"I feel bad about my neck"

I decided to right down these notes for people who are considering a cosmetic surgery. My message: do not be afraid, do it, if you want to look better. But also do some homework to know how to prepare and what to expect. I hope that this post will help you to make your decisions and get ready for the process.

How did I get to this point

I am proud of my strength and lean body. I lift heavy weights, practice regular yoga, love skiing, and, of course, am obsessed with pickleball. My face looked ok too: botox and some fillers kept my face in good shape, but the eyelids started to droop about 10 years ago and I acquired that dull, sleepy look. This led me to undergo a blepharoplasty (an eyelid surgery) in my mid-50s. This procedure nicely opened my eyes and made me look kinder and more awake, so I consider it very successful. The plastic surgeon, Dr. Khouri (https://www.denvercosmeticsurgery.com/), is the sweetest person, very knowledgeable, and I highly recommend him for eye, face, and neck procedures if you do not want to undergo the "deep plane." Additionally, you should be aware that he performs everything in his office without anesthesia. You will be given Valium and will hear his instructions. This saves quite a bit of money but is not for everyone. It worked fine for the eye surgery, but I would prefer to be knocked out for any more invasive operations.

I was content for quite a while about my appearanc until the pandemic hit. It appeared to be a favorable moment for cosmetic procedures, and I didn't want to miss out on this chance. Therefore, I had a Zoom consultation with Dr. Khouri once more regarding a mini facelift. Dr. Khouri, who is honest and transparent, advised me that I wouldn't notice a significant change (yet). A year later, I sought advice from another local surgeon who gave me the same feedback.

But during the last two years, I began to notice changes in my neck and lower face: the vertical muscle bands on my neck, sagging skin, and a hint of jowls. I, of course, remembered Nora Ephron's book "I Feel Bad About My Neck" (hence the title of the post). Here is a quote from it: "According to my dermatologist, the neck starts to go at forty-three, and that’s that... The neck is a dead giveaway. Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn’t have to if it had a neck.” Well, I was lucky not to have too many neck issues until I was at least 60. I still looked okay (see the picture taken before the surgery) if I stood super straight with my neck stretched up and if the light was just right. But once in a while, with horror and a gasp, I would catch my reflection in brutal morning light and realize how different I was from what I like to imagine about myself.

It was time to act! I mentioned my concern to my esthetician, Irena. Irena is a very direct person and she shares my desire to look the best at any age. She directed me to Dr. Garrett Locketz, who performs the so-called deep plane facelift (look it up). A couple of her clients were his patients, and she raved about the results. The deep plane facelift goes beyond skin reduction, pulling, and tucking, instead manipulating on the level of the underlying muscles and connective tissues (the SMAS layer). The SMAS (Superficial Musculoaponeurotic System) layer is a complex network of muscles, fibrous tissue, and fat located beneath the skin of the face and neck. This results in a much more natural look (not the deer-in-the-headlights look) but also implies a more invasive nature of the surgery. Dr. Locketz's gallery looks amazing (https://www.garrettlocketz.com/home/deepplanefacelift): most of the people there look like themselves "after," but just younger. Impressed by the gallery, I went for a consultation, and it was very quick (I pretty much had my mind set by that time). Dr. Lockettz said: my patients feel young inside, and they want their look to correspond to this feeling. Then he pulled half of my face (I tried to reproduce, but it takes a professional!) and said: that is how you will look. And that was how I wanted to look! The decision was made, and the surgery date was set for April 22.

Costs

A typical cost of the deep plane surgery is $20K-$30K (which will include the surgery facility and anesthesia). If you add a CO2 laser, it will probably add $3K-$5K. If you hire a nurse for 24 hours after the surgery, it will add about $1K-$1.5K. If you decide to use a hyperbaric chamber, it will cost you about $100 per session (nice to have 5-10 sessions). You might want to spend a couple of nights in the vicinity of the surgery to make the post-op appointment and allow the staff to be close on call. So add this to the cost as well. All in all, I paid close to $40K (surgery, CO2, 24 hours of a nurse, 3 nights in a hotel, 10 sessions of hyperbaric chamber).

