Face and Neck Lift

Dr. Bob Basu (00:00): So we've heard about the Zoom boom, and that's really all of us having our meetings and conference calls through the computer, through Zoom through FaceTime, but through other modalities. So when we're on the computer, we're all seeing ourselves, we're seeing images of ourselves much more frequently on a daily basis on the computer screen. And that's making people a lot more aware about their facial aesthetic.

Announcer (00:22): You're listening to Behind the Double Doors, bringing you behind the scenes to learn about cosmetic surgery procedures and the latest non-surgical aesthetic treatments with Houston board certified plastic and reconstructive surgeon, Dr. Bob Basu.

Dr. Bob Basu (00:35): When we talk about comprehensive facial rejuvenation, we need to talk about the surgical options, surgical options, including deep plane face and neck lifts, eyelid lifts. But we also have to talk about non-surgical options because it's not one or the other. Generally surgical and non-surgical to get the most refreshed results go hand in hand. And when we talk about non-surgical, we're talking about Botox, fillers and other noninvasive treatments. But thirdly, and equally important, we have to talk about skincare because you can do the surgical procedures, and you can do the noninvasive procedures, but if you don't address the quality of your skin to make your skin look as young as it can be, then I think you're not getting the most comprehensive rejuvenated results. So surgical, non-surgical, and skincare all go hand in hand. It's a synergistic effect.

Dr. Bob Basu (01:24): So one patient comes to mind, we'll call her Ms. Jane Doe. Ms. Doe was actually a cancer survivor. She actually had brain cancer many, many years ago and was successfully treated. She was cancer-free, healthy, and living her best life. She was in her late sixties. Her kids had grown and they're off to college, and how she felt didn't match up with how she looked. And so we sat down with her and we did a full consultation and evaluation, and her primary concern was really the loose skin, her jowls. She felt like she looked like her grandmother and she felt young. She felt healthy and she had beat cancer and she wanted to live her life to the fullest. So we set up a multimodal treatment program for her, which included a surgical treatment plan. We also included some non-surgical modalities that would give her a refreshed look. And then we of course got her on a comprehensive prescription strength skincare regimen that she could do on her own.

Dr. Bob Basu (02:19): But the real first transformation really came from her deep plane face and neck lift. And one of her biggest fears was she didn't want to look operated on. She didn't want to look different. She wanted to be herself. And we were both on the same page because good and effective facial rejuvenation is not about changing who you are. It's about turning back the clock and presenting a more natural refreshed version of you. So we performed a deep plane face and neck lift, and the result that she got, she was ecstatic immediately. And then what I told her is if you're happy now you'll be even over the moon once all your swelling is gone. And she was just overjoyed with the improvement in her neck contour. We removed all her skin. We corrected her platysmal bands, which are those little bands that can occur in the neck.

Dr. Bob Basu (03:04): She had a gorgeous flat neck and a jawline, and I wish I could share her before after result with you. I believe one of the results are on our website that she gave us permission to share, but it was transformative for her. And when she was all healed, she told me, I finally look like the way I feel. And the wonderful thing about her is she just wasn't one and done. She decided, okay, I've made this improvement, but I want to maintain my results. So she remains on a skincare regimen to maintain collagen. She takes care of her skin. And so surgery and non-surgery are definitely effective tools, but ongoing maintenance of your skincare is so, so important. I think everyone ages differently. I don't necessarily look at age. I look at the patient's concern and their anatomy. And based on their concerns in anatomy, that's when we open up the options of, do we really need to talk about surgery at this time?

Dr. Bob Basu (03:59): Or are there effective non-surgical things that we can do to address the patient's concerns? And of course, we have to talk about skincare, protecting your skin against sun damage. If you're in your twenties or thirties, and you're worried about aging, start using medical grade sunblock products to stave off or prevent sun damage or sun spots or pigmentary problems on your skin that can make you look more weathered and aged. Hydration is super important. Nutrition is super important. So all of these things go together in terms of coming up with a comprehensive facial rejuvenation plan. Sometimes it's not surgery. We have some very effective, minimally invasive or non-surgical treatment modalities that can achieve some fantastic results, but every patient is individual. So it's not necessarily about the age, it's about their anatomy and their concerns.

Dr. Bob Basu (04:52): Am I doing faceless on patients who are in their forties? Absolutely. Am I doing facelifts on patients who are healthy or in their seventies and eighties? Yes. I think the common concerns for patients opting for surgical facial rejuvenation are laxity in the neck. Maybe they have some loose skin. Maybe they have that turkey neck wattle, and more severe cases, jowls. Jowls are basically the area of skin that's sagging down on your jaw line that make you look older. Or is there laxity, you're losing your jaw contour because of loose skin, or is the cheek area hollow? You just look very aged and tired all the time. I evaluate the face from top to bottom, bottom to up. We divide the face up into three zones. There's the upper third. There's the mid-third. And there's the lower third. The upper third is really your forehead. It's your brows. Super important, brows.

