The Nonsurgical Neck Lift: Myth or Reality? with Dr. Suneel Chilukuri

Dr. Furnas (00:12):
The late filmmaker Nora Ephron, who gave us, When Harry Met Sally, called her own book about her life after 50, I Feel Bad About My Neck. The neck is a number one complaint that Josh and I see in our plastic surgical practices, our solution surgery. But a non-surgical neck lift? Is that myth or reality? Welcome to Skintuition. I'm Heather Furnas.

Dr. Korman (00:42):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the non-surgical world to bring you what's new, what's safe, and what to look for when you're ready to hit refresh.

Dr. Furnas (00:55):
I'm delighted to introduce our guest, Dr. Suneel Chilukuri based in Houston. Dr. Chilukuri is a globally recognized cosmetic dermatologist specializing in the C-lift, a scarless facelift technique. Among his aesthetic innovations, he has created the CN-neck lift, the CBL non-surgical facelift, and the silhouette non-surgical body lift. Welcome, Suneel.

Dr. Chilukuri (01:30):
Thank you. Thanks so much for having me. I appreciate you guys rushing from patient care and being willing to listen to a non scalpel based, uh, positive results for our patients.

Dr. Korman (01:42):
Okay, so what do you mean by a non-surgical neck lift anyway?

Dr. Chilukuri (01:47):
So anything that doesn't involve actually cutting, uh, I describe it as a way, what tools do we have currently where we can put down the scalpel? We're not removing muscle, but at the same time we could be changing,

Dr. Furnas (01:59):
Suneel, I'm gonna interrupt. You say we're not removing muscle, like what muscle?

Dr. Chilukuri (02:04):
So the platysma or anything along the zygomatic arch, anything that we're gonna be, what we would traditionally find in a deep plane rhytidectomy, that we're not cutting, we're not sewing, we're just using external devices to reposition or tighten the skin or the, give the illusion of a tighter angle along the jawline, the neck or other parts of the face.

Dr. Furnas (02:29):
So what is the platysma?

Dr. Chilukuri (02:32):
So the platysma is gonna be this band. Oftentimes as we continue to mature and we see as we're talking, there's like a little pop pop that we see along the front of the neck. And for, for patients, oftentimes when we were doing all the Zoom work back in 2020, uh, everybody was jumping on Zoom calls for work. We realized that we may not have looked as good as we thought, because a lot of times we take photos in a very static manner, right? We smile, we pose for the camera. Whereas when we're doing something with a Zoom call, you can see yourself actually talking and you realize that certain parts of the face, especially the lower third of the face of that area below the nose and that area of the neck where it kind of pulls down, you can see that the angle may not be as tight as it was when we're 18, 19 20, in our younger ages.

Dr. Furnas (03:23):
So how long do results last?

Dr. Chilukuri (03:27):
That's the perfect question. <laugh>, we keep asking ourselves, you know, I, I describe it this way, I don't have a permanent timeline because for the patients that come to visit with us at Refresh Dermatology, it's always a constant improvement. So, and I describe it this way, if you want to look like Arnold Schwarzenegger in his prime, you're not gonna go to the gym one time. You're gonna go to the gym on a very consistent basis and you're gonna improve. Same thing. If you want perfect teeth or you want healthy teeth, you're not gonna brush your, your teeth one time and say, well, how long does that brushing last? We know that we have to have some consistency. So for something like this, if we reset the clock and we're talking about rejuvenation rather than prevention, for most people, if you do nothing, it may be one year, two years, or three years depending on the quality of skin that we're resetting.

Dr. Korman (04:18):
So I'm going back to my other question. What do you mean by a non-surgical neck lift? I, you know, you just told us that it's everything but surgery. Okay, but what actually is it?

Dr. Chilukuri (04:30):
What are we doing? So I'm using heat based devices to reset where the skin sits on that muscle underneath or on the fiber sepal network, which is like a little mesh that we, I guess you can describe it like a mesh that our skin slides back and forth. So if you take your fingers and you take it from the middle of your neck and you slide it backwards, which oftentimes, you know, we do getting ready for, for a big event, I'm like, oh, that looks better. And a lot of times patients would come in to see me and say, is it time for surgery? Do I need to get this set? And they're pushing their fingers so tightly along the jawline towards the ears that it's not, number one, it's not gonna be a natural result. And number two, the forces don't allow us to, at least in my opinion, don't allow us to bring that skin that high or that close to the ear without looking pulled or weird. In this case, I'm utilizing heat to reset where that skin is gonna be sitting on that, that mesh underneath.

