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    When subtle isn't enough

    Plastic surgeon urges aggressive approach to neck contouring

    Mitchel P. Goldman, M.D.Dr. GoldmanThe neck is one of the most challenging parts of the body for cosmetic surgery to address, and a dermatologist told an audience of colleagues that they shouldn't settle for subtle contouring results.

    "If you want to achieve a beautiful neck, you really have to go to extremes," says Mitchel P. Goldman, M.D., volunteer clinical professor of dermatology at the University of California at San Diego. "If we really want to achieve meaningful results, we have to think about more aggressive procedures."

    Dr. Goldman, also medical director at Cosmetic Laser Dermatology, spoke at the 2016 CalDerm Symposium, a continuing education seminar offered by the California Society of Dermatology & Dermatologic Surgery.

    More heat, more pain, more results

    What does being more aggressive mean in terms of neck procedures? When it comes to contouring, Dr. Goldman says, heat produces tightening through inflammation, so a bolder approach can be better.

    "There are lots of ways to put heat into the skin. The key part of this is, the more aggressive you are, the more pain you cause. The more heat you put in, the more of a wound you're going to get, and the better result. That’s reality."

    What about techniques? Micro-focused ultrasound is one option.

    "You definitely get an improvement," Dr. Goldman says. "But this is something that's really not a one-time procedure." He adds that the procedures cost thousands of dollars, raising questions about whether they're worth the cost for patients.

    "You have to go into this knowing that you’ll have a percentage of patients who won’t be happy," he says. "But you do get home runs. Some patients get very good results. It tends to work on patients who are a bit younger, healthier, who exercise more, who have more skin elasticity."

    Next: Studies mixed on micro-focused ultrasound

    Randy Dotinga
    Randy Dotinga is a medical writer based in San Diego, Calif.


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