PODCAST: Zoom Lift: The Neck Big Thing

After spending the last year looking in the 21st century mirror that is Zoom, many people discovered their lower face and neck looked a bit too tired. Although the condition itself hasn’t changed, the name “turkey neck” has been replaced by the more modern “Zoom neck.”
Plastic surgeon Dr. Johan Brahme and non-surgical aesthetic nurse practitioner Khanh Nguyen, FNP-C join us to explain what causes the Zoom neck phenomenon in the first place, and what’s on the menu at LJC to treat it.

Dr. Brahme covers how aging skin loses elasticity and why tightening helps it appear younger and healthier. Then, he explains the best way to treat sagging skin and bands in the neck and advises patients to address wrinkles and sagging sooner rather than later since they can be challenging to get rid of later in life.

Khanh Nguyen, FNP-C explains how Zoom neck wrinkles worsen due to looking down for hours on end while using our cell phones and computers. He outlines the non-surgical solutions for dealing with wrinkles and aging skin, including Botox, fillers, lasers, threads, and other methods for helping the skin produce more collagen.


TRANSCRIPT

Speaker 1 (00:06):

You’re listening to the LA Jolla Cosmetic Podcast, with the LJC Chief Community Officer, Monique Ramsey.

Monique Ramsey (00:15):

Welcome everyone to the LA Jolla Cosmetic Podcast. I’m your host, Monique Ramsey. And today we’re going to speak about the neck, specifically Zoom neck. I think all of us who’ve been on Zooms throughout the last year we’ve all experienced a little something that we notice in the camera. So there’s a feature in Zoom that makes you look extra pretty, but it doesn’t work when you leave the house. So how do we talk about this buzzword, Zoom neck? It’s the complaint you have about the way your neck looks when you’re on a Zoom call and especially if your camera isn’t pointed down at you from above. So I’ve asked two of our amazing team members to talk to us today about the neck.

Monique Ramsey (00:59):

Dr. Johan Brahme and Khanh Nguyen are here to go over head to head on the subject of the Zoom neck. They’re going to help us get to the bottom of what can be done to slow down or reverse aging or sagging neck. And so we can just turn back that special Zoom filter. You can turn it to off, you can dial it down because there are ways to fix it so that no matter where you are, you’re going to look phenomenal. So Khanh is an aesthetic nurse practitioner in our medical spa. And we’re going to talk to him in a moment, but we’ll start with Dr. Brahme. He’s one of our plastic surgeons and has been with La Jolla Cosmetic almost two decades. So Dr. Brahme, welcome and how much neck and face surgery do you do?

Dr. Johan Brahme (01:43):

Thank you. And hi, Monique. I do a lot of neck and face surgery. The neck is usually the one thing that men come in for in facial complaints and then women it’s also high on the batting order. And before the Zoom, it was called the turkey neck. And that is something that is a predictable sign of aging as our collagen gets looser and our skin gets more stretchy and we lose fat, which is one of the signs of aging. And so you see all the little bands in the neck and what many people see is loose skin sort of in the central neck. And sometimes they see two parallel bands going from the chin down to the chest, and those are the edges of the neck muscles. And they require attention for a smooth neck. So I see a lot. And over my 20 years in practice, let’s see, how long has it been? 1992, almost 30 years in practice, many things have come and gone, but the neck is really where most of the advances, the significant advances in facial surgery has been.

Monique Ramsey (03:07):

So we’re talking about turkey neck almost is sort of the extra double chin maybe, or the extra skin that sort of hangs down, but then the sort of the chords that almost people see.

Dr. Johan Brahme (03:21):

Yeah.

Monique Ramsey (03:21):

So that’s the muscle. Is it just that because we’ve lost fat that we’re noticing the muscle or does the muscle somehow change as we age?

Dr. Johan Brahme (03:30):

Well, the muscle does change a little bit and the overlying fat layer gets thinner. So you see more of it. But , you know, the real culprit is the skin because as we age and with sun damage and constant stretching and changes in collagen and so on, you know, the skin just doesn’t spring back. And for many young people who come in with a heavy neck, we talk about liposuction to get rid of the fat layers, but then you have to make sure that you assess the skin. So you suck out the fat, then what is the skin going to do?

Monique Ramsey (04:07):

Mm-hmm (affirmative).

Dr. Johan Brahme (04:08):

And the skin is everything in plastic surgery, whether it’s breast or body or face the skin is everything. And if it has good elasticity, you know, maybe it’ll be good with just some minor changes, but if there’s less elasticity, then you need to tighten things.

Monique Ramsey (04:28):

And when you tighten things, where are the scars? Where do you make the incisions?