Just a couple of days ago, I learned that Irena, who went to Colombia to help her friend with the same surgery, was so impressed (https://nicolasmcleanmd.com/en/about-us/) that she had it done there as well (one week before me). She stayed there for recovery (which is nice) and the procedure cost her three times less than here. She looks amazing! Something to consider...

Logistics/prep for procedure

You will be given very detailed instructions at the pre-op appointment. Prior to that, you will need to see your physician who will need to fill out a form stating that you are fit for the surgery. This will probably require you to have a blood test and an EKG.

You will be given a list of over-the-counter medications and several prescriptions. Make sure that you have them (ask about any that are not on the list).

Bromelain with Quercetin (reduces inflammation and swelling around your nose and eyes, a great thing to have for the allergy season by the way, most effective if you take it before breakfast)
Painkiller (like Oxycodone)
Senna (the painkiller often causes constipation). Adding some fiber to your food after the surgery is a good idea too.
Diazepam or Valium (for anxiety, relaxing your muscles and help with sleep, you can take one the night before the surgery, I did not but I should have)
Valacyclovir pills/tablets (a must if you have laser with the surgery and/or you are prone to cold sores).
Anti nausea for the anesthesia (like Emend, just one pill before the procedure) and a different kind (like Zofran, as some people get nausea from painkillers).
Antibiotics

Additionally (after doing some research) I got these supplements for the nerve recovery:

Aceltyl L-Carnitine (500mg twice daily)
Vitamin B complex
Alpha Lipoic Acid (600mg daily).

You will be given some regimen which will probably include stopping any medications that thin your blood (Aspirin, Advil, etc.) and stopping red wine closer to the surgery. I would recommend eating a very light meal the evening before the surgery; you will just feel better in the morning. I made a mistake of having a heavy dinner with my friend Tommi, and it did not feel good. In fact, my last sentence before I was knocked out was "I hope I will not fart." I was gone after that.

I stayed in a hotel close to the clinic the night before and for two nights after. Tommi dropped me off and picked me up 3 days later. I hired a nurse (the best choice would be a person familiar with the surgery, and I was lucky to get someone who worked for the surgeon, thank you, Ashley!) to stay with me for the first 24 hours and take me to the first post-op appointment. I highly recommend hiring a nurse instead of asking a friend, as you will feel more relaxed, will not put a burden on your friends, and be in good hands.

I highly recommend scheduling a hyperbaric chamber session. Look for a service that will bring it to your house, as you may feel self-conscious and will be drowsy and stiff for several days after the surgery. It helps with healing and actually feels great. If you go to a medical-grade facility, it will be at least twice as expensive, but they might have higher pressure chambers (I went to the iCryo facility in Westminster). The chambers I used had 1.3-1.4 atmosphere pressure. Schedule the sessions as close to each other as possible and be aware that you will feel very sleepy and fatigued after them (it took me a while to connect my sleepiness with the chamber sessions!).

Recovery

Pain, scars, numbness

Today is day 35 and I still have some scabs and bumps. According to my surgeon, they look beautiful, though:-) It is pretty amazing that until after the surgery, I did not know where to expect the scars (as I did not really asked). In a typical lower part deep-plane lift, you will have a horizontal scar under your chin and all around the ears, including the inner part! They are not very visible because human ears are already very twisted.

I could not sleep on my side or on my stomach. They really ask you not to for at least two weeks but I also was so aware of my neck and my ears, that I still (close to week 5) sleep most of the night on my back. I am kind of afraid to break off my numb ear. On the 3d day of sleeping on my back, the back side of my neck and my upper spine started hurting pretty badly. So that I even thought that my cervical spine was damaged during the surgery! I had to start simple isometric exercises and highly recommend this video https://www.youtube.com/watch?v=BQKjRmHXK0M. It is in Russian but is easy to follow the visuals.

There was pretty much no pain, except for the one due to sleeping in an uncomfortable position and the pain in my right ear (the part called the tragus: a little part that sticks out next to the canal). In fact, that whole area was somewhat throbbing and still sometimes painful.

