Episode 37 - Dr. Brent Moelleken: Neck and Face Lifts Part 2

Transcript

This program is brought to you by PersonalLifeMedia.com.

This is part two of a two-part podcast.  If you'd like part one, you'll find it at PersonalLifeMedia.com.

Teri Hausman: I'm Teri Hausman, host of Beauty Now.  We have a weekly show on all the latest things, like lasers, lifts, lashes, lipo, breast augs, tummy tucks, and we're back with round two.  Doctor Brent Moelleken is  telling all about your saggy necks, cheeks, foreheads, and everything else.

Brent Moelleken: Don't smoke.  It's much worse than just the wrinkles you get around your mouth.  It kind of damages the skin as a whole.  When we're doing surgery on smokers, the complication rate is so incredibly high because smoking literally damages the blood supply to the entire body.  [It] causes, you know, damage to skin as a whole, it causes shutting down of the little arteries.  So when we do surgery on someone who smokes, or has smoked in the past, we need to be very careful.  This person may look normal, but their blood supply is not. 
What happens to the eyes over time is they start to look older.  You can take that droopy skin away, but also there's tremendous volume loss around the eyes.  We literally lose fat around the eyes, and they appear sunken and hollow.  Now we don't just take away skin and fat from the eyes anymore.  We really want to restore the fat, because that's part of the problem.  Yes, we can take some of the extra skin away, but let's also replace some of the volume that's been taken away by age.  

African American skin is tough, and microderm abrasions are generally fine.  And even the photo facials, you know, used very, very carefully, can be fine.  But we want to be very, very careful before we do lasers on the skin because what if it damages the pigment cells and you get a white spot?  And that's why we don't do CO2 laser at all on black patients, because the risk is just so high. 

Teri Hausman: Welcome back, Dr. Moelleken.

Brent Moelleken: Well, it is great to be back.

Teri Hausman: Well we had a great show with you last week, and you were talking about the LiveFill, and so let's just touch base.  If you guys, my listeners, didn't hear last week, please listen to round one.  LiveFill is the latest thing that Dr. Moelleken has been working on, and it sounds amazing.  Please tell our listeners.

Brent Moelleken:  Well LiveFill is basically a way to fill in the hollowness that occurs with aging.  So people, as their faces age, they get really hollow.  Their eyes get hollow, their cheeks get hollow, you know, the smile lines, the naso labial folds get hollow.  And sometimes, the lips even decrease in size.  So what one of the things we've been working on is something called LiveFill, and it is basically the patient's own tissue, we just take strips of the patient's own tissue, we do not damage it, so we don't suction it, we don't inject it in any way, but we make a little incision and we place the LiveFill grafts into the hollow areas in the face.  And then the body's blood supply, then it checks the IV, to make sure it's not somebody else's, because it's going to reject that, but LiveFill can't be rejected because it's the patent's own tissue.  And then blood supply from the patient grows into the LiveFill grafts and it becomes part of the patient.

Teri Hausman: So you can put it in your lips?

Brent Moelleken:  You can put it in your lips.  Lips is a great place to put it in.  We make an incision inside the mouth, you know, so you really don't see it, and we put the LiveFill into the lips, and also down into the frown area, called the marionette area.  Those are the Howdy Doody lines.  The ones that go down from the mouth to the chin area.  And they start to form, and they get worse and worse over time.  So we put a little bit of LiveFill in there, that really helps to reduce the, you know, the impression of aging.

Teri Hausman: What if' you've already had a filler like Radiesse, which is supposed to last a year and a half, can you still get LiveFill?

Brent Moelleken: You can still get LiveFill if you had a filler.  Usually we like to wait a while, you know, depending on the filler, so, you know, much of the filler has gone away.  But I can tell, you know, when I get in, where the filler's been, so I can still work with that. 

Teri Hausman:  And especially like in the lips, because usually people get their lips filled pretty often.

Brent Moelleken:  Yes, lip filling has become really popular.  Now there's one kind of artistic thing, when you go to have filler put into your lips, always make sure the doctor puts in a little bit in the smile lines, and a little bit in the frown lines.  The reason is that your face ages overall, and you don't want to just rejuvenate one little area.  So you see older ladies come in, and they get their lips augmented and nothing else, and it looks odd.  

