I Don’t Like My Neck…Nora Eprhon is Not Alone
As Nora Ephron’s popular book title, “I Feel Bad About My Neck” expresses, many of our patients share her feelings about their own necks. At some time in their late 30’s and early 40’s patients often notice changes in their neck, usually not for the good! 
Neck skin begins to appear saggy and crepe while the (playsma) muscle bands become prominent even when not actively clinching our neck muscles. In most young patients it is premature to immediately jump to neck lifting surgery to correct these early signs of the aging neck.
Fortunately, we have a few quick, safe, and effective non-invasive, non-surgical treatments to restore a youthful neck. These treatments include Radiesse hyper-dilute injections, Ultherapy, Profound RF (Radio-frequency), light CO2 laser, and Medi-Inject.
Radiesse is a biological stimulatory filler which mean once it is injected, your body reacts to it by making more of your own collagen where it was placed. Research has shown that mixing Radiesse 1:4 with lidocaine and saline results in the perfect mix to stimulate collagen in the neck resulting in immediate noticeable improvement of crepiness and horizontal “rings” of aging in the neck. Adding heat from a device (either Ultherapy or Profound Radiofrequency with microneedles) multiplies the effects of the previous hyper-dilute Radiesse injections. In select patients we add a very light CO2 laser superficially, and in others we add a customized “cocktail” injection with Medi-Inject. Medi-Injectis an automated injection system that precisely injects a cocktail of PRP, hyaluronic acid filler, Botox, and other ingredients in the epidermis resulting in fresh vibrant skin. Vitamins, skin lighteners, and even stem cells can be injected with Medi-Inject.
It is wonderful that technology and technological advancements have progressed to the point where we are able to address our patients concerns about their aging neck with non-invasive, non-surgical solutions so that they no longer have to feel bad about their necks. We offer surgical options as well for patients where surgery is indicated.
Please feel free to contact our office with any questions or concerns regarding your neck. Stay well.
Dr. Persky
The recent issue of Allure Magazine discusses the 11 most overrated cosmetic procedures. As the title would indicate, we don’t perform most of these procedures, we do use some of the treatments, but definitely have our opinions on all of them. So here we go:
1. Foot Lifts…this can vary from surgical intervention to make feet fit better into pointy shoes, shortening of a long second toe, and even lipo for a little toe that is too fat! The treatment that we are most asked about is the injection of hyaluronic acid to add padding to the balls of the feet (dubbed the “Loub job,” after Christian Louboutin). We do not perform any of these procedures, the risks and complications are not worth the small benefits of the treatments.
2. The “Vampire Lift”…involves drawing blood from a patient and then re-injecting plasma (the yellow fluid) from the blood into wrinkles around the eyes and lips. The problem with the procedure is that it has not proven to be effective, does not last, is not FDA approved, and adds about $1,000 to your filler injection bill. Kim Kardashian had a variant of this when she had her own plasma applied to her face after having had a dermapen treatment (it makes small pin pricks into the skin). We are not fans of the Vampire Lift.
3. Smart Lipo…is effective when performed properly. It uses a laser fiber to assist in liposuction of the body. There is an increased risk of skin burns and scars with the treatment. It is one of the best treatments that I have seen for loose upper arms in women. We do not perform body liposuction, and have found that standard liposuction of the neck is as effective without the risks and complications.
4. Stem Cell Facelift… is quite the rage, most surgeons believe it is more hype than substance. Almost immediately, surgeons began to claim—with no proof—that the stem cells in fat improved skin quality and starthttps://www.drpersky.com/ed calling fat injections a stem-cell face-lift, says Rod J. Rohrich, MD chair of plastic surgery at the University of Texas, Southwestern, in Dallas, and the coauthor of a recent paper on the subject. But the idea that fat injections could replace a traditional face-lift is “high on marketing and short on science,” Rohrich says. “Stem cells have great promise, but there is so much conjecture.” We have believed that the stem cells present in fat transfer procedures are responsible for some of the incredible improvement of the overlying skin, but doubt the added benefit of concentrated these stem cells and calling it a stem cell lift.
