Ultherapy or neck lift? 60 yrs old - would MUCH prefer a non-surgical approach, even if it ends up being more expensive. (photo)

Question

Is it realistic to expect at least moderate improvement from ultherapy for my "waddle?" I can accept a moderate improvement as a trade-off for not going the more dramatic surgical route. I can accept ultimate cost of ultherapy being higher and need for annual touch ups. Pictures below were shot from below. It doesn't look quite that bad head on. No idea why the upload rotated them.

Afshin Parhiscar, MD · Answer

Dear profhoffIn my opinion, you are comparing apples and oranges. In a facelift, your facial fat pads are repositioned, your jawline is re-contoured and you routinely will have a significant and predictable result.Ultherapy works best by tightening skin that has tone and thickness and can also reduce subcutaneous fat. Based on my experience, it works best for very limited improvement in patients in their 30s and early 40s. I think you would get an excellent result with a facelift. You might choose to use ultherapy afterwards to tighten the lower neck skin if needed. I don't think you could achieve a nice jawline and shaped neck with ultherapy.

Richard Baxter, MD · Answer

While Ultherapy is FDA-cleared for nonivasive skin lifting, there are no true nonsurgical facelifts. It is not a matter of the number of treatments, it just works best on patients who do not have enough skin laxity to justify a facelift. A well done facelift can look natural and not "dramatic!"

Jason Emer, MD · Answer

I treat this everyday in my practice. You are a surgical candidate (neck lift, platysmaplasty) but you may not need surgery for improvement. Properly performed liposuction with energy based devices (VASER / ThermiRF) and physical fat removal will do fantastic to remove the fat, lift the skin, and contour the jawline. I pretreat everyone with Botox 1-2 weeks before surgery to relax the neck muscles, allowing for better retraction of the skin after surgery. Then after treatment we do skin tightening with Venus Legacy to improve the results and decrease the neck swelling. I suggest you only see an expert for treatment of this area as a meticulous surgeon is required to get great results and complications in this area can be devastating both medically and cosmetically. A new medication that is used to remove chin fat with injections called Kybella may also be an option, as it secondarily allows for skin tightening/lifting as well. A formal consultation is needed to determine what are the best options for you.  Best, Dr. Emer.

Rebecca Fitzgerald, MD · Answer

Technology is wonderful and there's plenty out there that works very well. But all technology has limits.Facial laxity is caused by a break down of elastin and collagen - once that laxity level reaches a certain point, there's no technology that can change it enough to be satisfactory.Your photos show both laxity and excess skin. Ultherapy can't fix that for you. (Ultherapy's a great option for many, but it's not the cure all for everyone!)Take a little time and look for a really good plastic surgeon who makes you feel secure in selecting surgery. I think that will be your best option.Generally when the neck displays this loose, there are all kinds of things going in the face that should be addressed at the same time. Today most facelifts are accompanied by volumizing fillers and wrinkle relaxers, since volume loss is a primary issue in making someone look older. You'll probably be happier with surgery and volume replacement as opposed to any nonsurgical procedure.

Michael A. Zadeh, MD, FACS · Answer

An in-person consultation and examination would be needed to determine which treatment is best for your neck. Looking at your pictures, you would best be served by a surgical neck lift as it can address both the loose skin, subcutaneous fat, and separation of the platysma muscle. If you are only looking for a non-surgical approach then I think the ThermiTight treatment would be your best choice. It can both tighten the loose skin and melt the subcutaneous fat. More than 1 treatment will likely be needed based on your goals. Ultherapy will only provide a mild improvement in the loose skin. It will not reduce the fat. Though Ultherapy can work well in the appropriate candidates with mild to moderate skin laxity, in your case you will need multiple treatments for any significant result. Make you find an experienced physician who offers different modalities of treatments and can determine which would be best for you. Hope this helps answer your question.

Michael I. Echavez, MD · Answer

It would be helpful to see a picture of your lower face and neck from the side (profile) to more fully evaluate you.  The most dramatic improvement to the neck can normally be seen with surgery.  I would say Ultherapy generally could provide some mild improvement to the neck.  In most cases, the cost of surgery would definitely be more than that for Ultherapy.  If you are absolutely against any surgery, you can always have the Ultherapy and see how much improvement you get with it.  Surgery can always be done at a later time.

Hratch Karamanoukian, MD, FACS · Answer

Thank you for your question.I think a neck lift would serve you better than Ultherapy because of the fat pad.BestDr. Karamanoukian

Sugene Kim, MD, FACS · Answer

depending on the aesthetic goal you have in mind, will determine which treatment would be right for you. Ultherapy is a conservative approach. It will tighten and lift the skin over several months and has no down time. With a neck lift, It will remove all excess skin. You should set up a consultation with a plastic surgeon for a personalized consultation to see which treatment is best for you.good luck!

Sheryl D. Clark, MD, FAAD · Answer

I do appreciate why you might prefer a nonsurgical option.  You would obtain some tightening with Ultherapy, which would probably be evident on photos, but I am afraid that Ultherapy, even performed several times months apart, will not approach the results you are hoping for and can get with a neck lift.  You have a difficult decison to make, given that you are reluctant to have surgery and the recovery involved after surgery is considerable (at least one day of post op pain, two weeks of significant swelling and bruising) and a serious commitment to meticulous post op care at home is required.Pellevé and Ultherapy are excellent choices for those with less significant laxity, and are also very helpful in young patients who want to prevent significant laxity as they age.Just to clarify, in NYC anyway, several Ultherapy treatments are still much less expensive than a neck lift. Even six Ultherapy sessions cost less than a neck lift.  And Pellevé is far less expensive than Ultherapy.

Stephen Weber MD, FACS · Answer

Essentially every neck can be improved with Ultherapy. The question is how much improvement you can expect. This can be explained in detail during an in person consultation. Just based on the photos that you've posted, I suspect that you would be much happier with the results you would achieve with surgery in terms of the degree of correction. You are also an Ultherapy candidate but this non surgical option (while very effective) will likely achieve about 30-40% of the correction that is possible with surgery. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Ultherapy or neck lift? 60 yrs old - would MUCH prefer a non-surgical approach, even if it ends up being more expensive. (photo)

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