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Dr. DeBusk (00:11):
Welcome back to Behind the Double Doors. I'm Dr. Taylor DeBusk. And today we're going to talk about surgical procedures in patients in a younger demographic, kind of the 30s, 40s. Traditionally, patients specifically talking about facial rejuvenation or just surgery of the face, patients traditionally thought you weren't a surgical candidate until you're 60, 70 or beyond. You had to wait until you had severe age related changes in the neck or along the jaw or the brow, the eyes before it was time for you to address those surgically. But what we're seeing now more and more is younger and younger patients managing or addressing those age related changes earlier, as opposed to waiting until they're so severe that you can't button your collar or you have all this excess lax skin under the chin. One of the things too is the genetic kind of fuller neck where it makes you look like you have a small chin or not much jaw definition.
(01:11):
That's something that again, is not age related. It is just genetics. So we're seeing a lot of patients, younger patients coming in for what's called a deep plane neck lift. And I've done several patients in their 20s, 30s. And it's not that they've got age related changes because you're at that point too young to have any sort of those kind of characteristic jowling or turkey neck. But by sculpting some of that deeper tissue under the jaw and in the neck, you can really accentuate or even create a jawline that is very attractive, very natural, doesn't change who you are. Recently I just did a 29 year old, very attractive young person, but she just didn't like the fullness that she had in her neck. And talking with her and then talking even with the patient's mom, it's just a genetic thing. The patient's father had a heavy neck that didn't age well.
(02:06):
So the patient wanted to address these things before they became an issue. So what a deep neck lift is, typically it's small incision under the chin and then incisions behind the ear, so no visible incisions. And what we do is we go underneath that muscle and we reduce the fat that's creating some of that fullness under the chin. And oftentimes in these patients, they have low submandibular glands or spit glands in the neck. And that can create a lot of fullness and really blunts the sharpness of the jawline that's concerning for most of these patients. So by doing just conservative gland reduction, conservative fat removal, and then tightening and repositioning that muscle, you can create a much, obviously youthful, but much more attractive jawline without changing the patient's identity, not making you look any different. And the truth is, we're not, you don't remove skin, it's not a facelift.
(03:02):
All it is is deep neck contouring. A lot of patients that want to do this have really exhausted a lot of the non-surgical kind of injectable treatments. Kybella are the different injections that reduce the amount of fat under the chin because they think that that fullness is due to fat under the skin or subcutaneous fat. When in reality, the vast majority of the time, the issue is the deep fat and fat under the muscle, the glands under the muscle that creates that fullness. And they're very much, pretty much ubiquitously underwhelmed with the non-surgical treatments. I mean, necklifts are great for, and it's men, women. Again, all you're doing is really getting rid of that stubborn fat that's deep in the neck. Because you see a lot of patients that are super active, very fit, very healthy, great diets, but regardless of what their weight is, they always have this fullness under the chin that they just cannot get rid of.
(04:02):
And it's a different type of fat. And it's a fat that you can't take out with liposuction. It's something that you have to directly remove. But again, these procedures are great for men and women, especially men who want much more jaw definition, a very masculine jaw, but they have that fuller neck, or maybe they even have kind of a small chin. Combining that neck lift with a chin implant will really help to give them a much more defined jaw, masculine jaw, if that's what they're interested in. The recovery is much easier than something like a facelift. That first week, two weeks, you take it easy, little bit of downtime, but at the two week mark, your incisions are not visible. Swelling's pretty much gone. Typically, these patients are younger, healthier, they bounce back a lot quicker, but I think it's a great, great procedure. I mean, everybody saw this after COVID where all of a sudden we're all on Zoom, FaceTime, whatever it is, and there's a dramatic spike in facial procedures because we are looking at ourself at the worst angle every single day, especially FaceTime, we always create the double chin, you're always looking down.
(05:12):
So that was a big one. And then that combined with social media. So you're seeing more of these procedures on social media and you're seeing how natural they look. In the right hands, somebody experienced with these things, you get very natural results that isn't that facelift look, that's kind of very stereotypical or pathomonic with those old historic skin tightening procedures that didn't really address those deeper structures. Whereas now, I think patients have the luxury of seeing all of these before and after photos that are very natural. And I think it's demystifying the facelift. That's why we're seeing it much more common. People are much more open about it, specifically movie actresses, actors, people in the media. It's not as taboo as it used to be. And that's another reason why we're seeing younger and younger facelifts. So people in their 40s, early 40s starting to get the early jowling or a little bit of early laxity under the chin, they have a much lower threshold to intervene now because they've seen that people are underwhelmed sometimes with certain types of injectables or non-surgical
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treatment and they want to bypass that, address these things down.
(06:26):
And one of the things I tell all patients is it's better to do it younger for many reasons. Two of the main ones is one, your tissue's better. You're younger, tissue muscles thicker, better pull. It will last longer if you do it younger. And another is if you have minimal changes or early jowling, early submental early laxity under the chin, it's a lot easier to give you that snatched younger jawline if the age-related changes aren't as severe. Now, if you wait until you're 70 and all of a sudden that skin under the chin is touching your collarbones, well, it's a lot harder and almost impossible to give you that razor sharp or chisel jawline when you have that severe of age related changes. So I think for those reasons, we're seeing people that are much more comfortable doing these procedures younger and younger because the results last and the results are very natural.
