iEnhance..com Staff Report

When Robert Kotler, M.D.,a former star of TV's Dr. 90210, plastic surgeon and medical author picked up the best-selling book, "I Feel Bad about My Neck." Nora Ephron's witty collection of essays on the trials and tribulations of getting older, the doctor read a line that stopped him in his tracks.

Cosmetic Surgery

"I read Ephron's book because of the title which refers to a cosmetically displeasing neck," Dr. Kotler told iEnhance.com. "It caught my curiosity because I have performed many neck cosmetic surgeries and know a thing or two about the procedure."

Specifically, the Ephron phrase that caught Dr. Kotler's eye was: "If you go to a plastic surgeon and say 'I'd like to just fix my neck,' he will tell you flat out that he can't do it without giving you a facelift, too."

Retorts Dr. Kotler: "Not so!"

Neck Lift

Dr. Kotler, who is himself the author of several books and a member of the American Medical Writers Association, adds that Ephron's book is otherwise "terrific." Nonetheless, the highly acclaimed Ephron is dead wrong about her neck and plastic surgery, he insists.

"If a sophisticated, Oscar-winning writer can hold a false assumption about plastic surgery, so can many others in the general public," says Dr. Kotler.

Although not very many people have heard about the neck lift, it is a specific surgical procedure that can repair the much dreaded "double chin" that so often makes you look older and mars an otherwise wonderful profile. A sagging neck is also known to patients as the "family neck" because the condition tends to be inherited.

Plastic Surgery of the Neck

A neck lift is also known as an extended neck lift or a neck sculpture. Experts say it's relatively easy for a trained, experienced plastic surgeon to repair because it only involves a short, horizontal incision placed below the chin, leaving the ensuing scar out of sight.

"Good candidates for a neck lift are people 30 to 60 years old who have elastic skin," Dr. Kotler says. "Working through that one-inch incision under the chin, I remove fat with liposuction or excise it by surgery. I can then see the underlying platysma muscle."

Double Chin

A double chin often develops because, with age, the platysma muscles relax and allow other tissues and fat to bulge downward.

Following surgery, with the fat gone and the muscles rejoined, the patient's skin redrapes and falls smoothly over the underlying, now tighter structures. After healing, the sagging "double chin" is seen no more.

Depending on the patient's facial profile, he or she may also opt to have a chin implant put in at the same time. Experts say it's because many patients seem to have a receding, as well as a double, chin. The combination can drastically change the patient's face as in the accompanying before-and-after picture.

But if the patient is older, and has inelastic skin, an additional step must be taken to trim sagging neck skin away. Dr. Kotler makes incisions in the creases next to, and behind, the patient's ears and into the scalp. He then redrapes the excess skin up and back, toward the ears. The surplus skin is trimmed, leaving most incision scars hidden in natural folds and the hairline.

Apparently, author Nora Ephron discovered a common truth: while middle age may begin at 40, all too often, so do double chins.

In addition to being the author of three books for consumers, including "Secrets of a Beverly Hills Cosmetic SurgeonÖ" (Ernest Mitchell Publishers; 2003, Beverly Hills, California) the board-certified Robert Kotler is a Clinical Instructor at the University of California, Los Angeles, and has been in private practice in Beverly Hills for 20 years.

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