Dr. Korman (05:26):
So is that like My Big Fat Greek Wedding, but without having to hold each other's like necks behind the picture so people can't see that we're holding each other's necks?

Dr. Chilukuri (05:35):
That's a perfect description. A hundred percent <laugh>. <laugh>. Yeah. And I remember seeing that.

Dr. Korman (05:40):
So, so what, what you see these heat devices, is that like a laser?

Dr. Chilukuri (05:45):
So this is not a laser. I'm using radio, in this case I'm using radio frequency microneedling. And there's two different types of device that you can use. One is a single needle device. And when I take that single needle device, think of it like a soldering iron. And if you're gonna put two pieces of wire together or you're gonna move a wire and you're gonna attach it to a different part of that, let's say harness, we're gonna use this heat to put that wire together. The other thing is you can also use heat like a staple gun. So my first step is to reset that, uh, I'm gonna put little tiny pokes inside the skin and I'm gonna go through multiple layers underneath the skin, so it includes the skin, and we're gonna attach it to the muscle by fussing heat. And you can think of a needle going inside that's gonna generate a little bit of energy on that, that deepest part of that needle insertion. So that's gonna be the stocking guard.

Dr. Furnas (06:38):
So do you just stick it or do you slide it and advance it backwards?

Dr. Chilukuri (06:43):
I'm gonna use, uh, one hand to pull, just like we're talking about with the Big Fat Greek Wedding, that portion, that hand that's pulling back on the skin is gonna be pulling, I call it my non-dominant hand, not the hand that holds the needle. And then I'm gonna just use that needle to put tiny little pokes in and create fusion with that heat. So I'm, I'm using it like a soldering iron or like a heat gun, like a glue gun except with using heat.

Dr. Korman (07:10):
So then what happens with all that crepey skin that's often right in the middle of the neck or the bands? I mean all these things that make us all look older than we might want to think we are.

Dr. Chilukuri (07:22):
Well, exactly. So for the band itself, that's, uh, oftentimes the underlying cause of that band is gonna be the muscle. And that muscle, like we described earlier, is called the platysma. And so we have an amazing muscle relaxant. The first brand name was called Botox, and now we have four other players in that arena. So we have Botox, we have Dysport, we have Xeomin, and we have Juveau and the latest to be added to the market is called Daxify. All of those ingredients, those injectable ingredients, what they do is do a temporary regulation of the muscle strength. So if that platysma the muscle itself, especially on the anterior portion of the neck, the front portion of the neck that we can see as we're talking. And if you look in a mirror and you dictate a couple of sentences and you realize that there's something that a line that's going up and down from the chin down to the top of the chest, if that line is moving back and forth, that's usually the muscle underneath that's overactive or hyperactive or more noticeable. So we can use something as simple as a couple of needle injections to soften the strength of that muscle. Not paralyze it, but just soften it. So that's the anterior, the front portion of the muscle like you're describing. And then once we soften that, we can lift up the skin and use that soldering iron like we were talking about.

Dr. Furnas (08:38):
So the, the bands or the cords, you know, hang down. A lot of times people think that that's just pure skin, just sagging skin and, but that the platysma is unique doesn't happen in everyone, but it can cause those bands. And sometimes it's like a, a direct line from chin to collarbone. And uh, can you explain why? Because it seems like that would be a a, a hanging muscle. Hanging muscle must be relaxed. So can you explain how the neuromodulators, the neurotoxins, the Botox and the others work?

Dr. Chilukuri (09:14):
Definitely. So the way that it works, it's gonna soften the activity of that muscle getting activated. So if you're creating a bicep, right, you're gonna be lifting up your arm in this case on the neck as we talk, that muscle naturally the attachment that's gonna occur, at least from the, from the chin or from the jawline down to the top of the chest that's being activated with the speech that you're doing because the tongue is gonna move and you're gonna have some speech and you're gonna have some motion that way. The upper portion of that muscle oftentimes is gonna not, oftentimes it's gonna actually attach higher into the face. So if we release the portion of that muscle that pulls down the natural activity of the top half of that muscle is gonna allow it to, because it's unopposed, it's not being pulled down, it's going to be able to lift or release the downward pull. So you don't see as much of that, that neck skin being pulled downwards.