(07:22):
None of my patients look like a different person. All they do, they just look refreshed and that's the goal. For me, and that's all my patient's goals, you don't want to change who you are, you just want to turn back the clock. So specifically when we're looking in the neck, if you're starting to see the banding or that loose skin, the turkey neck, to be honest, there's no real non-surgical option that's going to give you the result you're looking for. Now people will market it as a non-surgical facelift and market results that may or may not be truthful, and they're really setting your expectations very high. And these aren't benign procedures. Some of these things do, skin tightening, they heat up the deeper layers of skin. And there are roles for those. I'm not saying they're bad, but in patients with the jowls and with the laxity under the neck, or if you start to develop those deep tear troughs that filler just isn't cutting it, those things I've found that patients are very underwhelmed and discouraged by those non-surgical treatments.
(08:26):
And honestly, I've found that sometimes it really does impair the quality of skin when you do decide to do the facelift. Sometimes that skin doesn't snap back, that elasticity isn't there that it may or may not have been there if you hadn't done those radiofrequency or those other non-invasive treatments. It's hard as a patient because there's so many things out there and everything is supposedly is this new miracle technology. And I don't think it's all bad. I mean, I definitely use it and I think there's specific or right situations where it's ideal. But that being said, laser treatment is something that, I mean, I love, advocate for, I think it's a great treatment for specific things. But facelifts, when we talk about facelifts or face rejuvenation surgery, now these things are more skin quantity issues. Now removing excess skin, repositioning volume, reducing excess volume. We're not necessarily addressing much with the skin with a facelift or
surgical procedures.
(09:25):
Yes, you're removing some and the quality of skin does look better, but in order to maximize the skin itself, you need to address it independent of the facelift. And that's where the lasers come in. Now, lasers can dramatically improve the texture and the visibility of your skin, the thickness of your skin, but it's not going to address that laxity in the neck. It's not going to improve significant or moderate jowling. So as long as patients are aware, because I love laser treatments, I think they're great, but they're not for all the age related changes that we see in the face and neck. But what I do tell all patients is that you need to have, starting in your mid 20s, to be honest, because that's when we start to lose collagen, but definitely in your 30s is when you need to start a daily skin routine. Now that's daunting in itself because everybody is overwhelmed with all the ... You go down the cosmetic aisle and there's thousands and thousands of different bottles, different treatments, whatever. Now, the four that everybody must be on is a retinoid at night because it helps to increase collagen density in the dermis or deep part of the skin. During the day, just a gentle facial cleanser, a vitamin C topical serum, and then your SPF moisturizer, and that's the bare bones.
(10:42):
And I tell people, start in your late 20s, but definitely start when you're in your 30s, and this helps to maintain the thickness of your skin. Then when we start talking about treatments, microneedling, laser treatments, whether they're ablative or non-ablative, injectable treatments, I think that the microneedling things that help to stimulate the collagen in your skin, starting in your 30s, even your late 20s, I think is ideal. Aggressive lasers, I don't think you necessarily need to do that until you're in mid 30s or so when we see a big dip in the collagen density in your skin. But invasive things, specifically young women who want things like lip lifts or where they're excising, removing skin on their face and doing more invasive things, I just say you have to be careful. It's not a no across the board based off your age, because this is really just based off your facial anatomy, but trying to do too much too early, mid-face lifts in your 20s and things like that, that try to address age-related changes when you haven't really had time to age as opposed to neck lifts in your 20s, that is a genetic issue.
(11:51):
That's not age-related changes in the neck. So like a neck lift is going to be more of a beautification surgery, whereas a face neck lift is a facial rejuvenation procedure. Another big one is honestly the lower eyes, because some people just get that tear trough or the fat visibility of the lower eyes younger, and that's just genetics. You inherited that. So one thing I love doing, because I mean, I've done these on patients in their 20s, is the lower blepharoplasty. And blepharoplasty can be done several different ways. The way I like to do it is it's not excising or removing skin. The incisions are hidden behind the eyelid. And what we do is we take that fat in the eye and we reposition it under that hollow that bothers people, that tear trough. So it volumizes that, creates that smoother contour from the lash line to the cheekbone.
(12:45):
And at the same time you go in and you put a little bit of the patient's own fat, just again, to really reduce that hollowness and accentuate that curve. And this is one of the things that really ages your face prematurely if you have that deep tear trough or those visible bags of the lower eyes. And patients always talk about, people ask me if I'm tired, I'm not tired, I feel great, but people always assume that I'm exhausted. And like I said, we see that in young patients. And unfortunately it's genetic, but it's one of my favorite surgeries to do is a lower bleph because it's transformational. And again, you don't look different. All you do is look more awake, more youthful. If you're in your 30s and you're interested in some of these procedures, you need to really evaluate kind of what bothers you.
(13:32):
Do you have that heavier neck? Do you have that tear trough? Are you seeing those age related changes in your face? Are these things that you're willing to get managed surgically or have you done a lot of non-surgical treatments, injectables, lasers, whatever, and not achieved the ideal result or aesthetic that you're looking for? I think those are the kinds of things that I'd want you to think about and give us a call because I mean, we'll be truthful just because you come and you want something done doesn't mean that you're a surgical candidate and that will do it because there are a lot of things as great as social media is, it also has a lot of negatives and creates unrealistic expectations or it completely falsifies results. So I think that it's unfortunate for patients because there's a lot out there. You kind of have to tease out what's real, but that's why we're here to help you.
Announcer (14:28):
Basu Plastic Surgery and Aesthetics is located in Northwest Houston in the Towne Lake area of Cypress. To learn more about the practice or ask a question, go to basuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team @BasuPlasticSurgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of The Axis, T-H-E-A-X-I-S.io.