22:27,640
the second half of forties,
fifties, and sixties.
335
00:22:27,850 --> 00:22:32,710
But skin quality is going to
start to show problems earlier
336
00:22:32,740 --> 00:22:36,910
in most folks. Finally,
337
00:22:37,630 --> 00:22:42,100
probably the best results are obtained
with a multimodality approach that
338
00:22:42,100 --> 00:22:46,300
addresses all of the little aging
changes in at least some measure,
339
00:22:46,570 --> 00:22:50,560
and that also allows you to use
things for what they're good for,
340
00:22:50,560 --> 00:22:55,060
use things in a moderate amount
rather than trying to take one
341
00:22:55,060 --> 00:22:58,930
modality and pushing it too hard,
342
00:22:58,930 --> 00:23:03,850
which gives you diminishing returns
and potentially more risk of
343
00:23:03,850 --> 00:23:05,170
complications.
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00:23:05,860 --> 00:23:09,550
Thank you Dr. Bass for getting me up
to speed on all things neck with this
345
00:23:09,550 --> 00:23:11,620
fascinating look at a critical area.
346
00:23:12,460 --> 00:23:16,570
Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.
347
00:23:16,630 --> 00:23:19,270
Follow us on Apple
Podcasts, write a review,
348
00:23:19,270 --> 00:23:20,800
and share the show with your friends.
349
00:23:20,980 --> 00:23:24,490
Be sure to join us next time to avoid
missing all the great content that is
350
00:23:24,490 --> 00:23:28,030
coming your way. If you want to
contact us with comments or questions,
351
00:23:28,030 --> 00:23:29,260
we'd love to hear from you,
352
00:23:29,350 --> 00:23:33,250
send us an email at podcast@drbass.net or
353
00:23:33,280 --> 00:23:35,710
DM us on Instagram at @drbassnyc.
00:00:01,170 --> 00:00:03,720
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,780 --> 00:00:07,470
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,470 --> 00:00:10,260
surgery. I'm your co-host, Summer Hardy,
4
00:00:10,320 --> 00:00:13,500
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,830 --> 00:00:17,670
I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
6
00:00:17,700 --> 00:00:19,770
educator, and technology innovator.
7
00:00:20,160 --> 00:00:25,020
The title of today's episode is No
More Turkey Gobbler: All Things Neck.
8
00:00:25,770 --> 00:00:28,200
I get the idea here
from the title Dr. Bass,
9
00:00:28,260 --> 00:00:31,860
but what is the scope of the topic
and why is the neck so important?
10
00:00:32,640 --> 00:00:37,500
Well, the neck tends to show
your decade of age even more
11
00:00:37,500 --> 00:00:42,210
clearly than your face and
age a little more quickly
12
00:00:42,420 --> 00:00:43,500
than the face.
13
00:00:44,670 --> 00:00:48,870
So it's a very important area
when we talk about facial
14
00:00:48,870 --> 00:00:53,760
aging. And if you have
that hanging wattle of
15
00:00:53,760 --> 00:00:55,500
skin under the chin,
16
00:00:56,460 --> 00:01:00,450
that definitively pegs you
in a certain decade of life.
17
00:01:00,450 --> 00:01:04,260
So typically in your sixties,
maybe in your fifties,
18
00:01:04,920 --> 00:01:08,880
but everyone's going to know for
sure you're not in forties or
19
00:01:08,880 --> 00:01:13,800
thirties. And the neck is a zone under the
20
00:01:13,800 --> 00:01:14,760
jawline,
21
00:01:14,820 --> 00:01:18,870
including that area under
the chin that's horizontal,
22
00:01:18,900 --> 00:01:23,640
but also the area from
the Adam's apple down,
23
00:01:25,050 --> 00:01:29,940
that includes the Adam's apple
and the neck skin going down
24
00:01:29,940 --> 00:01:34,740
to the collarbone or clavicles
and the top of the chest.