The amount of numbness and its duration were a real surprise to me. But given what I know now (I did not bother to study before as I really did not want to know too much), this should be expected. This surgery lifts, cuts, and rearranges your muscles and ligaments. The nerves get disturbed and separated. They need to heal and get attached again. You will be numb around your head except for the back and your forehead (at least this is my experience). You might also feel tingling (I interpret this as my nerves waking up). For weeks, you will feel tight like you are tightly wrapped and numb. In fact, you will eventually look better than you feel. And all this is normal, apparently.

Not sure why the right part is much more numb than my left and why the very crown of my head is also very numb. I compare this whole feeling to being shell-shocked, in fact (at least that is how I imagine being shell-shocked and this was consistent with my somewhat odd behavior). The doctors and the nurses do not really dwell on the numbness as they probably do not want to scare you, and also it is hard to predict each other's recovery time. But I now hear, it can be from 2 to 6 months, with the possibility of some areas being permanently numb. I am on the 2.5 months mark now an still pretty numb and uncomfortable around my ears.

Mental state

The whole process is pretty emotional. The night before surgery, I was pacing in the hotel room asking myself if this horror was really coming and why I had decided to do this. After the surgery, I was still full of drugs (although I was determined to impress my nurse with the Isagenics and made a shake for her the morning after the procedure) and did not think or feel much. I was eager to get home and on the 3rd day, after I took a really weird and cautious shower, Tommi took me home. It was nice to be there, although my cat sensed my off-ness and was somewhat deferential with me at first. After that, my memories are somewhat of a blur except that I remember really strong spells of bad mood and vulnerability. I also remember being very irritable with my mother, but it was very hard to control. This was probably due to the sensitivity of the whole process, discomfort in your face, ears, and the whole head, drugs, inactivity, and isolation.

I started driving almost right away, although the doctor recommended not to do so because it was hard to move my head without moving my whole body. In the 3rd week after the surgery, I managed to get two traffic violation tickets (ran a red light and was caught speeding). I had not received any tickets in many years, and this was a manifestation of the inadequate state of my mind and body.

Physical activity

Since I was allowed to do gentle walks, I started walking about 5-6 miles per day right away. This felt very good, although I had to cover my face completely. It's interesting that people fall into two groups when they see a person who looks like an invisible man. Some just turn away immediately as there is no foundation for their gaze and communication. Other people stare and even turn their heads as they pass you. Dogs really did not like me, although I tried to chat and pet them. Generally, they noticed me and walked around me in a very big circle. One day I decided to walk all the way to Brewing Market to get a latte, but discovered that the sidewalk is not continuous. I had to walk on the road and was worrying about the police picking me up. Be kind to strangers dressed like an invisible man and walking on the side of the road!

On the third week after the surgery, I ventured to go to the gym (the same club but a different location, so people would not know me there). I was still very red and swollen and wore a baseball hat. I only used the machines but felt very tired (I did not realize the tiring effect of the hyperbaric chamber) and thought it was due to the workouts only.

One morning (maybe at the end of the 3rd week), I woke up and decided that I looked almost normal. In reality, I probably did look a little less swollen, but I was also getting used to my recovering ugliness. So I went to my regular gym. I felt super self-conscious but wanted to overcome this discomfort and start showing myself to the familiar world. Most of my gym friends knew about the surgery, and they greeted me with feeble and fake excitement: "You look great..." or "You look like you just had a flu." or "You look like you had a bad sunburn..." If I ran into somebody who did not know about the surgery, I said a quick "Hi" and tried to run away. If I could not get rid of them quickly, before they could open their mouth, I declared to them (with unnatural cheerfulness) that I had had surgery, although this revelation was not really needed or expected. So after my first visit to the gym, I stopped confessing, as I realized that I behaved like a lunatic.

I started working out with my trainer in the 4th week (including deadlifts, pullups and running the ladder), but we started slowly, and I plan to be back to the full range of my routine by week 6. I will return to yoga after week 6 (as was recommended). At least, this is the plan and I typically follow my plans.

Conclusion

I am on the way to being happy about the results. Particularly, my neck looks great already. Despite hearing comments like "you didn't need to do this," "you always looked good," and "you look so young for your age," I pursued this change primarily for myself. I am happy that I took this step now, as I hear that at some point it might become too late for such a procedure. I want to enjoy my life looking the best I can. I hear such procedure will last me probably around 10 years.