What Chin Lipo Couldn’t Fix: Kirstin’s Deep Plane Neck Lift

Announcer (00:02):
You're listening to Alabama the Beautiful.

Kirstin (00:05):
All right. I'm Kirstin Jarvis and I'm here with Alabama cosmetic surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Koehler, and Dr. Gardner.

Dr. Koehler (00:14):
Hey, Kirstin.

Dr. Gardner (00:15):
Hey, Kirstin.

Kirstin (00:16):
How are y'all?

Dr. Gardner (00:17):
Good.

Kirstin (00:19):
All right. So today we're talking about something a little bit different. Today, I'm not just the host, I'm the patient. So Dr. Koehler and I are going to talk about my deep neck lift journey and the questions that you should be asking a surgeon that you're considering for surgery and why the right procedure chosen between you and your prospective surgeon is everything. Let's talk about it.

Dr. Koehler (00:49):
All right. Let's do it.

Kirstin (00:50):
Okay. So Dr. Koehler, what made you want to share my story specifically?

Dr. Koehler (00:56):
Well, because I don't think a lot of people are going to believe you're 55 years old. And that's why I was like, I mean, really, you look that good. I mean, no one's going to believe you're 55. So I'm going to have to talk about your story.

Kirstin (01:09):
Okay. All right. So for people who've never really heard of a deep neck lift, because I hadn't before I started working here, how would you describe it in simpler terms?

Dr. Koehler (01:20):
So basically it's a procedure where we're sculpting the deep neck. Basically, the soft tissues below the mandible. So when people have a double chin or a very full neck, that is what the deep neck lift involves. Now, in some people it can be done, like in your case, it was done as a procedure in and of itself. In a lot of surgeries, it's combined with a lower face and neck lift. So when we do a lower face and neck lift where we're tightening up the tissues of the face and the jawline, and in order to get a good neck contour, we need to do that deep neck work. And so it is pretty much always involved in a facelift, but in the right patient who doesn't have a lot of laxity, but just has some fullness in the neck, it's a procedure that we can use to contour the deeper neck structure.

Kirstin (02:20):
So it's different than a facelift.

Dr. Koehler (02:22):
Totally different than a facelift. Like I said, it's a part of a facelift. Like that procedure, the deep neck work is done with every facelift, but it is not a facelift. What it does, we do tighten the muscles in the neck, but we're also contouring and removing fat. Sometimes we're contouring some of the deeper muscles and sometimes we're shaving down the saliva glands that your submandibular glands, if they're hanging down a little bit, we're contouring all those deeper structures to give you a better jawline neckline. In a younger patient, so yeah. Like me? Like you, a younger patient who doesn't have laxity along the jawline and their cheeks are full and they haven't had descent of all their fat pads. In your case, you had fullness in your neck and it's something that you said it's bothered you for many, many years, right?

Kirstin (03:15):
Yeah. It didn't matter if I lost weight or not. It just was there all the time.

Dr. Koehler (03:22):
Yeah. I mean, I think what you said to me is you had more chins than a Chinese phone book. Is that right?

Kirstin (03:28):
Yeah.

Dr. Koehler (03:29):
Is that what you told me?

Kirstin (03:29):
That's what came straight out of my mouth.

Dr. Koehler (03:33):
Okay. Well, anyhow, no, but laughing aside, I mean, when we talked about this, in fact, the reason I thought it would be a good point of discussion is that my surgical team and a lot of people here were like, when they heard you were having this done, I mean, there were people going, "What? Why is she having that done?" And coming from people who this is what we do for a living here, right? I mean, I was a little bit kind of like, "Okay." But what was very interesting is in the whole process of doing it, it was one of those things that while we were doing it and after we did it, it was like a big light bulb went off with a lot of people. They're like, "Oh, they're like, I didn't really notice that before, but now..." And all of a sudden they're like, Oh, but once again, though, it's important that people are doing the procedure for themselves.