Dr. Korman (10:11):
So what about threads or does threads help? And I always thought threads are not strong enough to pull on the neck muscles. So tell us.

Dr. Chilukuri (10:19):
So there's several different types of threads. There's a, Dr Greg Mueller or Miller, he actually created a procedure using a thread where he used this thread, he calls it my elevate. And that thread he's using to saw through those bands that are in front of the neck, that part of that platysma part of that muscle. So he saws through the thicker portion of that and with the expectation and the hope that by sawing through it, you don't have to actually sew that muscle together. There's also something called P D O threads, poly dioxin threads. And they can be used, there's three different versions that are typically used in the US overseas. There's two other versions. And if you think about the one that you're gonna quote unquote reset or pull where the skin is coming from, think about it like the stem on a rose.

(11:07)
So there's little rose thorns that are coming out at different angles and you can take those thorns to grab the underside of the skin and kind of tug it upwards towards the ear on either side. So as a result, if you think about a V from the top of the chest, the base of the V is at the chest and the outward portion going towards the ears, you can pull some of that skin and help it kind of um, I guess angle it up towards that ear so it looks tighter. It gives the imaginate, it gives that illusion of being tighter over time if you're putting some of these threads in as they dissolve. It's the same material that we use for sutures, like when we sew somebody up. So over time those tracks that you're creating basically cause scar-like tissue underneath. And when that scar-like tissue is underneath with enough trauma or with enough uh, insertions, you can get some shortening of that scar which gives the illusion that it's gonna be lifted.

(12:07)
It's not the same thing obviously as a surgical neck lift, but it gives that illusion. Some people use, and especially in Instagram, you're gonna find they use something called smooth threads. And the ones that I'm describing or originally was called, they're called barbed, B A R B E D, like the thorns, smooth threads is what looks sexy on Instagram, on TikTok. And they're all these little pink, yellow, blue, whatever color that you have that are sitting underneath creating what looks like a hammock. And those, at least for the patients that we see, we see that it might improve skin quality, but in our hands it doesn't help us reset or reposition where the skin is.

Dr. Furnas (12:47):
Some people actually don't have bands, but in between the, the two, 'cause the platysma is a paired muscle, the left side and the right side, and there can be a space in between and deep to that there can be fat and sometimes that fat bulges forward and people often call it their Turkey gobbler. How do you handle that?

Dr. Chilukuri (13:11):
So the nice part is we have more tools that we can use. Again, the the gold standard, depending on how much fat is there, you can use liposuction very quick type procedure. The recovery is relatively, it's on the easier side compared to some surgeries that are out there. But if you wanna do it in a non-surgical fashion where you're not not, and really liposuction, some people argue it's not true surgery. But if you wanna do it in a quote unquote less invasive fashion, you can use something called Kybella, which is deoxycholic acid. And what that uses is your natural, it's a substitute for what we create in the gallbladder. It's basically a detergent. So when we eat, let's say steak and there's all this, this fat or gristle inside the steak, our gallbladder produces deoxycholic acid to break down that fatty tissue. Same thing, we can use an external version of that to inject inside where that fat is and we can cause that detergent to break down some of the fat cells.

(14:10)
Your body comes and absorbs it. Our issue with the Kybella or the deoxycholic acid, we couldn't control the swelling that would occur afterwards very well. So we wouldn't know whether that person, if you're coming in, we don't know, are you gonna be swollen for three days, three weeks, three months, an occasion. So it was a little bit less predictable with the advancements of what we can do with technology, we can use that same exact same device where I was talking about using it like a soldering iron. We can change how long it sits inside the skin. So we're changing basically the temperature inside, underneath and we can use that temperature when placed long enough to actually cause destruction of the fat cell. And the name, the fat cell is called adipocyte.

Dr. Korman (14:53):
There sounds like there's lots of these different technologies. Do you do these at the same time? Do you do them at different times?

Dr. Chilukuri (15:01):
So depending on what we see for the patient. So oftentimes I'll do these procedures in combination. If I'm treating the fat, we can do deoxycholic acid, we can use a device called Atmos. If we see loose skin, maybe we talk about threads where we can, if you're picturing repositioning where that skin is sitting, and one of the questions that you'd asked earlier was, what, where does that skin go? The skin actually, even though there's an accordion type of effect, it repositions itself and it smooths itself out. It's pretty remarkable how the body works. It's not like carpentry on wood where you cut it one time and and you know that wood's not gonna be coming back with the skin. We have regenerative capabilities and some of the trauma alone, just from using a needle or using a thread, we're gonna cause the right cells to come into that area to then produce collagen and elastin. I know those are buzz terms. Collagen, if you think about it, it's gonna be like the grid underneath the skin that gives us some structure and elastin is what's gonna give the rubber band effect for that skin. So if we lift up on our hand, on the back of our hand or if we pull down on our neck and if the skin snaps back, part of that is because of the elastin. So I do combination, short answer.