25
00:01:34,740 --> 00:01:39,660
And it generally includes the area
where the sternocleidomastoid muscle
26
00:01:39,660 --> 00:01:44,370
is, the strong muscle on either
side of the neck that creates a
27
00:01:44,760 --> 00:01:49,380
V or demarcation line for the front of the
28
00:01:49,380 --> 00:01:51,840
neck in the back of the
neck. It's behind that,
29
00:01:51,840 --> 00:01:56,580
but most people don't see the back
parts of your neck when you're
30
00:01:56,820 --> 00:01:59,430
talking to them or when
you're walking around.
31
00:02:00,420 --> 00:02:04,620
Okay, that makes sense. And then
given the title of this episode,
32
00:02:04,620 --> 00:02:07,470
can you tell me what is a
turkey gobbler Dr. Bass?
33
00:02:08,190 --> 00:02:09,180
So as I mentioned,
34
00:02:09,180 --> 00:02:13,650
it's that hanging wattle of skin
that hangs down from underneath the
35
00:02:13,650 --> 00:02:18,150
chin to just above the Adam's apple.
36
00:02:18,630 --> 00:02:22,260
Some people have vertical banding
even when they're very young.
37
00:02:22,260 --> 00:02:25,290
That's not a turkey gobbler,
38
00:02:25,470 --> 00:02:30,270
but when you really start to
have that hanging band of skin
39
00:02:30,270 --> 00:02:31,290
and fat,
40
00:02:31,770 --> 00:02:36,150
that's not muscle tenting up and that
41
00:02:36,150 --> 00:02:39,570
represents substantial excess of skin.
42
00:02:40,050 --> 00:02:43,230
That's a turkey gobbler that
puts you in your sixties,
43
00:02:43,230 --> 00:02:45,840
maybe in your later fifties,
44
00:02:46,710 --> 00:02:50,760
except for folks who have
lost massive amounts of weight
45
00:02:52,080 --> 00:02:54,360
that defines your decade.
46
00:02:54,870 --> 00:02:59,860
And most people really
hate it and feel it makes
47
00:02:59,860 --> 00:03:02,500
them look considerably less attractive.
48
00:03:03,070 --> 00:03:07,030
It's typically associated with
a bunch of other aging changes,
49
00:03:07,030 --> 00:03:11,140
and so it's something people really
want to chase and get rid of.
50
00:03:12,040 --> 00:03:14,830
Got it. What is the treatment
for a turkey gobbler?
51
00:03:14,920 --> 00:03:16,630
Are there nonsurgical options?
52
00:03:17,320 --> 00:03:21,700
So by the time you reach the
stage where you have that
53
00:03:21,700 --> 00:03:25,000
actual hanging band of skin and fat,
54
00:03:26,110 --> 00:03:30,610
you are past the stage where there's
any meaningful treatment using
55
00:03:30,610 --> 00:03:32,290
nonsurgical methods.
56
00:03:32,680 --> 00:03:37,360
And I do a lot of research and I'm very
57
00:03:37,360 --> 00:03:41,980
interested in new technologies
and I've tried all kinds of
58
00:03:41,980 --> 00:03:46,900
technologies on these things
and I've succeeded in taking
59
00:03:47,650 --> 00:03:50,950
a component, a percentage if you will,
60
00:03:50,950 --> 00:03:52,810
of the turkey wattle out.
61
00:03:53,980 --> 00:03:58,540
But if you have that hanging
turkey gobbler and I take
62
00:03:58,540 --> 00:03:59,890
20% of it away,
63
00:03:59,890 --> 00:04:04,750
which would be a really good result and
I've succeeded in doing that in some
64
00:04:04,750 --> 00:04:07,810
folks, you still have 80% of it present.
65
00:04:07,810 --> 00:04:10,480
You still have an obvious
visible turkey gobbler.
66
00:04:10,870 --> 00:04:13,210
You're still obviously in your sixties,
67
00:04:13,210 --> 00:04:17,470
you're not in that adult indeterminate
stage that we're trying to create with
68
00:04:17,470 --> 00:04:22,180
facial rejuvenation. So in
my view, that's a failure.