(04:29):
I mean, we're not here to please our staff members here. You didn't do your neck for them, you did it for you. " And same reasons, people can go, "Oh, why is she doing that? " Listen, that's her neck. There's something that has bothered her for a million years. And although you might look at it and go, "Well, I don't think her neck looks too bad." It was in your case, it was something that ... I mean, it bothered you, right? I mean- Yeah,

Kirstin (04:54):
I've had to learn how to hold my head in pictures so as not to enunciate my big fat neck and my many chins.

Dr. Koehler (05:07):
Your many chins, yeah. But I think the thing about your procedure and the reason why ... Well, you mentioned choosing the right procedure. If I can go off on that, I think there's a lot of doctors that if you'd gone in for a consultation, in fact, if you'd probably seen me in consultation in my first five years of practice and you came to me and said, "Well, I don't really like my jawline neckline," I would've offered you liposuction of your neck. And I assume that probably a lot of doctors would have offered you that and it would've been the wrong thing. You would've got a result. It's not that you wouldn't have gotten a result. You would've got a result, but what we did addressed where the problem really was. Okay? So we've got the skin underneath the skin, we've got a thin layer of fat. That's the fat that you can liposuction.

(06:03):
Beneath that fat is a muscle that runs from your chest all the way up into your face. And underneath that muscle are the muscles that we use to open our mouth. We've got deeper fat pads in there, and then there's the saliva glands and a lot of other structures.

Kirstin (06:20):
I can see where this is going.

Dr. Koehler (06:22):
Well, yeah. So if the problem is with this superficial fat, then liposuction works just fine. But in many people's cases, the reason they have that fullness in their neck is because of some of those deeper structures. And in your case, contouring that and tightening up the muscles and doing a few things like that made all the difference in your chin neck contour. And so that's where I think the experience of the doctor comes in and again, like I would've treated your problem differently in my first five years of practice than I do now. And it's just because of evolution of what my experience has shown me and what the limitations of each of those procedures has.

Kirstin (07:06):
I honestly thought you were going to say something about my big strong jaw muscles, neck muscles.

Dr. Koehler (07:14):
No.

Kirstin (07:15):
Okay. All right.

Dr. Koehler (07:17):
You have big strong neck muscles?

Kirstin (07:19):
Well, that'd be the first time that you wouldn't make fun of me running my mouth.

Dr. Koehler (07:23):
Oh, yeah. Well, you do have that problem, but that's just ...

Kirstin (07:26):
Okay. Well, okay. So what else? Didn't you do some Renuvion?

Dr. Koehler (07:32):
Yeah, we did do that as well to just sort of help with the skin tightening as well. But yeah, we mainly just trimmed down some of the muscles, like the deeper muscles we trimmed down your digastric muscles. We took some of the deep fat away from the deeper neck and then shaved down a little bit of your saliva gland that was hanging down just to make room for when we tuck all this other tissues up that there's somewhere for all that to go and it worked out really well.

Kirstin (08:01):
How do patients know if a surgeon doesn't have the right experience?

Dr. Koehler (08:07):
All of the pieces of information you research about a surgeon, like their before and after gallery, their reviews, their credentials, their board certification, each one of those things is a small piece of information. None of it in and of itself is like, if you say, "Oh, my doctor is a board certified X, Y, Z," whatever it is, that in and of itself is just a benchmark. It does not guarantee competence. It does not guarantee a result. So asking all those questions are all still very important, but you can't put all your eggs in one basket. It's like you got to look at the overall thing. If you were referred to the doctor by another patient or another doctor or whatever, all these things are confirming that, "Oh, well, this is somebody that's been recommended to me and I've looked at their reviews and I looked at their pictures and I liked their work and I met them and I trusted them. They seemed like to answer all my questions." I mean, it's the sum of all that information that's important.

Kirstin (09:06):
Okay. Well, you talked about how maybe a less experienced surgeon would choose neck lipo instead of a neck lift. Let's ask Dr. Gardner, can the wrong procedure make things worse or just less effective? And how do you decide what is the right procedure for a patient?