5. Artefill and Sculptra for Lips…should never be used. Lip tissue is delicate, Artefill is a permanent mixture of Plexiglas-like beads and cow collagen, is approved only for filling smile lines. We do not use Artefill. Sculptra is a wonderful facial volume rejuvenation treatment, but should not be used close to or in the lips.
6. Silicone Cheek Implants…The news for women who want to add volume to their cheeks is good: Facial fillers have all but replaced the silicone implants that were standard in the ’90s. I am not a big fan of permanent cheek implants as they remain static as the face changes over time, often causing a “funny looking” result (see Barry Manilow, Dionne Warwick, etc.). I much prefer using injectable fillers such as Sculptra and Radiesse to augment cheeks.
Before and After Ultherapy (Author)
7. Ulthera…is one of our favorite and most popular and effective procedures. The reason that Ulthera made this list is because so many practitioners are unable to control the discomfort of the procedure for their patients. We have by the judicious and strategic use of local anesthesia. After more than 250,000 worldwide treatments over the past 3 years, Ulthera remains the best non-surgical lifting and tightening tool for the face, neck, and eyebrows at our disposal!
8. Fat Injections for Breast Augmentation…There’s a good reason “fat injection” is the latest catchphrase in cosmetic breast augmentation. The results look good and feel natural, and unlike a scalpel, the needles leave no scars. But there are often downsides. Multiple procedures may be necessary and, with few exceptions, provide, at most, a one-cup-size enlargement. A study by Mihye Choi, an assistant professor of plastic surgery at NYU School of Medicine, found that half the volume created by shots of fat disappears into the body within months. More worrisome, there is concern that, years later, stem cells in the fat might stimulate cancer. We limit our treatments to the face.
9. Brachioplasty…is surgical treatment of the upper arms. The problem is that no one likes the scars that result, defeating the goal of the treatment, being able to again wear sleeveless clothes.
10. Butt Implantsare being replaced by fat transfer due to the lack of a natural pocket and the high complication and re-operation rate.
11. Zerona Fat Melting Laser…only melts your hard earned dollars from you wallet. The super market bar code reading laser cannot penetrate through the skin to cause the effects that are claimed by the company. The studies only measure patients results for two weeks after the treatment, and patients must take a dietary supplement, Curva to get the “results”. Zerona truly deserves to be on this list, probably at the top.
We are constantly evaluating new techniques, products, devices, and procedures. Unfortunately in the “business ” of aesthetics it is often difficult to distinguish the hype from what’s real. Other than Ulthera and SmartLipo, the Allure article has successfully done that for the public. Please feel free to contact us with questions or concerns that you may have regarding facial aesthetics. Be well!
Dr. Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California (The Lasky Clinic) but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you!
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“There is no such thing as an ugly woman, only a man with a utter lack of imagination!” Anonymous
In a recent online article Grated listed it’s 10 most unattractive (ugly is an ugly word!) celebrities. After looking at the photos, we must admit that many on the list have been previously referred to during consultations here at Persky Sunder Facial Plastic Surgery by patients who, “…do not want to look like so and so!” We have undertaken the task of reviewing each of the listed celebrities photos, pointing out what exactly it is that has landed them on this unenviable list.
Before going any farther, let us remind ourselves that we are only refering to superficial, outer appearance, and that in the celebrity world there are many externally “beautiful” people not on this list who are “ugly to the bone” on the inside. Conversely, in defense of those on this list, yes, they may have made some bad plastic surgical physician choices in the past, but they may be beautiful people on the inside, where beauty really counts.
We must remember that it only takes millimeters of change one way or the other for the human primordial brain within fractions of a second to determine if a face is symmetric, healthy, and one that another human would wish to share genes with (reproduce) for survival of the species. When the millimeters of change are positive, it is rejuvenative and youthful. On the other hand, as in the case with many of the celebs on this list, when the millimeters of change are asymmetric, or measured in centimeters (or seemingly feet), then the unnatural change can cause the face to look like a genetic mutant (not to infer anything about the celebs on Grated’s top 10 list).