Dr. Furnas (16:14):
What about the lines of the neck that some people see and even babies have them, but they can, they can get worse with time and they can be really deeply etched.

Dr. Chilukuri (16:26):
They are. And you're talking about the horizontal lines, like the necklace lines?

Dr. Furnas (16:29):
Exactly.

Dr. Chilukuri (16:31):
Those are so tough. <laugh> <laugh>. And I don't know if you guys have found some non-surgical ways or surgical ways to improve that. I do look at photographs and that's one of the requirements if somebody's gonna come in for new patient consultation, because I really wanna see how are they born, what did they look like in their toddler years, what did they look like in their teenage years? And especially now with the advent of high resolution photography, we can really zoom in with the older photographs. I always ask if they have a negative and we actually have a scanner here where we can take that negative, I can put it inside the computer within about 45 seconds and then I can blow it up and to see what was the depth of those horizontal neck lines as a child if they were deep as a child.

(17:13)
For me, from a non-surgical standpoint, I don't have much solution. We can do temporary fixes if it's that the, the line was always there, but it's a little bit deeper, then we can talk about doing things like, uh, like a filler. And fillers are most commonly hyaluronic acid is what most of us use because hyaluronic acid is, they're sugar molecules, they're naturally produced by the body. And as we continue to have birthdays, we don't produce as much hyaluronic acid with hyaluronic acid being there. It's, it's a water collecting type molecule and you can find it creates both structure as well as that hydration in that area. So it gives the illusion or the appearance of less depth to those horizontal neck bands.

Dr. Korman (17:55):
So let me go back just for one second. If we talk about prevention a little bit, what are the things that younger people can do? And I use younger people as loosely as you'd like to prevent some of the deeper wrinkles. Deeper etching is using, you know, lotions and potions on your neck when you're starting, when you're 20 the right thing to do. Does that mean you should be using Botox or having Botox like before you even see the bands? I think in the, the world of Instagram and other things, everybody's wanting to go earlier and earlier and some people are, oh no, that's just a waste of money. But I mean, I have a personal thought that the men and beards, beards since Covid started is very popular. But I think, I wonder whether that means that there's less moisture actually getting applied to the necks and whether that's actually ultimately not such a great idea for long-term, uh, support of the neck. But what, what do you think like what should people of all ages do to to help their own necks?

Dr. Chilukuri (18:57):
If you have to pick one topical products as something that gets put externally on the neck skin or the face skin and you can only pick one thing to go to a deserted island with, I would pick retinol or retinoid in that category and retinoids in that category, what they do is they improve cellular turnover. Somebody who's in 20, 30, 40, even 50, what we're talking about, how quickly does the entire skin layer turn itself over? And that's typically anywhere from 21 to 32 days. If you have healthy skin, no acne or anything like that when you use a retinoid, something in that category where it helps improve the cellular turnover, if you're using that product for more than three months, sometimes up to four months, you're gonna find that that cellular turnover where the bottom layer of that epidermis goes to the top and gets shed, it's as short as seven days.

(19:50)
When you're constantly improving that cellular turnover, the cells that are sitting underneath and the top layer of the dermis, which is just below what we scrape off, if you have a rug burn, they continue to be active and those fibroblasts, the little cells that produce collagen acid are more active when you're using some type of retinol. So that's my go-to. And there's different things in that category. Some people come to me, they're, I can't tolerate Retin A. Okay, no problems. Let's figure out what other ingredient that we can utilize for that same cellular turnover. So what can we do at home? There's a plant extract called bakuchiol. Bakuchiol is found in one of my favorite topical products and that product is called Melatonik. It's from a company called Isdin out of Spain. Melatonik, it doesn't dry out the skin so you can use it safely every single day on the face and safely on every single day on the neck without drying out the skin.