Teri Hausman:  How do you tell them that they need to do it?

Brent Moelleken:  You just tell them right away, I say “I'll be happy to do your lips, but what do you think about the smile lines and the frown lines, because it'll look more natural that way. 

Teri Hausman:  What if they say no?

Brent Moelleken:  Well then...

Teri Hausman:  Do you just tell them it'll look more symmetrical?

Brent Moelleken:  Usually people, when you tell things to them them logically, usually they'll
go with that.  You know, sometimes there are people that will say “Yeah, okay, you know, I'll just take my chances and, you know, just augment my lips.”  Usually it looks a little odd...

Teri Hausman:  Especially when they have deep lines around from the nose to the the lips?

Brent Moelleken:  Absolutely.  When we're rejuvenating the face, we don't just want to do kind of one area, because then it'll look like kind of an older face that has one area rejuvenated.  So a lot of times when we put filler in, we do the face lifts, the whole reason for the 360 face lift, we look at the face from all angles, is we want to make the whole face less old, and try to, you know, address all the little nooks and crannies, the little areas of hollowness, you know, or at least as many as we can. 

Teri Hausman:  On our last episode we did talk about the 360 face lift, I want to talk more about that, but I want to also to touch base, which I didn't ask you was, if you have like that big fat pad underneath your chin?

Brent Moelleken:  Right. 

Teri Hausman:  What do you do about that?

Brent Moelleken:  Well the fat pad under the chin is a tough problem.  For very young patients, a lot of times we can just do liposuction under the chin and that will be plenty.  For people in their 20s and 30s usually just liposuction will do just fine.  There are some patients who have, you know, they have fat under their chin but they also have the tongue muscle, called the hyoid bone, is really, really low.  So you know that the people that look like they have almost no neck, where the chin goes directly into the chest?

Teri Hausman: Right.

Brent Moelleken: So for patients like that, we don't just want to do lipo, because it won't do enough.  In those patience we want to think about doing a Neck-Lace procedure.  And what that is, is it's an incision below the chin, then we actually tighten up the muscles.  Like an interlacing fashion, almost like a shoe, like a shoelace.  We tighten up those muscles aggressively, and that gives a better jaw angle.  You know, so we don't want to see a double chin from the side, or worse yet, the chin going right into the neck.  So we need something a little bit more aggressive than just liposuction alone. 

Teri Hausman:  What about when older ladies have the big hanging chin thing going and the neck, is that included in the neck, or do you have to tell them that's something separate?

Brent Moelleken:  Well a lot of times when, it's called a witch's chin, and it's kind of, in Elizabeth Taylor you can see it a teeny bit, you know where the chin kind of comes down.  It's almost used to be going forward, and then it kind of sags down, and it's a difficult problem to fix.  But when we're doing the Neck-Lace procedure, we actually go backwards, and we take that witch's chin, and then we incorporate it, you know, into the Neck-Lace repair, so it makes the neck much smoother, and the angle that the neck makes with the jaw, we want it to be nice and smooth, and not have that, you know, witch's chin bump.  So witch's chin--

Teri Hausman:  That's true.

Brent Moelleken:  Is definitely something to fix. 

Teri Hausman:  The reason I'm obsessed with it is because you see so many women with gorgeous faces because they've had fillers or a lift or something, but then their neck looks horrible, you know how they'll wear a scarf to try to hide it or something like that, so I'm really about today wanting to talk about how can we rejuvenate our necks?

Brent Moelleken:  Well there are lots of to rejuvenate the neck.  In young patients, you know, liposuction is great, you know as people get in their 40s sometimes the Neck-Lace alone is enough, but then we have to start thinking about mini face lifts.  And the reason for that is once the skin starts to sag, then nothing we do by removing tissue, like liposuction, is going to help that sagging skin.  So we actually need to tighten the sagging skin.  For very minor sagging, we can do laser resurfacing, and that tightens up a little bit, using the CO2.  But that's not the same as actually getting in there and removing a bunch of extra skin.  You know the magic fingers, do you know what magic fingers are?  Magic fingers are when you go up to the mirror, and you put your fingers on your face, and you pull back and you go “Oh my gosh, that looks good.”  Those are magic fingers.  And that's the scourge of plastic surgeons, because people come in with those magic fingers and they want you to do miracles, because magic fingers can do miracles.  So, as a plastic surgeon, you always have to kind of bring people down to earth sometimes and say “Well those are magic fingers, so we can't use those.” 