69
00:04:22,540 --> 00:04:27,520
And my experience with patients has
been that they're still unhappy with
70
00:04:27,520 --> 00:04:32,350
their appearance because they were
really looking to minimize that.
71
00:04:32,350 --> 00:04:34,330
We never get rid of a hundred percent,
72
00:04:35,080 --> 00:04:40,060
but if we got rid of 80
or 90% of what's there or
73
00:04:40,060 --> 00:04:42,940
95% if we were really lucky,
74
00:04:43,540 --> 00:04:48,460
you look definitively better and
the future is mild rather than
75
00:04:48,460 --> 00:04:53,440
being obvious.
But if you only take 10, 20, 30% away,
76
00:04:53,500 --> 00:04:58,420
the future is still obviously there and
you're still obviously in that later
77
00:04:58,420 --> 00:05:00,400
stage of life.
78
00:05:01,270 --> 00:05:04,180
I didn't realize that once
you can really see it,
79
00:05:04,180 --> 00:05:06,700
surgery is one of the main options then.
80
00:05:07,210 --> 00:05:10,930
So what kinds of aging changes
are typical in the neck?
81
00:05:11,350 --> 00:05:16,330
So even though we titled
the episode about the
82
00:05:16,330 --> 00:05:20,140
turkey gobbler, we're really,
as we said in the subtitle,
83
00:05:20,140 --> 00:05:24,280
talking about all things
neck. So just like the face,
84
00:05:25,180 --> 00:05:29,890
the neck is an area anatomically
that that has a lot of
85
00:05:29,890 --> 00:05:30,790
complexity.
86
00:05:30,790 --> 00:05:35,410
There are a lot of different structures
under there in a very small amount of
87
00:05:35,410 --> 00:05:36,243
space.
88
00:05:37,000 --> 00:05:41,500
A lot of those structures are
really important things for your
89
00:05:41,800 --> 00:05:43,150
life and well being.
90
00:05:44,470 --> 00:05:49,240
So someone who works in the neck needs
to be intimately familiar with all of
91
00:05:49,240 --> 00:05:53,110
that anatomy and like
the face, unfortunately,
92
00:05:53,110 --> 00:05:57,190
there's not a single thing
that ages in the neck,
93
00:05:57,350 --> 00:06:00,380
a single anatomic structure
that needs to be addressed.
94
00:06:00,800 --> 00:06:05,000
But there are multiple components
and those components include
95
00:06:05,840 --> 00:06:07,700
skin quality things.
96
00:06:08,150 --> 00:06:12,560
So skin quality talks
about redness and vascular
97
00:06:12,560 --> 00:06:13,393
changes,
98
00:06:13,520 --> 00:06:18,080
pigmentary changes like age
spots and sort of bronzing of the
99
00:06:18,080 --> 00:06:18,913
skin,
100
00:06:19,250 --> 00:06:24,230
the turgor of the skin. Does
it look floppy and parchment
like or is it firm and
101
00:06:24,230 --> 00:06:28,790
springy like youthful skin?
And texture, wrinkles and
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00:06:28,790 --> 00:06:33,680
crepiness has that skin texture
103
00:06:34,310 --> 00:06:35,420
declines.
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00:06:35,690 --> 00:06:39,500
You show more and more aligns
wrinkles and irregularity.
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00:06:39,740 --> 00:06:44,240
So those are skin quality
issues. Then there's skin laxity,
106
00:06:44,240 --> 00:06:49,190
which starts out as a little bit of
hanginess and progresses to the point
107
00:06:49,190 --> 00:06:51,440
where you really have the turkey gobbler.
108
00:06:52,100 --> 00:06:56,900
There are muscle changes like separation
of some of the platysma muscle,
109
00:06:56,960 --> 00:07:01,670
which is really a paired muscle and
that can show some vertical banding and
110
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other kinds of lines and also
contribute to dissent and blunting
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of the cervicomental angle. The angle
between the horizontal and the vertical
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00:07:12,860 --> 00:07:16,040
glands in the neck can also show,
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00:07:16,040 --> 00:07:20,780
so glands like the submandibular
gland that sit under the jaw,
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00:07:20,810 --> 00:07:24,110
tucked up behind the jaw when we're young,
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00:07:24,380 --> 00:07:28,910
start to sag and droop down
and they can show on the
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side of the neck just under the jawline.