Dr. Gardner (09:22):
Well, I think the wrong procedure can definitely make things worse. And just take what you're talking about with the neck. I mean, if you're just going to do liposuction and they have skin laxity and all you're going to do is empty out every bit of superficial fat they have. But like Dr. Koehler said, you're not going to address the deeper structures, the glands, the salivary glands, as well as the muscles. And you're not going to reshape and recontour the neck. Well, I shouldn't say you are going to reshape it and contour it, but you're not doing it at the level that it needs to be done. You're doing it at the superficial level. You're just getting rid of superficial fat. So I agree wholeheartedly the wrong procedure, like he said, may get you a result, but it may get you 20% of the way to where if you did a deep neck lift, you're going to get an 80, 90% improvement as opposed to 20%.

(10:18):
So yeah, I mean, those patients are still going to probably be disappointed and they're going to end up looking down the road and now you've emptied out almost all their superficial fat and so you've affected their final result.

Kirstin (10:32):
Also, I think research is important too and doing tons and tons of research before you finally decide what you're going to do because if I didn't know any better, maybe I would have gone to this fantastic injector that I know and asked for a certain injection that is supposed to get rid of your double chin. And if I wasn't happy with that result and then I came to y'all, oh, you would have been so mad, so mad. And then you might have turned me away because now I'm a poor candidate.

Dr. Koehler (11:02):
Yeah. Well, I mean, to that point, like some of these injectables and things like that, so we've talked about this on other episodes, but things like Kybella, which I'm not a big fan of, that's awful stuff. And sometimes when you're in a med spa or at a place where that doctor is not a surgeon and that person does not offer the surgical procedure to treat the concern you have, I'm not saying that you can't sometimes do a less invasive thing. It's just sometimes less invasive does not equal less complications. In fact, it can bring on complications. So in the situation with Kybella, it causes tremendous scarring and issues so that when a surgeon finally does go back in the neck, an operation that could maybe give you a great contour now is an extreme challenge because of all the fibrosis and scarring and everything else.

(11:57):
And you might not be able to achieve the result you could have potentially achieved because you did something first that interfered with the tissue planes and the anatomy. Same thing with things like sculptra. I'm not an anti-sculptor, but it's a filler that's a little different than some of our other fillers. It's not a reversible filler and it can create some issues if you're doing a facelift and you've had a bunch of sculptor injected in there. It causes, again, scarring and fibrosis that make it difficult to maybe do the best job with a facelift. So anyhow, things, even if they seem as like, oh, this is minimally invasive or non-invasive, it doesn't mean that it can't come with potential negative consequences that affect later procedures.

Kirstin (12:38):
Okay. Let's talk about recovery. From your guys' perspective, how was my recovery?

Dr. Koehler (12:47):
I mean, I didn't see you for a few weeks and you did great.

Kirstin (12:55):
I came back to work on Monday after my surgery was Friday, by the way.

Dr. Koehler (13:00):
Oh, did you? Oh yeah, that's right.

Kirstin (13:03):
Yeah. And Dr. Gardner said, "Oh girl, you look bad. Here, try some of this cream."

Dr. Koehler (13:09):
No. No, I thought your recovery was actually very ... I think a lot of people were surprised that you were back at work in three days and I mean, you were swollen and you obviously had looked like you'd had some surgery, but really not bad.

Kirstin (13:25):
The bruising, and the reason that I kind of didn't look that awesome, was not from the neck lift, that was from a different procedure. And we used the Dr. Gardner's Dermacut, which I believe took down my bruising way, way, way faster than normal because when I get lip filler, I bruise for weeks and you did PRP under my eyes and I used the Dermaccut and my bruising was gone in like four days. And then we used the compression for my neck. It didn't look bad. We've got pictures that we're going to share from two weeks out, so there's still a little bit of swelling you can see, but the result already was super dramatic.That's the picture that all the staff was like, "Oh my gosh, wow."