Dr. Bob Basu (05:53): And it includes your upper eyelids. The middle third includes the mid-face. Fancy way of saying your cheeks. Are your cheeks hollowing out? Are they dropping? And we also take a look at your lower eyelids too, as part of that. And the lower third is really your jaw line around the mouth and your neck, do you have loose skin in your neck. So we like to evaluate the face into three different categories. In terms of the treatment let's go from bottom up. With patients that have concerns in the lower third of their face, or we're talking about the jaw line to their neck, a surgical face and neck lift is a very powerful procedure. Now let's dive deep on a surgical face and neck lift. There's a lot of different techniques out there. I can tell you the technique that I love that really gives me some wow factor results, which is called the deep plane facelift.

Dr. Bob Basu (06:46): Now everyone thinks facelift we're just tightening the skin and that's somewhat what we do. But skin tightening is really not the power of an effective facelift. It's actually tightening the deeper structures called the SMAS, that actually is below your skin. If we just tighten the skin, well we all know skin stretches out, right? And so are you really getting a long-term improvement if you're just doing a skin lift? My answer to that is no, based on my experience and in my hands. Rather, when we heightened the deeper structure of the face and so on our face, we have the skin, fat, and there's a deeper layer called the SMAS. Now there's a fancy anatomic name for that, but we don't need to get lost in all the anatomic chit-chat, but the deeper structure of the face is called, the abbreviation is called the SMAS.

Dr. Bob Basu (07:36): In a deep plane facelift, we're actually manipulating the deeper layer of the face to give you much more sustained support to your face so you get more long lasting result, but you get much more of a refreshed, rejuvenated look. And it's not looking so pulled and tight. The worst thing a facelift can do is you get that overly tight look and look, we've all seen it, right? We've seen Hollywood programs where patients get on stage and they're presenting an award and their face looks way too tight. They got these weird creases along their mouth because the face was pulled too tight. And that's not a good looking facelift. Look, if you can tell if someone's had an obvious facelift and they look weird, that's a horrible resolve, right? A good facelift is one where the patient looks really refreshed and looks younger than their age. But you're wondering, did she have, or he or she had work done, or it's just good genes.

Dr. Bob Basu (08:28): That's a good result. And in my hands, a deep plane facelift, helps to achieve that. So yes, we are tightening the skin a little bit, but the real power is the internal power of the facelift, is the deep plane technique. In that sort of facelift, we hide the incisions along the ear in the front. So my incision I like to do with called a retro tragal incision. What that means is there's an incision going in front of your ear, about a centimeter and a half, then we dive inside your ear canal. No one can see that scar unless someone's looking inside your ear canal, which unless you're in the doctor's office, that's not going to happen. And then an incision courses in front of your labial, and then it courses behind your ear, along that ear crease behind your ear. And then in more severe cases, when there's a lot more loose skin, we then extend the scar back into your hair line.

Dr. Bob Basu (09:19): So we try to keep it hidden. We want to be very sensitive to those incisions, so we can place them in camouflageable areas. Will a surgical lower third face and neck lift, or a deep plane facelift, help with the eyes. The answer's no. Oftentimes with my deep plane facelift, I'm also treating the upper third of the face. A very powerful technique I love to utilize is called a temporal brow lift. That's the technique that I use where I put the incision hidden in your hairline. And we're actually reshaping the brow to open up the eyes. And I know we're on a podcast, I can't illustrate it through video, but if you take your finger and put it in your temple area and pull upwards a little bit, it opens up your eye, right? It makes you look more alert and so a temporal brow lift gracefully shapes your brow.

Dr. Bob Basu (10:09): It corrects lateral hooding in the upper eyelid, and it makes you look much more refreshed in your forehead. Oftentimes we will add an upper eyelid lift if you have loose skin in your upper eyelid, and then we have to address the mid-face or the middle third of the face, and that's the cheeks. So for patients who are getting that hollowed out look, which creates an aged appearance, I love using adjunctive fat transfer, where I take fat from somewhere else in the body and we put it to good use and I do fat micro grafting or fat grafting. In other words, I'm restoring volume that you used to have years ago into the cheeks to give you a higher cheek elevation. It's called a mid-face lift, essentially, without having to do any major surgical procedure for the mid-face. So I love using adjunctive procedures, such as fat during a face and neck lift, to refresh the mid-face.

Dr. Bob Basu (10:58): And sometimes we need to do a lower eyelid lift too. If you have bags in your eyes or loose skin in your lower eyelids, then we also have to entertain a lower eyelid lift. So as you can see, it's not a one size fits all. It depends on your priorities and goals, but if you're looking for a comprehensive facial rejuvenation, it has to include treatments for the upper third of the face, the middle third of your face and the lower third of your face. But remember, a surgical procedure will remove wrinkles on your face, but it only tightens the skin that you have. It doesn't change the quality of your skin. So if you have a lot of sun damage, we may be making it better, clearly, but we have to treat the skin intrinsically too. And that's where skincare options or laser therapies come into play.