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And finally fat,
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which can be excessive
in the neck, building up,
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contributing to fullness,
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00:07:41,720 --> 00:07:45,740
contributing to blunting of
the demarcation between the
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00:07:45,740 --> 00:07:50,690
jawline and the neck
and fullness of the area
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under the jawline and under the chin.
So those are a
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00:07:55,580 --> 00:07:59,840
long laundry list of all of
the small things that can go
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together to create an aging
appearance in the neck.
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Wow, there are a lot of small
details that's really interesting.
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When do they show and what are
the big factors in this area?
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So of course aging is variable,
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00:08:15,050 --> 00:08:19,970
so there's no single age where a
given feature is going to show,
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but we do age based on some
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00:08:24,200 --> 00:08:28,820
controllable factors and some that
are not currently controllable.
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So sun exposure is a
big factor in skin aging
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and neck skin is really
affected by that as well
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as smoking. Those are our
two big controllable factors.
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00:08:44,150 --> 00:08:49,010
And then there's also timing of
skin aging based on your skin type
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00:08:49,010 --> 00:08:53,060
fair thin skin tends stage
more quickly than thicker,
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00:08:53,090 --> 00:08:57,540
darker skin. So those
are some of the factors.
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00:08:57,540 --> 00:09:00,420
But most people by the time
they're in their forties,
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will start to have some texture
changes in the skin of their neck,
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00:09:04,050 --> 00:09:07,440
often even in the thirties
and some fair skin,
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00:09:07,440 --> 00:09:12,420
people who get a lot of sun can
start to see these changes in their
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00:09:12,450 --> 00:09:13,380
late twenties.
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00:09:13,890 --> 00:09:18,690
There we're mostly talking
about skin laxity changes and
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00:09:18,750 --> 00:09:23,370
laxity starts to creep in
and most patients in their
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fifties accelerate in the sixties.
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00:09:26,460 --> 00:09:31,200
And for women menopause
is a watershed where
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again, skin laxity and other
skin aging changes can speed up.
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00:09:37,110 --> 00:09:39,840
Okay. So we've heard about
a few of the problems.
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What is the approach to treatment?
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Well, this depends on what is
really showing and predominates
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00:09:47,250 --> 00:09:52,170
in the appearance of the neck
and on when the patient shows
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00:09:52,170 --> 00:09:55,620
up asking for help. So some
people come very early,
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00:09:56,190 --> 00:09:58,980
they're starting to see
some skin quality changes,
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00:09:58,980 --> 00:10:03,300
some lines going side to side
across the bottom of the neck,
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00:10:03,750 --> 00:10:08,580
a little bit of sagging of skin or a
little bit of fullness or banding of
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skin. So at that point,
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00:10:11,100 --> 00:10:15,180
skin quality treatments are going
to be the focus and sometimes
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00:10:15,180 --> 00:10:19,470
liposuction or a little muscle
tightening just done through small
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00:10:19,470 --> 00:10:21,480
incisions under the chin.
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00:10:23,340 --> 00:10:26,940
As skin laxity progresses,
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we can come in with energy
based treatments for the skin,
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00:10:32,040 --> 00:10:36,990
and these are ideally for people
in their forties and some people in
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00:10:36,990 --> 00:10:41,310
their fifties who don't yet
need a surgical neck lift or a
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surgical facelift,
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00:10:44,700 --> 00:10:46,920
if they just have a little laxity,
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those energy-based treatments
can give them what they need,
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00:10:50,610 --> 00:10:52,980
which is just a little bit of tighten up.
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00:10:53,340 --> 00:10:57,840
But if there's significant laxity
or the obvious turkey gobbler,
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00:10:58,290 --> 00:11:03,150
those technologies are not going to
be able to contribute enough change to
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00:11:03,150 --> 00:11:04,950
make a meaningful difference.