(20:43)
And when you have promote that cellular turnover long, you're gonna find that it looks like you had a laser resurfacing, a chemical deep chemical peel, and you have more skin health noticing that if you pull down on the neck skin or you pull out on the facial skin, it snaps back faster. That's my number one go-to. If you let me have a second go-to where I go on that deserted island and I'm stranded, I'm gonna pick a sunscreen. And if I have to say what broad category sunscreen, not naming any name brands, I want something that has zinc oxide and titanium dioxide. Those two ingredients are called mineral sunscreens or physical blocks because they are, they're, it's not a chemical sunscreen. A chemical sunscreen's gonna be avobenzone, oxybenzone, meth, benzone, those type of chemicals and chemical sunscreens, when they're exposed to air, they basically dissolve.

(21:37)
They're not stable molecules and they dissolve in most cases in around two hours or so. In this case when you're using a physical sunblock, unless you're washing it off with the ocean sand or either sand or with the water, they last most of the day. And so that's gonna prevent some of that collagen and elastin breakdown. So now I'm promoting elastin and collagen buildup because of the, the retinol or retinoid and I'm gonna prevent some of the breakdown with the sunscreen. So those are two of my favorite ingredients. I think everybody should be on them. And when people come to visit me as a dermatologist or as a cosmetic dermatologist, they have to have the right regimen for their skin. With those two products, everything else is a bonus.

Dr. Furnas (22:22):
There are some products made specifically for the neck. What are your feelings about that and why are they specifically for the neck?

Dr. Chilukuri (22:32):
Good. So that's a great question and also it's also relates to another question which I always ask companies and I ask patients, and patients ask me oftentimes, especially online and on Instagram, they ask, do I need to do a medical grade or professional grade skin care line? And what's the difference between something like Oil of Olay, CeraVe, Cetaphil, Aveeno, great products that are out there and typically it's gonna be molecular size. So we know for the facial skin and the neck skin, they're slightly different on the facial skin. We have more blood vessels, we have more pores or openings and so we have more capability to allow some of these molecules to penetrate in and provide activity for, for whatever we're doing. Let's say it's building collagen elastin for the neck skin, two things happen. We have fewer, if you wanna call them pores, we have fewer openings inside the neck skin and the neck skin tends to be a little bit thinner and a little bit more delicate.

(23:27)
So there are specific products that are medical grade products that allow us to better protect the neck, better enhance the elasticity and the collagen production that's going on underneath that neck skin. So I do think that there's really, there's four pretty darn good products that are out on the, the market right now. One is by DefenAge and DefenAge you can get from any, uh, medical provider. And what does that do? That's gonna be, it's even though they call it a serum, it's gonna be the last step that you put on, if you use a moisturizer, it's gonna be the last step, or it's gonna be the last step before you put a sunscreen on. It activates something that sits at the, that follicular opening, the pore opening of that we all have, and that's called an LGR6 cell. That LGR6 cell then goes and asks your own body to activate the fibroblasts, which again, that produces collagen elastin.

(24:24)
So it's a neat product. There's something by Revision, it's called Nectifirm. So how does it work? It uses, depending which, which version you're using, it used anywhere from four to 12 different peptides. And peptides is kind of a buzz term, but those are the active molecules that are gonna go inside the skin if they can penetrate in and then create more of the production of collagen elastin. Same thing. SkinMedica has a fantastic product that's out there and my other favorite is from Alastin. So four skin care lines have really done research, not just from looking externally by taking photographs, but really looking internally by doing biopsies to see what's going on underneath the skin.

Dr. Furnas (25:04):
Now some people don't wear sunscreen for many years and they will come in with an unusual sort of pigmentation where under the chin, you know, it's like the, the chin is the awning and it's uh, there's not a lot of sun damage, but there's a lot of sun damage on either side where you don't have that awning sticking out. How would you address that hyperpigmentation

Dr. Chilukuri (25:30):
On the outside portion? So I call it the lateral, um, two-fifths of either side of the neck. What we do is we oftentimes will use lasers, lasers or I P L, which is multiple wavelengths of light. A laser means it's a single wavelength of light. So we can target, especially with an I P L where you're using multiple wavelengths to go after the pigment and the redness, depending on which wavelengths you're utilizing, they're gonna be absorbed by different things inside the skin. And those things that are absorbing the light are called chromo force. So the top three or the most common three chromophores that we talk about from plastic surgery as well as dermatology, are gonna be water. They're gonna be melanin or pigment and it's gonna be hemoglobin or oxyhemoglobin. So the oxyhemoglobin represents the redness that we see visually outside of the skin.

