T-Z Plasty Update: Tightening Necklines for Men & Women

Monique Ramsey (00:01):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. So a little while ago, Dr. Salazar joined us on the podcast and we talked about a very cool procedure called T-Z Plasty, and we talked about who it's for, and recently he realized it can benefit more people than he originally thought. So today he's back to talk about a quick update to that procedure and what he has found. So welcome back to the podcast, Dr. Salazar.

Dr. Salazar (00:34):
Thank you so much, Monique, and as usual, as always, a pleasure to come and talk to you and our audience about different topics.

Monique Ramsey (00:41):
So for a quick recap for the audience, in case you missed that episode. So what is a T-Z Plasty and where are the incisions and how does it help people?

Dr. Salazar (00:50):
So T-Z Plasty is, as we were saying, a very powerful surgery to correct the excess skin of the neck. So the bottom of the chin and the upper mid part of the neck, if patients call it turkey gobbler, to have to correct the turkey gobbler deformity. So basically it's the tissue that goes from your chin to around the area of the Adam's apple, and a patient have excess skin in that area, and they want to improve that without the need for a neck and a facelift. Meaning pulling from far away from where the area of the issue is, you can address it with a T-Z Plasty directly. So you just wedge out that tissue and then you perform, let me say it this way, a fancy closure in order for you to have the best scar possible. Why? Because patients will have a scar right here. The scar is placed right underneath the chin and then goes down from the chin area to the area of the Adam's apple. But we have been very successful performing this surgery. Patients are very, very happy. And the scar, even though it's present tends not to be a big issue.

Monique Ramsey (02:09):
Okay. So you mentioned for some patients who don't want to have maybe a traditional face and neck lift, and this is a great way to address that turkey gobbler. So how is the scar different from maybe what would be traditionally done with the neck?

Dr. Salazar (02:28):
So in order for you to perform a neck lift, you need to make incisions, but in a traditional way, the incisions are made in front of the ear and then goes underneath the ear lobe and then it tracks back into the hairline. And then sometimes it even needs to go back into the hairline and you create a pull. Because as you know, plastic surgeons, we are really good at doing two things. One, creating nice thin scars, thin, thin scars, and we're good at hiding those scars. So traditionally the scar for a face and neck lift, it's going to go at the hairline or a little bit behind the hairline and the temple area, and it's going to go down, go around the ear, and then come up into the posterior scalp, into your hairline, behind your head. So then you give a pull all the way from the back. And then patients, sometimes they simulate by pinching the skin and the back of their neck. And then that's basically what happens with the neck lift. But you are asking how different this is. Well, you just make those incisions right where the problem is. So that's the reason why this is extremely powerful because you're not pulling from a distance, you're just correcting it right there.

Monique Ramsey (03:50):
Right there. And is the recovery different than a full face neck? I would think maybe it's a little bit simpler because less extensive?

Dr. Salazar (03:59):
It's much simpler.

Monique Ramsey (03:59):
Okay.

Dr. Salazar (04:00):
It's less extensive. You're not, and I'm going to get a little technical here, you're not undermining, you're not lifting up a lot of skin and tissue. You're just addressing the problem right here. Of course it's not, I mean, different surgeries, different abilities, different powers addressing different things. But for a turkey gobbler deformity, the excess skin right here, there's nothing better than excising the tissue directly right there. And that's what a T-Z Plasty is for.

Monique Ramsey (04:29):
Now, so we teased everybody at the beginning of the episode that there's an update. So what's the big update?

Dr. Salazar (04:38):
Well, so T-Z Plasty traditionally is a surgery that was designed or mostly performed in men. It's a surgery that, I mean men due to different reasons, I don't know, surgical stigma or they sometimes come in and say, doctor, just take care of this. I don't want to have any other incisions. I cannot accept that I'm having a facelift neck left. I just take care of this and I don't care.

Monique Ramsey (05:06):
It's too much.

Dr. Salazar (05:06):
It's too much. So sometimes that happens, and that's the case. And this traditionally has been a surgery that's been more practiced in, men. Recently we had a patient, a female patient that specifically asked for this surgery. And we examined her, we analyzed our different skin characteristics, the amount of fat, the amount of subcutaneous tissue she had. We addressed her muscles of her neck, and we determined that we needed to cinch those muscles and bring them together. And it turns out that she was a very good candidate for this surgery. And we performed the surgery following the same technique principles, and it turned out to be fantastically well. Sometimes when you hear even specialists, even other plastic surgeons talking about putting an incision in the neck of a nice lady, different from a man, right? Because the man has a beard. And then if you develop a scar here, you can grow a beard and then you're going to hide it.

Monique Ramsey (06:11):
It's a manly scar.

Dr. Salazar (06:13):
It's a manly scar, and then you'll be proud about it. So for a female patient, it's funny, as I was discussing this surgery with this patient, she said, there's nothing that a good concealer, there's nothing that good makeup in that area cannot hide Dr. Salazar. But there's not a single brand of a cosmetic product that will hide this. And she was pinching the excess skin that she had right there. She had a face and neck lift in the past. But she said, you know what? I don't want to go through that. I just want to address this area. I heard about this surgery, I heard that you perform many of these and that your patients are very happy. And Monique, that's one of the things that actually I can tell you that from all the patients that we perform this surgery, patients are not only very pleased with the results, but they don't see the incision as a detrimental aspect of the surgery.

