Aaah! The Aging Neck
Among our patients’ greatest concerns is that of looking older than we feel. We all want to look our best because it gives us the confidence to express our personality and thoughts without feeling self conscious of our appearance.
Several technologies have come along over the years to help with the neck and face falling problem. There is always a surgical neck or face lift, which may be absolutely essential for patients who have waited a bit too long to take preventive measures and where the skin laxity is too great to correct nonsurgically. However, for the vast majority of patients, we can accomplish neck tightening without the worry of a long scar along the hairline or ear and without extended recovery times and most importantly, without the danger and fear of looking “overdone”. Even if a prior facelift has been done, maintaining with these less invasive approaches is important to save one’s investment.
Among the two best approaches are Ultherapy and ThermiRF.
ThermiRF is the latest kid on the block. It uses monopolar radiofrequency energy that is delivered via a thin probe to the SMAS (Superficial Muscular Aponeurotic System). This is the tissue under the skin which covers and binds all the facial muscles. During a surgical facelift, the SMAS is sutured in a manner to effectively shrink it and hence tighten the muscles. With ThermiRF, the SMAS is shrunk using RF heat (essentially think of it as controlled electrocautery). The procedure is extremely safe with temperature readings coming from the tissue, the probe and through an external heat sensing camera, which helps achieve both therapeutic and safe target temperatures for controlled shrinkage of tissue. Excess fat tissue can also be targeted and destroyed, such as under the chin, at the same time. Finally, the heat radiates to the skin itself and stimulates the production of new collagen and elastin fibers. ThermiRF is performed entirely under local numbing. The patient is awake and may drive home on their own post procedure. There is no discomfort during the procedure. A compressive chin strap garment is all that is required for 48 hours. No sutures are placed as the three tiny puncture access points close up within 24-48 hours.
Ultherapy is also a highly effective procedure and can be used to treat not only the neck and jowls as ThermiRF can, but also the cheeks, chest and eye areas. As both a surgical facelift and ThermiRF affect the SMAS, so does Ultherapy! We can easily see that in order to be effective, the procedure must affect the SMAS. The difference is that Ultherapy is applied directly through the skin using HIFU (High Intensity Focused Ultrasound). The tissue is directly visualized via ultrasound so we know exactly where the energy is being delivered. There is some discomfort as the ultrasound waves travel through the skin to the underlying SMAS target tissue but is well tolerated and well worth it in the end. There is no real recovery time, outside of mild redness and swelling. One can resume social obligations and public appearances immediately. Ultherapy also targets the dermis to stimulate collagen production with a second pass that is highly recommended. The lips and delicate skin under the eyes are also very responsive to this technology.
It takes about 4-6 months to see results. The same is true with ThermiRF. A procedure called SmartLift uses the SmartLipo probe to deliver heat under the skin and could potentially mimic ThermiRF. The difference is in the control and constant feedback of the heat delivered to get effective yet safe treatment. We are not using SmartLift/SmartLipo as much in our practice now due to having the more advanced ThermiRF.