(26:19)
And the melanin is gonna represent the pigment that we see outside of the, like with our, our naked eye. So you wanna pick a light source that's gonna absorb, get absorbed by those chromophore. So we have fantastic devices. I mean it's incredible what we can do today versus what we were doing 20, 25 years ago and quite safely for all skin types. So even as dark I am, if I know you're on the, we're on doing a podcast so you can't see me, but I'm what's called a type four skin. I'm from India, and so I can tan easily. I have good tan skin, olive skin if you wanna call it that. And so I absorb a lot more of this light that's being produced from a, uh, a laser or an I P L. So I have to be cautious because my melanin inside the skin, the pigment inside my skin is gonna absorb some of that light.

(27:08)
And if too much energy is being absorbed, it'll cause a burn. And that's what leads to, uh, either chemical thermal burns or it'll lead to something called post-inflammatory hyperpigmentation, which is gonna be darker spots that we're trying to get rid of. And so we have safe lasers. Usually it's in something called a 10 64 nanometer and 10 64 stands for the wavelength of light that's gonna be produced so we can treat all skin types safely. There's a newer one that's out, it's the company's called AdvaLight, A D V A L I G H t. It used a 5 89 nanometer that's safe for every skin type throughout the summer, throughout every season. So we really have better technology today.

Dr. Korman (27:49):
So it's amazing. And since you can't clone yourself to be in every, every block on every street corner in every town in in the world, if someone is looking for non-surgical aesthetic treatments, how would you recommend choosing a practitioner? Because they don't know what to ask for to have all these many different availabilities of lasers and things. So what, what would you suggest?

Dr. Furnas (28:15):
And there are a lot of people advertising, so there's a huge,

Dr. Chilukuri (28:19):
There are a lot of people advertising <laugh>

Dr. Furnas (28:21):
<laugh> a huge selection. Yeah. So how do you choose?

Dr. Chilukuri (28:24):
And uh, you know, um, I think the three of us, I consider us to be old-timers. This is my 24th year of practice and we didn't have advertising like this. We were frowned upon even if we put an ad in the yellow pages and forget about a billboard, uh, back in our, when we started practice. And today Instagram is an automatic billboard. TikTok, if you can dance well that's a different billboard and everybody's a self-proclaimed expert. So how do we, what questions would I ask my daughters to ask when they go to see somebody who's a physician or a non-physician provider? Number one, how long have you been doing this? So let's say it's for lasers. How long have you been working with lasers? What was the training that you had for those lasers? Meaning did you take a weekend course? Did you train in it in residency?

(29:12)
And uh, both of you all are plastic surgeons. So you know that residency is anywhere from five to seven years. The same thing in dermatology. It's three intensive years after your internship year to train. And then for me, I did a, a fellowship as well. So that's another year to two years depending on which, where you're doing your fellowship. So that's relatively extensive training. Not that you can't do the technical aspect of running a laser, but it's more to recognize what settings should we use and if there's a complication. 'cause if we do this long enough, there's gonna be a complication. How do you handle that complication? How many complications per week do you see? And if somebody tells me they have not seen a complication, that's probably not the person I'm gonna visit with for getting my own personal work done. Because that, I always say that means if you have never had a complication, either that person's gone somewhere else or you haven't been doing this long enough to see your own complication. Because at the end of the day, when we see a complication, we need to know how to treat it to prevent any long-term scarring. So those are probably my top three questions that I would, I would ask a physician or a healthcare provider.

Dr. Furnas (30:20):
And you mentioned the social media, TikTok and Instagram. Now some people will, will steal photos and whatnot. Is, are, are there any sort of security type ways to figure out who's honest?

Dr. Chilukuri (30:37):
I haven't seen that yet. Well, so there's two different questions there. I think one is online. Can I tell that it's actually that person's work? Not necessarily. But if I'm doing an in-person consultation and somebody's coming to see me as a potential patient, I'm gonna be showing them this is a 54 year old woman who's similar to you. This is a 61 year old man who's similar to you and here's what we did. And it's not, uh, you know, as a patient coming in who may not be educated in what we're talking about, it's not about what device or what technique is mentioned. It's does that person look like I do and does the result look natural to how I want it to look? And so I'm a huge proponent of asking for multiple before and afters. And if those before and afters, the before looks like you do now and the afters look like how you want it to look, there's a chance that you can ask further questions. Then you ask you about, you know, experience complications, et cetera. And so I, I do think it's important to have an in-person consultation if you're attracted to whatever the, the postings are on social media.