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00:11:05,910 --> 00:11:10,380
I've heard that the neck is harder to
treat. Is this true? And if so, why?
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00:11:11,490 --> 00:11:16,350
The neck skin is significantly
different from our
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00:11:16,350 --> 00:11:17,220
face skin,
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00:11:17,250 --> 00:11:21,480
even though the neck skin is only
a few inches away from the face,
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00:11:22,530 --> 00:11:26,640
blood supply is different, the
thickness of the skin is different.
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And most importantly,
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00:11:29,010 --> 00:11:31,950
there are things called
adnexal structures in the skin.
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So these are sweat glands,
oil glands, hair follicles,
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things that are in the
skin that are not skin
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material, skin fabric themselves.
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00:11:42,120 --> 00:11:46,770
And that's a source of
healing and regeneration in
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00:11:46,770 --> 00:11:50,430
part for skin when it's wounded.
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00:11:51,360 --> 00:11:55,600
And just in terms of its
regeneration and turnover,
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00:11:57,010 --> 00:12:01,810
skin turnover declines as we age and
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00:12:01,810 --> 00:12:06,310
our neck skin has a thousand fold fewer
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00:12:07,510 --> 00:12:09,850
adnexal structures than our face skin.
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00:12:10,420 --> 00:12:14,890
So that skin is going to
show aging changes first.
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00:12:15,310 --> 00:12:19,930
And it also tells us why it's going
to be harder to treat because its
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00:12:19,930 --> 00:12:24,580
ability to heal and
regenerate is significantly
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00:12:24,580 --> 00:12:26,290
less than that of face skin.
190
00:12:26,920 --> 00:12:31,000
That's really interesting. Here's
something I've always wondered about,
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00:12:31,000 --> 00:12:34,120
what is the difference between
a facelift and a neck lift?
192
00:12:35,260 --> 00:12:39,280
So that difference means
a lot more to patients
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00:12:39,340 --> 00:12:43,720
semantically than it
does to plastic surgeons.
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00:12:44,530 --> 00:12:49,060
There are some procedures
that focus on addressing
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00:12:49,060 --> 00:12:53,890
lax skin in the neck or addressing
deeper structures in the neck.
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00:12:54,340 --> 00:12:59,080
And these are sometimes done in early
stage of aging where we make an incision
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00:12:59,080 --> 00:13:03,640
just in front of the ear
or just behind the ear
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00:13:04,150 --> 00:13:09,010
to lift the skin just in the neck in a
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00:13:09,010 --> 00:13:10,600
more focused fashion.
200
00:13:11,440 --> 00:13:15,820
But most of the time we're
making a more extensive
201
00:13:15,820 --> 00:13:20,680
incision that's both in front of
and behind the ear and back into the
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00:13:20,680 --> 00:13:22,480
posterior hairline.
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00:13:23,350 --> 00:13:27,730
And we're generally resetting in harmony,
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00:13:27,820 --> 00:13:32,440
a lot of the tissues in
the face and neck because a
205
00:13:32,440 --> 00:13:37,300
key element of what both
a facelift or a neck
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00:13:37,300 --> 00:13:42,130
lift are aiming to correct
is hanging skin in the
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00:13:42,130 --> 00:13:45,670
neck and a sharpening of the jawline.
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00:13:45,670 --> 00:13:49,600
And the jawline is that demarcation
between the face and the neck.
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00:13:50,320 --> 00:13:52,870
So in either a facelift or a neck lift,
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00:13:53,260 --> 00:13:55,990
that has to be made as sharp,
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00:13:55,990 --> 00:13:59,320
defined and youthful
as it possibly can be.
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00:13:59,950 --> 00:14:04,120
And that means that all the adjacent
structures both above and below are going
213
00:14:04,120 --> 00:14:08,920
to require a little bit of
tinkering so that everything
214
00:14:08,920 --> 00:14:10,630
remains in harmony.
215
00:14:11,440 --> 00:14:15,610
So there are just facelifts
and just neck lifts,
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00:14:16,000 --> 00:14:20,680
but most techniques are going to
involve at least some work in all or
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00:14:20,680 --> 00:14:22,570
both of those areas.