Teri Hausman:  I like that.

Brent Moelleken:  But, here's what I can do. 

Teri Hausman:  Right.  You're a physician, not a magician. 

Brent Moelleken:  Exactly, exactly. 

Teri Hausman:  Actually though, really think you guys are magicians, you see some really great work.  So I think that's not really true.  What can we do about wrinkles in your cheeks and things like that?  I know you're going to do the lifts, and I see people that have the face lift and everything, but then they don't do the fillers and they still look old. 

Brent Moelleken:  Right.  Well wrinkles in the face, you know, there are sort of two ways to look at it.  One is that sun has shown down and it's damaged the DNA of the skin, and we have sun damage, we have wrinkles and sun spots.  And sometimes those wrinkles get really deep.  So we can't treat wrinkles like that, with face lifts.  We have to treat those wrinkles with resurfacing.  And, you know, there's lots of different types of resurfacing, but basically all of them do the same thing.  They all damage the skin a little bit, and let new skin grow. 

Teri Hausman:  Right, and that's amazing.  I love some of the new treatments out like Fraxel I love, I love the Fraxel repair, I've seen some amazing results, because I'm a sun worshiper, and so I just do that on a regular basis, just to rejuvenate myself.  And I think that's what people need to look at, regardless if they've had surgery or not.

Brent Moelleken:  Exactly, sort of taking care of your skin.  And the Fraxel is one of the new treatments, you know,   the Photofacial is something that is, you know, relatively safe, and it gives a decent result, you know, and all these things done together.  But of course, the number one and two things people need to remember is:  Number one, don't smoke. 

Teri Hausman:  Let's talk about that.

Brent Moelleken:  Yeah, smoking will damage, damage, damage the skin.  It's much worse than just the wrinkles you get around your mouth, it kind of damages the skin as a whole.  When we're doing surgery on smokers, you know, the complication rate is so incredibly high, because smoking literally damages the blood supply to the entire body, including the face.  We always think about “Oh smoking, oh I will get lung cancer, or I won't.”  Oh no, smoking causes the little lip wrinkles that get it causes, you know, damage to the skin as a whole, it causes shutting down of the little arteries.  So when we do surgery on someone who smokes, or who has smoked in the past, we need to be very careful, and just realize that hey, this person may look normal, but their blood supply is not. 

Teri Hausman:  And explain what happens when you cut into somebody that's like about smoking.

Brent Moelleken:  You definitely don't want to lie to your doctor about smoking, because, you know, for a face lift you do this beautiful face lift, and you get this incredible result, and the patient could smoke a cigarette, and the very next day there would be a huge black scab of dead skin.  That's literally how powerful smoking is, in a negative way. 

Teri Hausman:  It kills your skin.

Brent Moelleken:  It literally kills the skin.

Teri Hausman:  My mom just died of lung cancer, so not only am I against smoking for that, but also because I really want everybody to have, [to] be healthy from the inside-out, and you're not going to be able to have this procedure if you're smoking, let alone if you get lung cancer, you're taking a big risk here.  So, and I'm going to dedicate this to my mom, and also I'm going to warn my sister, she's trying really hard to quit, Mary Jo, and so maybe she'll listen to this and quit right away, she's trying, but I'm on her, we're on her, right Doctor?

Brent Moelleken:  Well the biggest gift you can give to someone who smokes is hound them until they quit. 

Teri Hausman:  That's what we're doing.

