๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Combination procedures
Combination procedures
While surgically based procedures are effective, results can be maximized by combining these approaches with energy- based devices. Following liposuction, highintensity ultrasound, RF needling or thermistor-regulated radiofrequency technology can be performed on the neck to aid in further contraction of the skin.
Recently, the synergistic effect of combination botulinum toxin injections (using both a microbotox approach and a Nefertiti lift) and sodium deoxycholate injections has been described.9,13,46โ48 The Bellatox technique led to significant aesthetic improvement after
a single treatment, though further studies are needed. Ultimately, complete rejuvenation of the neck is rewarding and requires many different devices and techniques in the dermatologic surgeonโs armamentarium (Figs. 79-5 and 79-6).
CONCLUSIONS
The neck is a critical cosmetic area that has historically been overlooked by aesthetic dermatologic surgeons. As patients increasingly expect rejuvenation of not just the face, but the neck, hands, and other areas as well, neck rejuvenation is increasingly becoming a focus of patient concern. Indeed, perhaps related in part to the new availability of minimally invasive approaches to neck rejuvenation, a significant proportion of patients are now interested in such procedures.
Figure 79-5. Combination treatment with high intensityโfocused ultrasound, onabotulinum toxin A, and sodium deoxycholate. (A) A 58-year-old woman before treatment. (B) Three months after treatment with high intensityโ focused ultrasound to the lower face and neck and 60 units of onabotulinum toxin A to the platysma. (C) Four months after previous treatment, no additional intervention. (D) Three months after a single treatment with sodium deoxycholate for submental contouring (4 mL); note improvement in submental region and worsening of platysmal bands as onabotulinum toxin is no longer active.
Figure 79-6. Combination treatment with intense pulsed light and nonablative fractional laser. (A) A 49-year-old woman before treatment. (B) After a single treatment of intense pulsed light and 1,927 nm fractional laser.