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00:14:23,020 --> 00:14:27,430
And that doesn't really
modulate the recovery,
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00:14:27,790 --> 00:14:32,590
which is part of the reason why some
people are focused on getting just a neck
220
00:14:32,590 --> 00:14:37,360
lift or just a facelift because they don't
want to mess with more than they have
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00:14:37,360 --> 00:14:38,193
to.
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00:14:38,350 --> 00:14:43,300
And you get more or less the same recovery
223
00:14:43,360 --> 00:14:48,070
if you have a proper
neck lift or facelift.
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00:14:48,070 --> 00:14:52,430
Just the area where that bruising
or swelling may occur is slightly
225
00:14:52,430 --> 00:14:53,390
larger,
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00:14:53,900 --> 00:14:57,530
but it doesn't necessarily
last any longer.
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00:14:58,670 --> 00:15:02,480
If you're adding a bunch of other
procedures, it may last a little longer,
228
00:15:03,620 --> 00:15:07,520
but not between the
facelift and the neck lift.
229
00:15:07,940 --> 00:15:11,390
Okay, that makes a lot of
sense. Thanks for explaining.
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00:15:11,870 --> 00:15:16,730
So then more recently, I've heard the
term deep plane neck lift mentioned.
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00:15:16,790 --> 00:15:20,120
What does this mean and how is it
different from traditional neck lifts?
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00:15:20,810 --> 00:15:23,630
So deep plane techniques,
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00:15:23,750 --> 00:15:27,200
which is really a better way
of putting it than neck lift,
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00:15:27,680 --> 00:15:32,450
is sort of a marketing term that
a lot of people who are promoting
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00:15:32,450 --> 00:15:34,670
deep plane facelift are using,
236
00:15:35,120 --> 00:15:39,920
but it does have some
significant medical meaning to
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00:15:39,920 --> 00:15:41,870
most of us in plastic surgery.
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00:15:41,870 --> 00:15:46,850
And the important thing here is
that there are a bunch of structures
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00:15:46,850 --> 00:15:51,740
in the neck that need to be addressed
in a patient who has a significant
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00:15:51,740 --> 00:15:55,310
amount of aging besides just the skin.
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00:15:56,090 --> 00:15:59,120
And so deep techniques,
242
00:15:59,360 --> 00:16:04,100
deep plane techniques in the neck mean
addressing things that are under the
243
00:16:04,100 --> 00:16:06,860
skin and under the platysma muscle.
244
00:16:08,150 --> 00:16:11,180
So in addition to taking
out subcutaneous fat,
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00:16:11,180 --> 00:16:15,890
often there is fat under
the platysma and that
246
00:16:15,890 --> 00:16:20,390
fat needs to be reduced
to create the shape in the
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00:16:20,420 --> 00:16:24,470
submental area or the area
under the chin that we want.
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00:16:24,800 --> 00:16:27,680
Some patients, if you just
take the subcutaneous fat,
249
00:16:27,710 --> 00:16:31,340
they'll still have some
bulging under the chin
250
00:16:32,480 --> 00:16:37,400
that has to be done in proper measure
because if that's over aggressively done,
251
00:16:37,400 --> 00:16:42,260
you can get concavity and hollowness
under there what's called the cobrah neck
252
00:16:42,260 --> 00:16:47,060
deformity, which is undesirable.
There are also muscles there,
253
00:16:47,060 --> 00:16:51,110
the anterior gastric muscles that
sometimes contribute to fullness,
254
00:16:51,500 --> 00:16:54,830
and sometimes these are
at least the anterior
255
00:16:57,080 --> 00:17:00,560
leg of that muscle is debulked.
256
00:17:02,150 --> 00:17:06,620
The submandibular gland, which
we talked about previously,
257
00:17:06,620 --> 00:17:08,480
which can start to sag down,
258
00:17:08,480 --> 00:17:12,530
can either be tugged up in some
techniques or more commonly debulked.