Brent Moelleken:  Hound them til they quit.  And eventually, you know, maybe the voices will prevail and the person will lay down those cigarettes.  We have really an interesting thing among our patients.  When a patient comes in for plastic surgery, we tell them, “Look, you have to stop smoking for four weeks before, and four weeks after.”  And once they do that, that's eight weeks, that's two months that they stopped smoking.  Well if they can stop for two months, they can stop for good.  And we have a number of patients who have actually done it, and quit.  That way without medicines, just by pure willingness, by willpower, you know, “I really want this plastic surgery, because I don't want to look old anymore.”

Teri Hausman:  Right, and you want to look as beautiful as you want to feel.

Brent Moelleken:  Exactly, and that is the thing that prompts them to stop smoking. 
Teri Hausman:  Well I'm going to pray for my sister that she quits smoking, and I'm going to be on her.  I'm going to be on her, because she's going to come in to you. 

Brent Moelleken:  That is a gift.  That is a gift, you know, if you can get her to quit smoking, that is far more important than anything I could possibly do in my operating room. 

Teri Hausman:  Well, I'm on her, so we'll be in there soon, and I believe in her that she's going to quit, I really do.  I think she's going to be serious about it, we're talking about it.  So anybody else out there, if you're thinking of quitting, you know, just go down to two a day, you can go down to two cigarettes a day, and then cut it out.  You can actually gradually quit, or if you can't, go to an addiction specialist, and have them prescribe some Chantix.  Is that how you say that, Dr Moelleken?  Chantix?

Brent Moelleken:  Yeah, you know, there are lots of that are coming out that are having benefits for smokers.  And I think those are all great, and whatever else people want to do, if they want to do acupuncture or behavioral therapy modification.  But ultimately, ultimately it's going to come down to a willingness to quit. 

Teri Hausman:  Yes.  Whatever works for you personally. 

Brent Moelleken:  Exactly.

Teri Hausman:  And I think that's great advice, and I'm really glad we talked about this.  And now we're going to have to take a short break to thank our sponsors, for PersonalLifeMedia.com we'll be right back with Dr. Brent Moelleken.

Teri Hausman:  Hi, this is Teri Hausman for PersonalLifeMedia.com, and Beauty Now.  We've been getting all great information from Dr. Brent Moelleken, there's so much good information in these two episodes, and it's a must-listen to.  Welcome back, Dr. Moelleken.

Brent Moelleken:  It's good to be back.

Teri Hausman:  Thank you, and you know, we've touched base on a lot of things, and I think now we need to talk about saggy, baggy eyes, you know, eyelifts.

Brent Moelleken:  Right.  Well the eyes, what happens to the eyes, over time, is that they start to look older.  As a surgeon you want to kind of analyze and say, “Well why do the eyes look older?”  Well the droopy skin, we all know about that, you can take that droopy skin away, but also there's tremendous volume loss around the eyes.  We literally lose fat around the eyes, and they appear sunken and hollow.  So now we don't just take away skin and fat from the eyes anymore.  We really want to restore the fat, because that's part of the problem.  Yes, we can take some of the extra skin away, but let's also replace some of the volume that's been taken away by age.  That gives us a more natural look than if we just take skin and fat away.  The way that, you know, we have done in the past. 

Teri Hausman:  Well, where are the incisions?  I mean, sometimes you can really see people's incisions, and it's kind of creepy. 

Brent Moelleken:  Right.  Well for the upper eyelids, typically what we do is we stick to the crease above the upper eyelid, and that means we don't go all the way to the center.  If we go all the way to the center of the upper eyelid, then even when your eyes are open you'll see that scar.  The other thing is, when we do the upper eyelids, we want to be conservative.  If we take a radical amount of skin away, and fat away, the eyes are going to appear very hollow, and the scar will be there for everyone to see.  So just five percent less removal of the skin, and the eyes look so much better, and the scar is so much better hidden. 

Teri Hausman:  I have actually seen women that can't even close their eyes, so it's really to check out your doctor, to make sure of what kind of eye lifts they do.

Brent Moelleken:  You know, but there's another thing that women do without saying a word.  And that is when you look at the before and the after pictures, look at the lower eyelids, and see what happens to them.  A lot of times, when the lower eyelids are done by just removing skin and fat, the eyelids will pull down, and they will start to look rounded.   Well that's a clue that you may not want to get your eyelids done there.

