aesthetic plastic surgery procedures

So…what IS the best way to get rid of a double chin?

Posted on February 21st, 2016
Posted by Julene

This is a good question. I just saw a commercial for CoolSculpt’s new transducer that alleges to treat the double chin, and I just have to make some comments. After all, this is my opinion column! It’s not that CoolSculpt DOESN’T work to reduce fat on the face or anywhere else…it does do this…it’s just not the best way to do it. And before the commercial was even finished, I knew what I would see (in what I assume was the best before and after picture they could find), and there it was…a thinner neck, but one that now looked like it needed a neck lift! I mean, is that the desired result? A thinner neck but one that now has a new problem…loose skin? I don’t think so. And even more importantly, it certainly isn’t the only option out there besides surgery. In general, and I don’t care if we are talking about surgery, non-surgery, devices, lasers or injectables – whatever is being offered – I really don’t think it’s fair to create a new problem in the process of trying to reduce another. In a nutshell, while it is wonderful to be able to make a neck thinner, wouldn’t it be even more wonderful to make it look tighter at the same time, so that the patient doesn’t then wish it wasn’t so saggy? Even saggier than when it was fuller?!?

The reason that freezing the neck fat isn’t the best option for the neck is the very same reason it isn’t the best option for non-facial or non-neck areas either…the skin isn’t helped at all by freezing. Only heat can tighten skin, and in the case of CoolSculpting, the skin is actually stretched in order to be fitted between the cooling plates, so it looks worse than it did before the treatment.  In the neck, this just looks like a neck that needs lifting, because it is a small area; but in the body (like tummy or thighs), the skin can look irregular or even create shelving in these larger areas which are also incompletely treated in a single session.

So then you might ask, what IS the best way to treat a double chin? The cheapest thing to do is Profound. This device can be used (via radiofrequency heat that is injected under the skin) to contour out unwanted fat deposits (unlike with CoolSculpt for the neck, the size of the area doesn’t matter with Profound), and the heat under the skin of a Profound patient will AT THE SAME TIME cause skin tightening. About 50% – 75% of what you’d see with a neck lift surgical procedure in fact. Next on the double chin options list would be, VASER liposuction with Profound for larger double chins (still doable in the office), or lastly, the new injectable Kybella with Profound to tighten skin if necessary, however, Kybella is more expensive than in-office lipo, and one might still need the Profound to tighten the skin after it.  And let’s not forget the tried and true face/necklift with direct fat excision!

Hope that helps anyone spending time worrying about a double chin or what to do about it…



Julene :)

Profound…Another way to tighten skin…anywhere!

Posted on May 24th, 2015
Posted by Julene

I told you all I would let you know when and if an interesting new technology came along that could tighten skin of the face and (Yes!) the neck without surgery or prolonged recovery…well, here it is! (Actually, we are also using it to tighten skin of the inner and outer thighs, that loose skin above the knees, the arms and abdomen as well!)  We still love our Sciton Laser Skin Tyte treatments for those who don’t mind undergoing a treatment series, and who don’t mind the need for maintenance treatments, but for those who can allow a week of downtime and don’t desire laser skin surface healing (as with ProFractional, Fraxel or CO2RE lasers)…there is now Profound by Syneron-Candela.  And until we get some of our own before and afters on our website, visit Profound by Syneron and learn more about this single-treatment wonder!

Basically, the treatment involves numbing the skin of the treatment area, and then treating it with microneedles that safely and quickly deliver radiofrequency (heat energy) below the (chilled) skin’s surface. Any area of the body may be treated, but face and neck may be the most popular.  The procedure takes an hour from start to finish in our office…no pain, no anesthesia and no incisions. There is 3 to 5 days of mild bruising and swelling. Make-up may be applied immediately. Our office is the first to offer Profound in Kentucky, and we are already treating patients!


