Why Fat in Your Neck Is Actually a Good Thing (Ep. 98)

Dr. Jason Hall:

0:36

Are you tired of wasting money on skincare products and treatments that don't work? Or are you afraid of looking unnatural after having some non surgical treatments done? If you are then my new book, The Art Of Aging, is for you. In The Art Of Aging, I break down the aging process and talk about treatments that target specific parts of the aging process, what works and what doesn't. Also, I lay out a biology based skin care and non surgical treatment plan that will keep you looking great without looking fake. Check out your copy of The Art Of Aging on Amazon or in any of your local booksellers. Contrary to what you might think, fat in your neck is good for you and looks good in this episode of The Trillium show, we're going to talk about why I'm your host, board certified plastic surgeon, author of the new book Art Of Aging. Welcome to The Trillium Show. We help you improve your mind, your body and your life. Please check out a copy of the book Art Of Aging at Amazon. We'll put a link in the show notes for you to check it out. Kind of go through and break down. You know what works and what doesn't in the esthetic industry, because there's a bunch of garbage out there. It's easy to get tricked. One of my favorite topics is facial rejuvenation surgery, specifically neck fat necks have become a huge thing with the Zoom boom after covid, people spend a lot of time on FaceTime, a lot of time on Zooms, looking down. It's probably one of the most unflattering ways we can look at ourselves, is staring down at a computer screen and the demand for and the questions about contouring of the neck have gone way up in the last five years. There's a lot of stuff out there to treat neck contouring and neck fat, non surgically things like KYBELLA, CoolSculpting, threads, energy devices and kind of very gently tell you that while they may work, they cause long term problems, which, if you are interested in surgery, you are going going to want to avoid, even if you're not interested in surgery now, you are going to want to avoid because it makes surgery a lot more difficult later. This is something that we see a lot of, and we're seeing more of as these trends and these treatments become more and more popular, specifically in med spas and non surgical offices. Before we get into each one of those different treatments and what they do, it's very important to for you guys to understand that we have had a kind of a shift in our understanding of facial aging the last 10 or 15 years, in that we understand and appreciate the value of fat In the face to preserve elegant, pretty, soft contours. And so gone are the days of just removing as much fat as we can and pulling things as tight as we can, because we see long term that doesn't look good. It doesn't age well. And so a lot of our surgical rejuvenation now is focused on restoring and preserving fat, not trying to eliminate it. The problem with a lot of the non surgical treatments that I talked about a few minutes ago is that most of those are uncontrolled ways to destroy fat where we don't want it, specifically in the neck. And any of my surgical colleagues that do any volume of facial surgery have operated on multiple patients who have had these treatments, and they're much more difficult. And so we'll talk here about why that is complications also difficulty and complications kind of go hand in hand. And so we'll talk about why that is, and the reasons to avoid a lot of these treatments if you're thinking about having surgery in the future, one of the most popular ones, and we have talked about what I don't like about CoolSculpting in the past is CoolSculpting. And what CoolSculpting is, is essentially freezing fat. You know, if you've ever had it done, you've ever seen the videos online of people who are having it done, they put a pad on whatever body part that they're treating they cool it down to just above freezing, and it causes the cells, the fat cells there, to die. The problem with it is that there's something called paroxysmal adipose hyperplasia, which, in nerdy doctor speak, means we don't know why, but the fat that's there gets bigger instead of smaller. And this is a, this can be a. Problem with CoolSculpting you've seen that you know before. If you don't google it, you can see what that looks like, but it's the last thing you want, if you're trying to treat double chin, is to have it come back twice the size. When it works, and it works in most people, PAH doesn't happen often, but when it works. What it does is destroys the fat cells, not only the fat cells underneath the skin, but in between that skin and the platysma muscle layer, which is kind of what gives your neck its underlying shape. And so going in and trying to operate there the natural surgical planes when we separate, kind of lift the skin flap up, you know, we want to leave a nice layer of fat on that skin so it stays healthy. That tissue plane gets obliterated, and it makes it very difficult to elevate a nice, uniform skin flap. That fat also gets hard and kind of lumpy, and so the chances of having contour irregularities afterwards are much higher. It also, kind of, like most of these treatments, causes scarring in the layer over the platysma muscle. And you think, Well, you know, scarring on that layer, if it's kind of saggy, some scarring may tighten it up. It kind of does, but then it makes trying to surgically tighten that layer much more difficult. And so CoolSculpting can can be, can pose a real problem for surgery down the road. Now, it's not nearly as damaging is the second one we're going to talk about, which is KYBELLA. KYLBELLA has been around for 10 years or so, and is a bile salt. So it is essentially think about somebody sticking a needle into your gallbladder, draining some of that stuff out, and then injecting it under your chin. That's kind of what that stuff is. And what that does is dissolves fat where we inject it again. The problem, kind of like CoolSculpting, is that it is completely uncontrolled. When that stuff gets injected, we don't have a lot of control over where that goes, which is why they do tons of little needle pricks. Have you ever seen it done, or had it done? They do tons of little needle pricks to try and distribute that