Dr. Furnas (31:46):
Uh, a lot of people also rely on reviews and you're a plus 4.9 'cause we never want, uh, 5.0 because that, that tends to mean faked reviews. 'cause you've got 204 reviews, so

Dr. Chilukuri (32:02):
Oh wow. Thank you. I didn't know that.

Dr. Furnas (32:03):
 <laugh> so, so, so reviews also are another way to, you know, if you see a lot of reviews that are 5.0 and they, they sound the same, they're very often, uh, maybe suspect, but reviews I think overall can be helpful in choosing.

Dr. Chilukuri (32:21):
I think they're very helpful and it also gives you an idea a lot of times, like whether we review, if I look at reviews on Amazon, I look at reviews on Google. If I'm looking up somebody or something, I wanna see what was the negative experience and if the negative experience is with the physician or healthcare provider, I'm more likely to see is that something I could live with? I saw recent reviews with a who, somebody who's a fantastic plastic surgeon, like state-of-the-art cutting edge does so much research. And when I saw her reviews, I was surprised. I was like, oh, okay, let me see what the patient said. Every single patient was thrilled with their results from her and expressed how compassionate she was, how she's a leader in the field. But the ones that gave negative reviews, let's say a three star or below always criticized her front desk and they, the ones that were negative reviews were from a year and a half ago. So I called her and I said, Hey, any chance you've read your review reviews and has that person been upgraded? And sure enough, she'd already upgraded that, that reception area.

Dr. Korman (33:24):
I think it's also a testament when you have really good reviews that this is a, a world of realistic expectations are really important. So I think it also, especially when you're doing a non-surgical neck lift, obviously having true for anything but specifically the neck is such a, a dynamic area that non-surgical great reviews is also a testament on your being able to tell people what they can expect realistically.

Dr. Chilukuri (33:55):
Thank you.

Dr. Furnas (33:56):
I agree. I think, you know, even with surgery, the, you know, the neck skin is inelastic with age and it can really be be tough. Some people have, you know, their trachea and little, you know, sort of this wishbone like thing is very forward and, and you know, with very little, um, chin and people are looking for that right angle. And so if that, uh, that clarity is not explained, you know, with no matter the the most aggressive surgery there will be people who, if they don't understand that will be disappointed with non-surgical techniques. That really does take a lot of communication as far as what can and can't be done. And so yes, that means that the patients really understand what you're able to do and I'm impressed with all that you are able to do so.

Dr. Chilukuri (34:48):
Thank you. You're so kind.

Dr. Furnas (34:49):
It sounds like it's not a myth. It is a reality. <laugh>

Dr. Chilukuri (34:55):
To a point.

Dr. Furnas (34:56):
Yeah. To a point.

Dr. Chilukuri (34:58):
And uh, I think what you've described is so important because it's not a, do we only do non-surgical? Do we only do surgical? I think that overlap is pretty remarkable. We're so blessed in Houston, we have fantastic plastic surgeon that I refer several plastic surgeons that I refer to and they refer back and occasionally the plastic surgeon will actually refer the patient to say, let's improve the skin health of the neck so that way we can give you realistic surgical expectations and vice versa. If somebody has a very heavy neck like you described, maybe there's more fat there, there's more skin there, or a lot of skin laxity, which is skin looseness. I'm gonna recommend, let's go get a consult first, see how much is gonna improve and then come back. And my job or my goal anyway, is to maintain that surgical result for the rest of that person's life.

(35:48)
And in the past we couldn't say that and we would say, okay, last about seven years to 10 years now with the technologies that we have, especially somebody who's undergone the knife with the facelift, a neck lift, a lower third or a full facelift with the neck lift, we've been able to maintain those results so far for 15 to 17 years without looking like there's any change. So it's maintaining that person's balance and harmony in the face and neck. So I think it's really important to understand that your cosmetic physician or healthcare provider really should be aware of their limitations. And I say that all the time.

Dr. Furnas (36:27):
Thank you for joining us, Suneel. This has really been so interesting and we've really enjoyed having you on as our guest.

Dr. Chilukuri (36:37):
I appreciate you both.

Dr. Korman (36:39):
And tune in next time where we look at new things for non-surgical treatments here on Skintuition.