Thank you for your question. I understand that you have some crepiness on your neck that you’d like to have addressed, and you’re wondering if Ultherapy and Pellevé are safe for this area, and if it’s technique-dependent. However, you’re also concerned about the horror stories from other patients who have said that they’ve lost fat from these treatments.I can certainly help you with this question as I have used a lot of technology in the 20 years that I’ve been practicing as a Board-certified cosmetic surgeon in Manhattan and Long Island. I own Pellevé in my practice and I certainly can give you some guidance with modalities, technology, and some other alternative options.These heating devices are largely oversold and aggressively marketed. Most of the time, the claims are disproportionate to what the actual results can deliver. However, consumers are often easily swayed by all hype surrounding such devices, thus making it difficult to make rational choices. Understand that this is a cycle—a new device will pop up, and all the TV shows will be talking about it, and then before you know it, it's obsolete and people stop using it.Going back to your concern regarding crepey skin, you must first understand the difference between skin redundancy, skin laxity, and skin quality. Sometimes, when people have crepey skin, they’ll simply pull back and upwards on their neck and think that that will solve the issue. However, we know from surgical experience that the limitations of face and neck lifting lies in the natural elasticity of the skin.Here is where people turn to thermal energy devices that claim that heating the skin can contract and tighten the collagen in your skin. While this is true to a certain extent, there is also a limit, as skin can only take a certain amount of heat before you end up damaging it. Many of these thermal devices are overused by both practitioners and patients. What happens is, when people do not get their desired results from a thermal energy device, the practitioner will naturally increase the temperature and energy. From the patient’s point of view, they feel more heat, so they think that the treatment is working better, when in fact, their skin and fat is literally being “cooked”.It’s important to remember that there is always conduction of heat occurring. Despite the claims of manufacturers that their device can heat the skin very specifically, keep in mind that you’re dealing with structures that are very delicate and very thin, so it is very easy for heat to be transferred.Tightening is not necessarily always the answer. If you look at the face of a younger person, you’ll notice that their skin and face doesn’t look tight. Rather, they have volume, they have glow, they have healthy skin. It is my conviction that the fat under the skin plays an important functional role when it comes to skin quality.In our practice, instead of heating, we use platelet-rich plasma (PRP). Mind you, we still use Pellevé, but not as the first line of treatment, especially in patients with very thin skin. We use Pellevé very conservatively and very specifically, usually on people with darker skin who are not good candidates for laser treatment. Other than that, we prefer to use platelet-rich plasma, which is a material derived from your own blood and has several healing and growth factors that are highly beneficial to the skin. This is then injected into the dermis, where it stimulates collagen and blood supply to the area, at no risk to the fat. In fact, many published studies in peer-review journals show that platelet-rich plasma actually improves the appearance of fat cells.In your case, I would caution you against thermal energy devices. You may want to learn more about the Y Lift™, which is a non-surgical procedure that entails the placing of a long-lasting filler deep into the structural level of the skin, below the muscle and above the bone, in order to give the appearance of a facelift. Alongside this, platelet -rich plasma can also be administered to improve skin quality. I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.
