Neck Lift

Recently, I received an inquiry from a surgical nurse who saw a feature on “The Doctors” TV show demonstrating the “latest, less invasive” neck lift technique from Beverly Hills that is supposed to be less expensive with faster recovery:

“I am a surgical R.N. and I have seen the procedure on TV, ” The Doctors”. A plastic surgeon is one of the hosts. He practices in L.A. A series of tiny incisions are made under the chin (maybe eight) from ear to ear. An “I guide” (a lighted cannula type device) is weaved in and out of the incisions with a suture shoestring resemblence. It goes under the chin and is pulled tight, just like tying your shoes. Very good results for a less invasive procedure that takes minutes to perform with an experienced surgeon. Less costly and recovery is fast. Everyone wins! Just check on the website “doctorstv.com”, it was on Wednesdays show I think. Wish someone would bring this here! Keep me informed please. I have also seen this on another show, but I didn’t catch the name. I just remember hearing it is fairly new and clever. I will volunteer to be a learning patient if you need. Thanks!”

“Surgical R.N.”(Actual Name Withheld for Privacy)

My reply:

Dear “Surgical R.N.”,

Many thanks for the follow-up note.

I found and reviewed the video of the procedure you mentioned here: http://www.thedoctorstv.com/main/procedure_list/1344.

The Doctors TV link gave me enough information to further research the procedure on the Internet.

There is nothing published about this technique in our respected refereed medical journals, nor has there been a presentation at one of our scientific meetings.
The IGuide technique is a variation on the Thread Lift which was a bit of a hype 5-7 years ago and has fallen out of view, if not into disrepute because it turned out to have too many unsatisfactory results and did not hold up well for most patients.
One problem is that the cost of the special sutures is so high that the procedures cost as much as more conventional techniques.
I also have some questions as to the validity of the technique conceptually, knowing what we know about essential plastic surgical technical principles. For example, experience has shown us that without some actual surgical re-draping of the tissues, suture suspension alone (like the Thread Lift and the similar appearing IGuide) fails to hold up over time (6-12 months).

There have also been problems with skin pleating: if you pull the loose or redundant skin up with a thread and don’t remove/cut-out the excess, where does the extra skin go? I have seen numerous patients who have tried the thread lift and ended up with wrinkles and pleats of the neck and cheek skin.

As a surgical nurse, you have probably seen various surgical techniques come and go, and can appreciate the importance of good medical reports including long-term outcomes that instruct us regarding validity of the procedures, satisfactory results and complication rates.

As a Plastic Surgeon, I would not do a procedure on a patient that I wouldn’t do on my own wife: Besides my doubting the conceptual validity of this technique, in my assessment, the IGuide face- and neck lift and techniques do not yet have the track record to merit one volunteering to be a guinea pig.

“Caveat Emptor!” (Let the buyer beware!)

Having said that, I do not know of anyone in Denver who is trying or offering the IGuide technique, but I am certain someone will be, in the near future, and it will be prominently advertised in our media, offering “more for less.” As I mentioned in my previous e-mail, cosmetic surgery is subject to a lot of marketing hype; The IGuide is a perfect fit for that sort of thing, with a catchy name and a promise of fewer incisions, less invasiveness (Are 8 stab incisions along the jawline better than the 1-inch incision in the crease under the chin of a conventional neck lift?) and as good results.

Thanks again for your inquiry and follow-up note.
Paul C. Zwiebel, M.D., D.M.D.