(07:15):
They do not complain about the scar. As you know, we do all of our, I mean, we take all the different steps to create the best scar possible. Then patient genetics and patient skin type take over. And that's something that it's important for our patient audience to understand that we are working with, we are a team. We're making very fine cuts. We use very, very small needles, very small threads. We are very meticulous in our work, but we're teaming up with them. And then they are the ones that take over that healing process. But for all of them, the ones that have undergone the surgery, they love the result and they don't see the scar as a big problem. And I know that we have some of those pictures available and are different platforms and patients can see that it's not very prominent.

Monique Ramsey (08:13):
And I saw the particular lady that you're speaking of because we have, she very kindly gave us the permission to use her photos. And so we have them on our website in our gallery, but we also have them on Instagram. And it's amazing at even just two weeks later, yeah, there was some redness, but I mean really would be super simple to cover with makeup. And like you say, it's like turtlenecks and scarves can only go so far. Certain things you just have extra and it's like, yeah, the scar's a trade off, but you're not trying to disguise all this extra skin.

Dr. Salazar (09:00):
And here's another thing, I mean, you just look at, I mean, during Covid and the Covid neck and all the different face and surgery, facial surgery that we had because of Covid and all the Zoom meetings and all the different interactions that we started having in a different way, we start becoming more aware of different facial features. But even for our audience that they're right now, I mean, you could be listening to the podcast or you can actually be watching the podcast and you can see that the area that we're talking about, Monique, the area from my chin to my Adam's apple in a social interaction, you don't see it that much. And the same thing, I mean, I'm looking at you and I mean, if you would have had a T-Z Plasty, you get all the benefit, but you're not really showing that incision with or without makeup on a regular social interaction. Of course, if you peek underneath, you can probably be able to see that, but in a real regular interaction, you don't. So that's something that patients actually appreciate a lot.

Monique Ramsey (10:11):
Yeah. Now, what are some of the signs that a man or a woman are a good candidate for this procedure? What is it that you're looking for as the surgeon?

Dr. Salazar (10:23):
So what we are assessing is, of course we do not, I mean, we don't start by assessing just the area. We start by assessing the patient as a whole, right? That they have to be healthy, that they don't have to have any cardiac problems, et cetera, that safety comes always first in our practice. Once we've been, and we jump that hurdle and then we continue assessing, we assess the rest of the phase, of course, let's see if there is some jowl formation. Let's see if there's any mid face needs, if there's any upper third of the face needs, and then this become part of a whole. And then we can discuss the different options that we can provide for them. But if then we are just only focusing on that area, and let me share one thing with you, Monique. I think we educate our patients, but you know who has the, has the last word in terms of areas that they want to improve?

(11:20):
Our patients have the last word. Imagine if you're looking for a house and then you go to a real estate agent and then you say, we're looking for a new house. And the real estate agent says, unless you want to get a house with a pool, I'm not going to help you. You're not going to get it. And you're like, but I don't even want a pool, I think it's right? So it would be the same as saying, no, you want to address this area right here, but if you don't address the jowl formation, if you don't address the lack of volume on your midface, you don't address your eyelids, we're not going to do it. So for patients that have that desire of improving this area right here without improving any other area, it's totally doable. So that's another thing that we of course take into account. And then we assess the thickness of the skin, the amount of the skin laxity, what's underneath the skin, is there fat that we need to do liposuction to improve? Is there a need for us to bring the muscles together? Is there any fat underneath those muscles that we can also address during the same procedure? Then we evaluate them, we give them our recommendation, and then if they're good candidates, they'll benefit from a T-Z-Plasty.

Monique Ramsey (12:36):
That's neat. And I like the fact that you can kind of customize it to what their needs are, because some people you'll see have just it's very thin skin and this extra skin, and it's just almost, not like tissue paper, but very, very thin. And you don't see any fat, you don't see that thicker skin. And some of us have more bulk, let's say, underneath that area. So it's good to know that you can customize it to help get them the best result possible. Well, anything else about the T-Z Plasty that we have to discuss? Because what I'll do is for everybody listening, I'll have in the show notes, I'll have a link to the prior episode, which is a little longer and it has more information. And then we'll also put the link to the T-Z Plasty gallery on the website. We do have some examples for you to look at. And then really the next step is a consultation with you, right, Dr. Salazar?

Dr. Salazar (13:35):
Absolutely. And you know that the doors are open, patients should come in, it's a nice conversation. We go through pictures, we go through, we explain to them exactly by the end of their consultation, they know exactly how we do the procedure and exactly how they're going to expect their recovery. But to tell you that it's a high satisfaction surgery. Patients, even though we're talking here about a very, very localized area, but patients that truly benefit from a T-Z-Plasty, they say that it's life changing. They say that, oh my God, now I take that concern out of my mind, out of my daily life. They said, this is great, I should have done it sooner. So it, it's a really nice surgery. It's not as invasive if you want to call it as a facelift or not as extensive. And the same thing with recovery, and you get all the benefits.

Monique Ramsey (14:33):
Yeah. And I love the fact that it's now the other half of the sexes can participate.

Dr. Salazar (14:40):
Absolutely.

Monique Ramsey (14:41):
Yeah. So anyway, thanks all for listening, and we'll have the links in the show notes, and we'll see you on the next episode. Thanks, Dr. Salazar.

Dr. Salazar (14:50):
Thanks for an invitation.

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