259
00:17:14,780 --> 00:17:19,070
And there's a lot of
different kind of effort,
260
00:17:19,070 --> 00:17:23,990
more extensive effort being
expended on how the platysma muscle
261
00:17:24,260 --> 00:17:29,210
itself is handled separate
from the skin draping that
262
00:17:29,210 --> 00:17:32,780
takes place in the neck
to tailor out the laxity.
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00:17:33,320 --> 00:17:38,210
So controversial which techniques work
264
00:17:38,210 --> 00:17:41,780
best for the platysma and It's probably
different in different patients
265
00:17:41,780 --> 00:17:44,270
depending on what their
neck shape is like.
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00:17:44,810 --> 00:17:49,800
And so examination and
customization of the for any
267
00:17:49,800 --> 00:17:54,360
patient is important
when you're chasing more
268
00:17:54,360 --> 00:17:57,630
advanced techniques as
part of an neck lift.
269
00:17:58,410 --> 00:18:01,950
Can you tell me a bit more about
the approach to procedure selection?
270
00:18:02,040 --> 00:18:04,680
What is the best option
and how should I choose?
271
00:18:05,490 --> 00:18:10,350
So in terms of which procedure for skin
272
00:18:10,350 --> 00:18:13,380
lifting, as I was just explaining,
273
00:18:13,830 --> 00:18:18,600
we need to customize based on the shape
of the neck, the shape of the jawline.
274
00:18:18,600 --> 00:18:22,590
Some people have a very long
jaw, a very projecting jaw,
275
00:18:22,590 --> 00:18:23,940
other people do not.
276
00:18:24,390 --> 00:18:28,440
Some people have a jaw that's angulated
very much up and other people have a
277
00:18:28,440 --> 00:18:30,090
much more horizontal jaw.
278
00:18:30,090 --> 00:18:33,780
That's all going to
affect how things drape
279
00:18:34,650 --> 00:18:39,300
with the skin, the fat, the
other structures in the neck,
280
00:18:40,440 --> 00:18:44,460
people have different
positioning to the hyoid bone.
281
00:18:44,460 --> 00:18:48,750
It's a little bone that sits again
at the cervical mental angle.
282
00:18:49,110 --> 00:18:53,280
The intersection between the
horizontal and the vertical
283
00:18:53,790 --> 00:18:58,410
above the Adam's apple and
how low or high that bone
284
00:18:58,410 --> 00:19:02,850
sits is going to affect the shape
of the neck, how much fat is there,
285
00:19:02,850 --> 00:19:04,350
how much skin laxity.
286
00:19:05,040 --> 00:19:09,900
So what all of that means as a bottom
line is there's no one procedure
287
00:19:09,900 --> 00:19:13,650
that's the right procedure.
And
288
00:19:14,610 --> 00:19:19,470
also different surgeons have
different approaches using
289
00:19:19,470 --> 00:19:21,120
the same basic techniques.
290
00:19:21,540 --> 00:19:26,100
So what's most useful is to work
with someone who's an experienced
291
00:19:26,100 --> 00:19:30,330
plastic surgeon, knows what
works well in their hands,
292
00:19:31,230 --> 00:19:35,850
looks closely at which
features and what layout is
293
00:19:35,850 --> 00:19:37,380
present in your neck,
294
00:19:37,860 --> 00:19:42,120
listens carefully to which
features bother you the
295
00:19:42,120 --> 00:19:45,630
most and make sure that they
work that into the plan.
296
00:19:46,320 --> 00:19:49,830
So that's in terms of
skin laxity and surgery.
297
00:19:50,370 --> 00:19:53,460
In terms of skin quality treatments,
298
00:19:53,730 --> 00:19:57,870
there's really a big range of treatments
and there are a lot of different ways
299
00:19:57,870 --> 00:20:01,080
to push the skin quality
and get it to improve.
300
00:20:01,530 --> 00:20:06,300
These treatments are going
to vary depending on how
301
00:20:06,330 --> 00:20:09,990
extensive the finding
is, how severe it is.