Teri Hausman:  Right, okay, so that's good to know.

Brent Moelleken:  Right, we want to have natural looking eyes when we're done.  Natural almond-shaped eyes, not eyes that look rounded or pulled down.  That's one of the main causes for eyes not closing properly after surgery, is that a lot of skin and fat was taken away from both the upper and the lower eyelids, and it's just too much.

Teri Hausman:  Oh, you just brought up something that I wanted to ask, on two points, that, you know, I have almond eyes, so it would be scary to get an eye lift or have skin taken out, because I wouldn't want them to look cat-like, which can happen.

Brent Moelleken:  Right.  Well we do for that is there's the procedure I published, and it's called the Superficial Cheek Lift.  And what we do is we go to just the corner of the eye, and we tighten, we pull up the cheek a little bit, and that gives us the ability to tighten the skin below the eye, without changing the eye's shape.

Teri Hausman:  Oh yeah, that's good, I like that idea.

Brent Moelleken:  It's a difficult concept, but the bottom is, when we do the lower lifts, we need to preserve the natural almond shape of the eye.  Or, if someone has, you know, there's people whose eyes just look sad.  There's one of, you know we did an extreme makeover on one lady whose eyes, she was very young, but she just looked so sad, because her eyes literally went down in the corners.  But we were able to change that slightly by making them go up a little bit, and, you know, do the upper lids and the lateral brow, and the whole thing just looked more open and friendly. 

Teri Hausman:  Yeah, that's a really good concept.  I've never heard of that, to try to pull your cheek up instead.  Because what about Asian eyes, I know we have a lot of Beauty Now listeners that are Asian, and could you give them advice?

Brent Moelleken:  Well, I have a philosophy about Asian eyelids, I don't like to put in the crease, the way that, you know, Occidental patients have it.  Because a lot of times, that will just not look natural.  If you put a crease in, it looks like, in many cases, like an Asian person's had their eyes done.  Now, that's just totally my opinion.  And there are, you know, doctors like Dr. Eshima, in San Francisco, is wonderful at Asian eyes, brilliant at Asian eyes, and he does such a subtle procedure that, you know, you barely, barely notice it.  And that's the kind of surgery, if you are Asian, and you don't have a fold above your eyes, that you may want to consider. 

Teri Hausman:  What about if you're white, and you're going to Dr. Eshima, can he do white eyes?  I mean, that's a loaded question, but...

Brent Moelleken:  He is a very good doctor, he is a very good doctor, no question.

Teri Hausman:  Yes he is, he is someone that I recommend a lot to people.  So, what about African-American skin?We haven't really touched upon that  for many of our listeners that do faceless cheek lifts, I hear that they keloid a lot, and it's harder for them to have surgery, is that true?

Brent Moelleken:  It is partially true that black patients, or darkly pigmented patients can be more to scar formation.  You know, keloid forming.  So we want to be doubly careful when we do the surgeries, and make absolutely sure that the surgeries are designed right, that we're not being too aggressive, and we watch the patients very carefully post-operatively.  We have them put creams on it, we see them frequently, if they need any injections to reduce keloid formations then we do those injections.  So it's not just cut and run in surgery, you've got to take care of your patients afterwards. 

Teri Hausman:  Except for so, let's touch base a little bit more about the African-Americans' skin, what kind of rejuvenation can they do?

Brent Moelleken:  Well, the African-American skin is tough.  Of course, skin care is fine, and microderm abrasions are generally fine.  And even the photo facials, you know, used very, very carefully, can be fine. But we want to be very, very careful before we do lasers on the skin because what if it damages the pigment cells and you get a white spot?  Now in a fair-skinned patient, if you do get a white spot, you might not even notice it.  But you definitely will notice it in a darkly-skinned patient.  And that's why we don't do CO2 laser at all on black patients, because the risk is just so high.  And that's one of the areas where the new technologies of Fraxel, you know, Fraxel is very minimal compared to CO2.

Teri Hausman:  Right.