The direct result of delivering heat specifically deep to the skin’s surface within the dermis, is that the heat causes collagen remodeling, which leads to tightening and smoothing without damaging the skin surface. For once, the neck may be treated the same as the face (which is not possible with laser or other skin tightening modalities, which require that “lighter” settings be used on the neck). Also, another unique feature of this type of radiofrequency delivery, is that there is no need to physically undermine the skin in order to deliver the heat energy (as with the minimally invasive Thermi-TyteRF treatment), so there is no disruption to the normal connection between skin and deep soft tissues (we call these connections “retaining ligaments”, and they help the skin resist the effects of gravity). This is important for what we call “skin redraping” with energy delivery. If a formal surgical lift is NOT being performed, how the heat energy is delivered becomes critical when trying to tighten skin significantly. Heat energy alone cannot overcome gravity’s attempts to loosen skin, and once the retaining ligaments are divided (as with Thermi-TyteRF procedures), the skin is much more easily loosened by gravitational aging.  Therefore, it is vitally important to try to maintain as many of the deep connections between skin and the deeper layers while delivering the heat that causes tightening in the collagen and elastin fibers of the dermis. Once these structures have been divided, it is best to perform a formal lift (ie, face or necklift). But with the advent of microneedles that can deliver the radiofrequency heat, it is now possible to get the heat to the appropriate sub-skin elastin and collagen fibers WITHOUT dividing the important connective tissue and retaining ligaments that support the skin against gravitational effects. VOILA!…tighter and smoother skin results with maximal benefits seen at 3 months after a single Profound treatment.

The Profound procedure benefits anyone who desires tighter skin without surgery…patients with acne scarring, patients who are seeing early facial and neck laxity but are not ready for a facelift (or not interested in having one), and patients who may have had a facelift or necklift but are not interested in having it surgically revised are electing to use this exciting new modality. In other words, Profound can be a great way to put off having a facelift or necklift, or to maintain one after it’s been performed. And unlike laser skin tightening, it is a single step procedure, and one which is just as good for the neck as it is the face.  We have also seen patients suffering with deep acne scars or wrinkles receive benefit from the Profound tightened skin, and Profound can also be combined with more traditional laser peels and tightening treatments for added benefits.  Laser and Profound can be performed together as a single treatment or separately, and treatments may be customized to suit each patient’s needs and budget.

Cost: $3500 for face and neck (cost may be slightly higher for non-facial body areas).

Profound treatments may also be customized in order to be combined with other laser or liposuction procedures.

Finally…a “profound” way to make a “profound” difference!
Call our office to schedule a consultation to see if Profound is right for you.

Happy Memorial Day!


My Favorite Skin Care Program

Posted on January 13th, 2015
Posted by Julene

My favorite skin care program involves cleansing at least twice a day, following that with a good toner (I use Dermesse, which has a regular cleanser/toner, a gentle cleanser/toner, and a line specifically for acne). Then I appy either hyaluronic acid or a vitamin C product as an anti-oxidant and skin firmer, and then an under-eye serum (I prefer Skin Medica’s Uplifting Eye Serum), followed by a light powder foundation. At night I cleanse and tone again, then apply Jan Marini’s Enlighten MD (has a skin lightener plus retinol), or just a retinol (collagen stimulation) and Neo-Cutis’ Lumiere eye cream (I like a night cream for under the eyes at bedtime). Finding the Jan Marini skin care line at a plastic surgery meeting recently allows me the ability to use retinol and a lightening agent in a single product. Once irregular pigmentation is corrected (brown or red), I like for patients to continue a retinol or Retin-A without a nightly skin lightener. Retinol and Retin-A are important to use for collagen stimulation (and compliment the use of Sculptra, our favorite collagen stimulating injectable, by making the Sculptra last longer…see the blog re Tip #1 about Sculptra if you are unfamiliar with this “liquid facelift”). Since I like to do 2 to 4 annual BBL (Broadband Light) laser treatments, I don’t have a lot of pigmentation problems left until the end of summer after all my outdoor activities are over, so the BBL is a great way for me to clean up sun damage. But “Forever Young BBL” treatments also are a super way to slowly retexturize and tone skin…ie, make it actually younger!  Plus, there is NO DOWNTIME with BBL, making it so easy to do these treatments anytime of the year.  (See Tip #3 blog entry on “Forever Young BBL”). And last but certainly not least, I have 2 favorite neck creams…NeoCutis’ Biocream and Jan Marini’s Juveneck…both hands down the best anti-aging defense for the neck, applied morning and night after cleansing.  Other than laser options such as Sciton ProFractional or Skin Tyte, Fraxel CO2, or the new CO2RE (fractionated fractional CO2), there is nothing better to keep your neck skin from looking “crepy” and old.

So there you have it…what you should be doing for your skin from the desk of JBS!

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