302
00:20:10,680 --> 00:20:15,450
So even if you pick the exact
same laser or the exact same PRP
303
00:20:15,450 --> 00:20:15,870
treatment,
304
00:20:15,870 --> 00:20:19,920
you're going to do it differently
based on what the stage of aging is,
305
00:20:19,920 --> 00:20:22,980
what the skin type is,
how severe the finding is,
306
00:20:22,980 --> 00:20:25,410
what other associated findings are there,
307
00:20:25,950 --> 00:20:28,530
and how many treatments
you're willing to have,
308
00:20:29,930 --> 00:20:33,210
and how much recovery time
you're willing to have.
309
00:20:33,720 --> 00:20:38,040
So you pick something that's a
good intersection of all of those
310
00:20:38,040 --> 00:20:42,300
factors and it should be pretty
clear from that discussion. Again,
311
00:20:42,300 --> 00:20:46,110
there's no one right answer
or one best technique,
312
00:20:46,410 --> 00:20:50,740
but it depends bothering you and
how much effort you're planning to
313
00:20:50,740 --> 00:20:54,760
expend to chase that feature
and get it corrected.
314
00:20:55,930 --> 00:20:58,810
Got it. And what are
your takeaways, Dr. Bass?
315
00:20:59,470 --> 00:21:04,300
So the neck is a really
important area to include in
316
00:21:04,330 --> 00:21:06,700
any rejuvenation plan.
317
00:21:06,700 --> 00:21:11,440
It's just as important as the face
because people see it all day every day.
318
00:21:11,440 --> 00:21:14,350
It's not an area of
the body that's hidden.
319
00:21:16,510 --> 00:21:21,220
So don't chase away aging changes
on the face and forget to treat the
320
00:21:21,220 --> 00:21:25,030
neck. That's really important as a first
321
00:21:25,030 --> 00:21:29,980
step. Recognize that it's going
to take more treatments to get
322
00:21:29,980 --> 00:21:34,630
a given amount of correction
on the neck than on the face,
323
00:21:34,630 --> 00:21:36,730
so it's more treatments.
324
00:21:37,000 --> 00:21:41,410
It's a slower and more limited
response when you treat the
325
00:21:41,410 --> 00:21:45,610
neck. because of that
difference in the skin biology,
326
00:21:46,450 --> 00:21:51,400
that means you really ought to
plan early and get a jumpstart on
327
00:21:51,400 --> 00:21:56,140
things before they're really
set in cement and difficult to
328
00:21:56,140 --> 00:21:59,710
undo. So working on skin quality early,
329
00:22:00,310 --> 00:22:05,290
certainly with sunscreen in your
twenties and starting to look at skin
330
00:22:05,290 --> 00:22:10,090
products and protection and
moisturizing in your thirties and
331
00:22:10,090 --> 00:22:14,560
maybe even some in-office
treatments is really important,
332
00:22:16,690 --> 00:22:19,840
especially skin quality things.
333
00:22:20,020 --> 00:22:24,310
The laxity comes later,
typically late forties,
334
00:22:24,610 --> 00:22:27,640
the second half of forties,
fifties, and sixties.
335
00:22:27,850 --> 00:22:32,710
But skin quality is going to
start to show problems earlier
336
00:22:32,740 --> 00:22:36,910
in most folks. Finally,
337
00:22:37,630 --> 00:22:42,100
probably the best results are obtained
with a multimodality approach that
338
00:22:42,100 --> 00:22:46,300
addresses all of the little aging
changes in at least some measure,
339
00:22:46,570 --> 00:22:50,560
and that also allows you to use
things for what they're good for,
340
00:22:50,560 --> 00:22:55,060
use things in a moderate amount
rather than trying to take one
341
00:22:55,060 --> 00:22:58,930
modality and pushing it too hard,
342
00:22:58,930 --> 00:23:03,850
which gives you diminishing returns
and potentially more risk of
343
00:23:03,850 --> 00:23:05,170
complications.
344
00:23:05,860 --> 00:23:09,550
Thank you Dr. Bass for getting me up
to speed on all things neck with this
345
00:23:09,550 --> 00:23:11,620
fascinating look at a critical area.
346
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Thank you for listening to the Park
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