Brent Moelleken:  It just can't be compared to CO2, because it's just little teeny dots here and there that get put down on the skin.  But it may be suitable for darkly-skinned patients if they need to rejuvenate their skin. 

Teri Hausman:  And that would go lightly, right?  You tell the doctor to go lightly that first time to make sure?

Brent Moelleken:  Yeah, you can't...

Teri Hausman:  Or you could do a test patch, do you do that?

Brent Moelleken:  You can do a test patch, but, you know, it's one of those things where you want the best doctor, someone that's had a lot of experience with it, and is comfortable, and he will tell you, “Look, your skin is a little bit of a problem potentially, so let's design our treatment differently by XYZ.”  That's what you want to hear, rather than, you know, “Oh, we'll just do this procedure on you.”  You want to make sure that the doctor's aware of the special risks that are involved.  You know, when we, as plastic surgeons, we see, you know, kind of two kinds of patients.  One is the patient who's never had surgery before, and is at low risk for having a problem.  And then the other types of patients are patients who've had surgery before, and they really need corrective work, or they need additional work, and those are much more difficult.  Just like patients who have very dark skin, you know, there's special problems that go along with that, and special risks.  So then, you know, the stakes are higher.  The stakes are higher because we can't have problems in those patients due to ignorance of just, you know, using the techniques that we used in, you know, fair-skinned patients on darkly-skinned patients. 

Teri Hausman:  Well, that's all good advice, and the last I always like to touch base on is how do we find a qualified, board-certified plastic surgeon? 

Brent Moelleken:  Well, this is a very, very, very tough question.  And, you know, I have a little segment on my website, you know, DrBrent.com, and you can probably get it through your references also, but you basically want to find someone who's board-certified in plastic surgery.  That's a great first step.  Then there are a couple of other societies that they can belong to, like The American Society of Plastic Surgeons, which has those two half-circle symbols, or the Aesthetics Society, which has the Nefertiti head, you know, that little Egyptian head from the side.  Those are all good signs, and that's a good starting point. 

Teri Hausman:  Because what's the difference between a cosmetic surgeon, and especially when I go to L.A., I see so many ads for cosmetic surgeons, or, you know, plastic surgeons, because I actually had a girlfriend from Newport Beach who was hilarious, and she calls me up and she says, “Oh, this doctor doesn't believe in endoscopic brow lift.”  And I said, “Do me one favor, call back and ask can he do them?  And what type of doctor is he?”  Turned out he was an internist who got his cosmetic surgery license, and he's going to do, you know, full frontal, what do you call that, the cranial one on the top, from ear to ear, the old type, and she was 39.

Brent Moelleken:  Well luckily she headed it off at the pass.  We all should kind of stick to our specialties a little bit, I would never manage high blood pressure, you know, I'm just not skilled in it.  And you wouldn't want an internist doing plastic surgery on that, I don't think.

Teri Hausman:  No, you definitely don't, and that's why I want to tell Beauty Now listeners, you can look up your and get their credentials, and I think we're learning more to do that than before, I think, you know, a long time ago we were all very naive about it.  But now, you know, after people have had complications, I think we do need to look up to see who is doing surgery.  And I know that one thing, Dr. Brent Moelleken would be a great person if you could get to Beverly Hills to do surgery with him, I think you could feel very secure.  We have learned so much great information today, thank you so much.

Brent Moelleken:  Well it's certainly my pleasure.

Teri Hausman:  And please, listeners, listen to part one first, and part two, Beauty Now, and go to PersonalLifeMedia.com for any transcripts, and links to Dr. Brent.  You can find him in Beverly Hills, and PersonalLifeMedia.com.  If you have any show ideas, or questions, concerns, if you have any questions about Dr. Brent, email me at [email protected].  Now we're going to have Dr. Brent back again, because we want to know everything we can do to our bodies from the inside-out to look great and feel great.  Thanks again, Dr. Moelleken.

Brent Moelleken:  Wonderful, it's wonderful talking with you. 

Teri Hausman:  You too, thanks, God, thank you so much. 

 

Ending song:  Mark Winter - You Had A Little Work Done

Find more great shows like this on PersonalLifeMedia.com.