Dr. Bob Basu (11:45): Generally when I develop a surgical treatment plan, I also have patients come back in about two weeks or so, maybe three weeks or so, and do some noninvasive treatments. For instance, the forehead lines. A powerful way to treat the forehead lines is with Botox. There's no reason to have surgery because Botox, yes, the downside it only lasts about four months, but there's no incisions, there's no downtime. It's very safe and works beautifully well on the forehead to rejuvenate the forehead without any major incisions. I also like to address the lips. It's very important to address the lips. So for women and some men, when we age, the distance from our nose to our upper lip increases. So if one of our listeners now is looking at their photos and let's say they're in their sixties and they look at a photo of themselves from when they were in their thirties, I bet you they will notice that the distance from their nose to their upper lip has gotten longer over time.

Dr. Bob Basu (12:48): And that elongated effect actually gives more of an aged appearance. So to correct that you can use fillers, but I don't want patients to get this duck lip overfill look, that looks horrible. What I really love to do is what's called a bullhorn or upper lid lift, where I put my incision, hidden underneath the nose, and we actually reduce the distance from the nose to the upper lip. That does two things. One, it reduces the distance from the nose to the upper lip and two, it actually, everts the lip, making your upper lip look much more youthful what you had decades ago. And let's say, patients say, you know what? I don't want to do the upper third of the face. I don't want to do the mid-face. I just want to do my lower third face and neck.

Dr. Bob Basu (13:35): But if I see that they have an elongated nose to lip distance, if I just do a lip lift, wow, they look so much better. No fillers, it's a long lasting result. And it really turns back the clock with a simple procedure where the incision is hidden underneath the nose. A lip lift you can absolutely have it as a standalone procedure. And the good news is a lip lift, I can do this under local anesthesia. It typically takes me about an hour or less to do. And if a patient is comfortable under local anesthesia, we can put some music on, get them relaxed and it can be safely performed in under an hour under a local anesthesia.

Dr. Bob Basu (14:09): And the results are immediate. A little bit of swelling for a week or two, and the wonderful thing is that we hide the incision right underneath the nose, and it can immediately evert the lip, give you a little bit more volume, improve your shape. I've treated patients that have lip asymmetries, or they have a very thin lip or an atrophic or weak lip. And a lip lift really improves the appearance of the upper lip and it provides balance and harmony to the face. A lip lift by itself, even if you don't do a face and neck lift, will make you look younger.

Dr. Bob Basu (14:38): Patients are very comfortable to go home the same day. I do see all my face and neck lift with patients back the next morning, and the reason why is I like to put a small drain in on the face. So it's a little plastic tube that goes underneath the area where I've done the work and the tube comes out behind your ear, and we remove the drain the next day. The reason why I like to put this drain in is because the drain is connected to a little suction bulb, very easy to manage. I know it sounds kind of scary, but super easy to manage. But that drain sucks out any fluid that may build up, any scant amount of blood that may want to build up underneath the skin and sucks it out. And if it sucks it out, it does two things.

Dr. Bob Basu (15:16): Number one, the suction effect helps to heal down that space quickly. And number two, it sucks out any small amounts of blood that may want to collect up under the skin. When that happens, patients get a lot less bruising and they get a lot less swelling, faster recovery. And so I still advocate for a drain, but I take the drain out the next day. We make sure everyone's doing great. They have their compression garments on, they're comfortable. And the good news from a face and neck lift is rarely do patients need pain pills because I use a lot of long acting numbing medicine and the numbing medicine sticks around for 12 to 16 hours, at least. So rarely do patients need pain pills after face and neck lift surgery.

Dr. Bob Basu (15:56): Swelling varies from patient to patient. Some patients, swell a lot, some patients don't, some people are fluid retainers, some people aren't. It also has to depend on what we're all doing. Clearly a longer surgery, if we're doing temporal brow, upper and lower eyelid lift, fat transfer to the mid-face, lip lift and a full face and neck lift with liposuction and fat resection of the neck, that's a comprehensive treatment plan the patients do well with. They'll likely have more swelling than say, if we're just doing a lower third face and neck lift with a lip lift. That's going to be a much easier recovery. So longer surgical times, a bigger procedure has typically has more swelling, but don't worry. The swelling typically settles out within about seven to ten days. So you do need to plan ahead for a recovery, just like with any surgical procedure, planning ahead for your recovery rest is super important.