With that in mind and with tongue in cheek, here we go:
10. Melanie Griffith has had her share of bad plastic surgery and fillers over the years since she first met Miami Vice’s Don Johnson, but actually we feel that she is returning to normalacy (thank you Antonio Banderas), and most definitely there are other celebs out there more deserving to be on this list (see below). Melanie’s lips had been filled with something permanent, which created an imbalance, her upper lip being much larger than her lower lip. The proper lip proportions have the upper being smaller than the lower (upper lip should be ~70% the size of the lower lip).
9. Janice Dickinson has lips and breasts that enter the room a time zone ahead of the rest of her body. Other than her alien sized lips, her facial volume otherwise looks good for an older woman.
8. Jackie Stallone appears to have work done on her face by the same surgeon who worked on her son, Sly. Whenever it is obvious that someone has had plastic surgery, the surgeon has failed the patient (see the late Michael Jackson). Ms. Stallone has excessive lip volume, facial volume, elevated eyebrows which all add up to make her look like she is Carrot Top’s mother. By the way, Carrot Top’s plastic surgery is most deserving of a spot on this list.
7. Mickey Rourke has been a veteran of these lists for many years after having a premature, poorly performed facelift many years ago. Since then, boxing and multiple surgeries have changed Mickey’s appearance. His current appearance is actually becoming more normal, so this may be one of his final appearances on lists such as these, as long as he doesn’t go back to the same surgeon for a revision.
6. Male rocker Pete Burns has been transformed to a large “lips and cheeks on a stick” female look a like (see Housewives of Beverly Hills, he would fit right in). What is it about those lips? We are constantly having to reassure our prospective patients that it is not the injectable filler treatment that causes these abberations, but rather the injecting physician or nurse’s lack of artistic vision. By the way Pete, I hope that your coat is imitation, or that you are staying far away from PETA.
5. Cher is one of our favs and personally we don’t beleive that she belongs on this list. Cher has maintained her facial volume relatively well, and takes excellent care of her skin with non-invasive stimulating treatments. She would likely be a hugh fan of Ultherapy by Ulthera, lifting and tightening of the face, neck, and brows. “I’ve Got You Babe!”
4. David Gest may have the gold and platinum albums behind him, is worth multi-millions, but like his late friend Michael Jackson is the two word answer to a RealSelf.com question that we responded to a few years ago. The question was, “Do celebrities get better plastic surgery because they have more money?” Only the ones who choose their surgeons most carefully! Mr. Gest’s exaggerated elevation of his forehead and eyebrows, along with the feminizing upper eye lid blepharoplasty (can you say Bruce Jenner Kardashian?), the lower eyelid sceral show and ectropion from poorly performed blepharoplasty, and disproportionate volumization of his face have landed him most deservedly on this list of celebs.
3. Poor Donatella Versace, don’t know who she saw for her plastic surgery, but they have turned her into an aging Willie Mays (sorry Willie). Her facial volumization with fillers and/or fat is exactly what keeps many patients away from ever stepping inside a plastic surgeon’s office…”fat, pudgy face”.
2. Jodie Marsh. Not sure who she is, but what is again quite obvious is that she has had plastic surgery that is not in line with Leonardo da Vinci’s Devine Ratio of proportion. All that you can say about Jodie’s plastic surgery is that they tried their “breast”!
Drum roll please……..1. Iggy Pop (Really?) Mr. Pop is an example of where loss of facial volume and not dressing appropriately for one’s age will land you, as the winner of Grate’s Ugliest Person List! As we age, we lose facial volume, mainly fat and bone, but also some muscle. Before the days of filler and Ulthera, Catherine Deneuve said, “At a certain point in a woman’s life she must choose between her face or her fanny!” Fortunately today with fillers such as Sculptra, Radiesse, Juvederm, Restylane, and others, a woman (and aging rock stars) can remain slim but still maintain their facial volume.
Honorable Mention: Mick Jagger, the great front man of the Rolling Stones. See Iggy Pop above.
Be well!
Dr. Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California (The Lasky Clinic) but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you!
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