medicine where they want it. This can have a number of issues. One, it can injure the nerves that live in this area that kind of let your muscle, your muscles of your lower face, move, so you can have people with temporary nerve paralysis from KYBELLA injections. More importantly is that the amount of fat that gets dissolved is variable, so you can have areas where that fat gets in completely dissolved, and it gives you significant kind of contour deformities in your neck and chin. If too much gets dissolved, we end up with a situation that's kind of unique to this one, is where all of the fat is gone and you have just a very, very thin layer of kind of papery skin that's stuck to the muscle underneath, and that is makes for a not a good appearance, but it also makes it really, really difficult to get a good result after, you know, a neck that's been essentially hollowed out of all the fat that's there with modern, deep, plane neck lift surgery, which is what I do, and what you know a lot of facial surgeons are doing. Now we're doing a lot of work under that platysma muscle, but we're relying on that muscle to be able to stretch and kind of create those new contours. If the skin is plastered down to that muscle, and that muscle is scarred from from repeated injections. It makes that muscle stiff and hard to work with, and it also makes it difficult to get under that muscle to help shape everything underneath and give a nice neck and jaw line contour. It also makes it much more risky to lift the skin up to help redrape it because that the vasculature or the blood supply to that skin gets damaged. And so you know, skin loss under the chin after neck lift surgery, the chances of that go up, and that's not something obviously that we want to have happen. The third treatment that is really kind of taken off in popularity in the last couple of years are radio frequency treatments. These are things like, face tight. These are things like, to a much lesser degree, Morpheus. Um cold therapy, which is, which is focused ultrasound and things like that, which use energy to essentially boil that fat, destroy it and and let your body kind of resorb it. So, you know, take up whatever's destroyed, and you get rid of it. And the problem with those kind of like with KYBELLA, is that while it is a little bit more controlled than an injection, is because the whoever's doing that procedure is actually watching that happen is that it causes a lot of scarring, again, on top of that platysma muscle, and that energy can actually transmit that scarring through the muscle, down into the deeper layers of what we call fascia or connective tissue, which really makes that deep neck work, that deep neck contouring, so glands and other muscles underneath, fat underneath in the center, can make it really difficult to get to those areas, to contour and shape those areas nicely and then put things back together, where we where we want them. More than KYBELLA, the blood supply to the skin, can get compromised with those treatments, and can make wound healing problems much more common. And so it's it is really something to keep in mind if you want to undergo one of these non surgical energy based treatments, to understand that you're really putting yourself at a disadvantage if you want to have deep neck surgery, a deep plane, face and neck lift later. That's not to say that we can't do it, and we'll talk about different things here in a minute, but you got to understand going into it that it does make the surgery more difficult, more risky and more prone to complications. And lastly, kind of mention the this concept of like a neck lift with threading. I can, I kind of dismiss this one, just because it doesn't work real well. It's been around for a long time with permanent sutures, with sutures that dissolve, which is kind of what most people are using. Now, there are some devices out there that people market to try and do this. The results just aren't that great with permanent sutures. You see, do see problems with some scarring in the platysma muscle underneath the skin, usually they're combined with energy based treatments like face tight to try and contract the skin around the new shapes that they make. And the problems really come from the energy more than the threads. I tell people typically stay away from threads, just because they don't work very well with all this. One question that you may be asking is, well, what about just traditional, just plain old liposuction? What does that do? While it does cause some a little bit of scarring in the in the surgical planes of the neck, it is much more controlled and really, much more gentle on the tissue than any of these, any of the energy based devices, any, any of these things that are causing the cells of the fat cells in your neck to die in your body, to kind of chew those up and replace them with collagen. And so, you know, most of us have have operated on a number of patients who have had liposuction under their chin for double chin. And while the dissection kind of freeing up those tissue planes is a little bit more difficult, it really isn't nearly as bad as one of these energy devices in terms of scarring and things like that, especially if the person who's done it has been careful and conscientious and left a nice layer of fat to cushion that skin and give it nice, soft contours and keep it from getting crepey and kind of hollowed out. You know, the biggest thing with neck liposuction is you don't want to overdo it, kind of like anything else, if you're considering one of these non surgical treatments. So KYBELLA, CoolSculpting, some face tight energy device or threads, it's important to just understand that these will largely negatively impact your surgeon's ability to get a nice result with a low complication profile. Down the road, should you ever decide to have surgery? And it may be worth talking to someone who does a significant amount of facial surgery if you're considering one of these, to kind of talk through your options, see if the risk is worth the benefit, and come up with the right decision for you and. Where you are right now. So if you have any questions, always feel free shoot me an email info@drjasonhall.com. Shoot me a DM @drjasonhall, hope you've enjoyed this and we'll see you on the next show you.