Dr. Koehler (14:07):
Yeah, no, and that's one of those things where the result is noticeable, but it's also subtle. I don't want to say, it wasn't like a problematic neckline or anything. It's just, I know it bothered you, but then when we cleaned up your neckline and you can see in those pictures, it's like, wow, it's not like we did a lot, but it made, I think, a pretty significant improvement in your neckline.

Dr. Gardner (14:37):
Noticeable and natural.

Dr. Koehler (14:39):
Yeah, definitely

Kirstin (14:39):
Oh, yeah. That's actually a really crazy thing that you say that, Dr. Gardner, because we saw the architects that are building our building, we saw them at a meeting two or three weeks after my surgery and they were like, "Something's different about you. I don't know what it is. Something's different about you. You look refreshed." And I was like, "Okay, that was the goal." So satisfied customer.

Dr. Gardner (15:03):
Boom. Yeah.

Kirstin (15:04):
Okay. So we still had some swelling two weeks out. What would you tell people to expect in that two, three, four week window immediately post a big surgery like that?

Dr. Koehler (15:17):
Oh, I just think there's got to be a level of patience. And a lot of it depends on the size of the patient and how much work we did in the neck. So for instance, you're not a big person, you don't have a big heavy neck, but we did do a lot of deeper work on your neck, which causes some swelling. And so if you've got a small person and then you throw in some swelling and maybe you're at the second and third week, you may be looking at a bunch of swelling and kind of going, "Oh, I'm hoping that it's going to look whatever more defined or whatever." It's too early. And so the biggest thing for people when they have this done, especially if they're a smaller person and whatever, once the swelling kicks in, it's like you got to give that at least ... It takes three to six months to get to the final result, but you need to wait till at least six weeks before you're going to be like, "Okay, yes, seeing the kind of results that I would expect." You may see results like in your pictures, you can see clearly even at two weeks there's a big improvement, but it continues beyond that.

(16:23):
And some people have more swelling than others and some people don't look as good as you did at two weeks, but not very many.

Kirstin (16:30):
Is there anything that you want people to take away from this story?

Dr. Koehler (16:35):
That you can take somebody who's beautiful and even make them more beautiful by doing a little deep neck lift.

Kirstin (16:44):
Wow.

Dr. Gardner (16:46):
You can take a nine and a half to a 10.

Dr. Koehler (16:48):
You can. You can do it.

Kirstin (16:51):
I need somebody to check these guys' temperatures. Are y'all sick? Is there something going on today? Something in the water?

Dr. Koehler (16:58):
No.

Kirstin (16:59):
Okay. Well, thank you.

Dr. Koehler (17:00):
I don't have any special take home messages. I think the big messages, do some research, get a few opinions before you pull your trigger.

Kirstin (17:11):
Okay. So where can people go if they want to see before and after photos of your work, Dr. Koehler and Dr. Gardner?

Dr. Koehler (17:20):
Online.

Dr. Gardner (17:21):
Website.

Dr. Koehler (17:23):
Check the website out.

Kirstin (17:24):
Easternshortcosmeticsurgery.com and visit the gallery.

Dr. Gardner (17:27):
Instagram.

Kirstin (17:28):
And yes.

Dr. Gardner (17:29):
TikTok.

Kirstin (17:31):
Instagram and TikTok @drvincentGardner.

Dr. Gardner (17:35):
And Facebook.

Kirstin (17:37):
And Facebook.

Dr. Gardner (17:38):
All the things.

Kirstin (17:40):
All the social media platforms. Dr. Gardner is ... We're going to get him dancing one of these days, but for now, he just likes to show us before and afters on his TikTok and Instagram.

Dr. Gardner (17:50):
Yeah. Dancing, no.

Kirstin (17:54):
Okay. If you have a burning question for Dr. Koehler or Dr. Gardner, you can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler and Dr. Gardner.

Dr. Koehler (18:08):
Thank you.

Kirstin (18:08):
Go back to making Alabama beautiful.

Announcer (18:13):
Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.