Dr. Bob Basu (16:46): If indeed we're doing everything, I would say to plan to be at home for about seven to ten days. Now you can work from home or in the Zoom world now, you can just close down your video and conference call with people and that's fine. But seven to ten days. I think to have social engagements and feel very comfortable, in about two weeks you should be good to go. So let's walk through some of the non-invasive ... Remember we talked about there are surgical options, there are non-surgical options, and of course there's skincare even for the neck, super important, right? So let's talk about surgical options. We just talked about a lower third face and neck lift for a patient that has moderate to severe loose skin.

Dr. Bob Basu (17:27): If you've got banding in your neck, if you got deeper jowls, okay. The definitive treatment for that is really going to be a lower third face and neck lift or a deep plane face and neck lift. But for moderate to milder cases, or a patient that's younger, that is starting to worry about laxity in their neck, or they have a little bit of fat in their neck, or they have a lot of fat in their neck when, but their skin tone's good, well, we may be able to treat the neck using a procedure called FaceTite. Now FaceTite is called radio frequency assisted liposuctioning, but it's very different than just regular liposuction, and in fact, it really shouldn't be called FaceTite. It should be called NeckTite because that's where it really works the best.

Dr. Bob Basu (18:12): And what it is, is it can be done under local or it can be done under IV sedation. It typically takes me just an hour to do, very quick recovery. And I make a tiny opening. I don't even use a scalpel for this. I use a special instrument that makes a tiny one to two millimeter opening underneath the chin. And then I use a special instrument to make a little opening behind the ear. That's it, no major incisions. And I use a cannula or a rod basically, that at the tip of the cannula or rod, emits radio frequency energy.

Dr. Bob Basu (18:43): Radio frequency energy does two things. It helps to liquefy fat, so it is a method, a modality to remove fat or for lipo. But number two, radio frequency energy creates heat that stimulates skin tightening or skin contraction. So on table, when I heat the skin with FaceTite, with radio frequency FaceTite, it will tighten your skin 10 to 20% right away. But that's not your end result because when we heat the skin to certain critical temperatures, it starts the process of collagenesis, a fancy word for saying rebuilding collagen. That means retightening your skin. And the studies show that skin tightening after FaceTite radiofrequency treatments continue out six months out, sometimes 12 months out. So your results will continue to improve. 50% of my FaceTite patients opt to do it under a local, meaning I numb up the tissue.

Dr. Bob Basu (19:39): I can always give them some Pro-Nox or what's called laughing gas. It's a mixture of nitrous and oxygen to take the edge off, and 50% of my patients have it under local and they tolerate very well. They're very comfortable. The other 50% choose to have IV sedation. You know, they can't sit still or they're anxious about needles and that's fine too. It's a personal choice. We have two very good options and we tailor it to the needs of each individual patient. FaceTite is a one and done procedure. What is helpful as an adjunct after FaceTite, so FaceTite is radiofrequency treatments from the inside outward. So we're hitting the skin from the inside out, but we also have external radiofrequency treatments too, that can hit the skin with radiofrequency energy from the outside in with a non-invasive non-surgical technology called Morpheus8. Morpheus8 is basically microneedling. I think a lot of people have heard about microneedling, but it's microneedling on super doses of steroids.

Dr. Bob Basu (20:39): Now there's no steroids involved, but what it is is microneedling at the tips of the needles, it's admitting radio-frequency with several millimeters of penetration into the skin. What that means is that you're getting the heat into the dermis to help further tighten and resurface skin. So oftentimes when I perform FaceTite, I also recommend we do a series of Morpheus8 treatments, which my nurses do for the patients. They drive themselves in, we do topical numbing medicine, they get the Morpheus done and they're out the door and they can go to the gym right afterwards. So there's no downtime for Morpheus8. You'll see the result right away, particularly if we're removing fat. It's pretty immediate. The results get better. So I tell patients if you're happy now and you see the difference, you'll be ecstatic as the collagenesis, or building of the collagen continues. So your results will get better with time.

Dr. Bob Basu (21:31): I think the first step is to call our office at (713) 799-2278 and speak to one of our friendly and experienced patient care consultants. They help with the journey of all my patients. They understand what I offer and they have a very good understanding of the pros and cons to at least give you some very reliable information, including costs, recovery and so forth. Of course, the most important step is to visit with me so I can actually evaluate you, look at your medical history, really get a good understanding of what your goals are and what your time off tolerances, what are you trying to achieve? And then I will give you my best recommendations.

Dr. Bob Basu (22:13): And my job is to lay out the options for you. I'll give you a recommendation clearly, what I think will give you the absolute best result, but we'll also try to develop a plan B too, if there is a plan B. So we have hundreds of before-after photos on our website photo galleries. I encourage you to visit our website at basuplasticsurgery.com. That's a B as in boy, A-S-U plasticsurgery.com, or follow us on Instagram @BasuPlasticSurgery.

Announcer (22:41): Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, 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 dot io.