Dr. Johan Brahme (04:34):

Well, I tell people, you know, we’re talking about the neck now, but the neck is connected to the face and it’s connected at the jaw line. And so it is virtually impossible to do just a neck lift. For the best result, you really have to work along the jawline and the skin from the jawline gathers sort of in front of the lower part of the ear and the skin from the neck gathers behind the ear. So the incision usually goes up along the inside the ear on the front, and then in the crease of the ear behind the back and out into the scalp. And then we also make an incision right under the chin and that little crease that everybody has. And we work on the muscles through that incision so that you can get a nice, smooth central neck and get rid of those bands that we talked about.

Monique Ramsey (05:31):

And what are you actually doing to those muscles? Are you shortening them or how do you make those sort of disappear?

Dr. Johan Brahme (05:38):

Good question. So since there are two muscles, one on each side of the neck and you have those two bands running down the center of the neck, what we do is that we stitch up the muscle. We sort of lace them up like a shoe from down deep in the neck up to the chin. And then what we do is, through the incision around the ear, we mobilize the neck muscles, that is, we sort of free it up and then we pull it behind the ear and anchor it there. And that, you know, when you put that stitch in, you just get an incredible jawline. The nurses always go, “Oh, that looks so good.”

Monique Ramsey (06:23):

So you’re sort of suspending it back behind-

Dr. Johan Brahme (06:25):

Right. Exactly. We’re tightening it.

Monique Ramsey (06:27):

Uh-huh (affirmative).

Dr. Johan Brahme (06:28):

Giving it that youthful tightening.

Monique Ramsey (06:30):

And how long could that last?

Dr. Johan Brahme (06:33):

Well, I usually tell people that barring any, you know, illnesses or major weight changes and things like that, about 10, 12 years, something like that. I’m starting to see some of my patients from earlier on now. And the nice thing is that once they’ve had the surgery, A, they know what it’s about and they know what the recovery is about. So there’s less fear, but also, you know, if you do this and I prefer to do this in younger people, you know, I don’t like to wait until the skin gets really bad. So if you do it in young people, you can really get a smooth result and you really set the hands of time back and you will look better 10 years down the line, than you would have had you done nothing.

Monique Ramsey (07:22):

Mm-hmm (affirmative). And so you talked about healing and recovery. Well, how long does it take to heal from a neck lift or let’s say it’s a lower face and neck or face a neck.

Dr. Johan Brahme (07:34):

Right, right. It depends on how many other things you do, you know, because sometimes you do some eyelid work. Sometimes you do some fat transfers and so on and so forth. But I can tell you that it’s about a week to 10 days. I had it done myself and I had it done on a Thursday and I was back in the operating room the following Friday. I probably should have taken another day or so, but doctors are bad patients. So it takes about a week. And then you’re really sort of presentable. You can put some makeup on, you can go out and you’re not going to scare anybody.

Monique Ramsey (08:11):

Yeah. I actually, a long time ago had a face and neck lift and my lower eyes and a brow. And I was at my dad’s wedding eight days later.

Dr. Johan Brahme (08:21):

Yeah.

Monique Ramsey (08:21):

And nobody knew I had my hair covering the spots where the incisions were. And I told everybody, of course, because I love talking about it. But, you know, that was a, people were surprised. I think they’re surprised that you can actually be feeling well enough to go out and be presentable.

Dr. Johan Brahme (08:41):

Yeah, I mean, compared to a lot of other things that we do, you know, big body surgeries and so on, this is really a breeze to recover from. There’s not a lot of pain and usually not a lot of swelling and bruising and , you know, that can be covered up too. So it’s really not as bad a recovery, as many people fear it’s going to be.

Monique Ramsey (09:02):

Mm-hmm (affirmative). Now, if you were, say somebody, I actually had a friend years ago who came in and she kind of a hereditary issue with her neck. She did not like the way her neck looked. She was, you know, in her mid 20s and was wanting to look better for her wedding. And so, you know, if you’re doing either lipo or you’re doing the neck lift with the incision under the chin, is what I think she had, something like that, do you see most patients when it’s just that part of the neck that could be younger?

Dr. Johan Brahme (09:36):

Certainly people have genetic influences and inherited traits and so on. And somebody in their family has a heavy neck and they have a heavy neck. And, you know, you have to evaluate all of the layers before you recommend any treatment. You know, some people will do fine with liposuction. Some people need to have their muscles tightened. Some people need to have their skin tightened. So it’s not sort of a cookbook thing. It’s very much a judgment thing. We have a lot of options. So we have wonderful audio visual aids and pictures. And then we have a ton of before and after photos. And we can always find somebody to look like them. I must say though, I do prefer patients come in maybe a little earlier than a little later, because once you have all the wrinkles in the face, those are very hard to get rid of.

Dr. Johan Brahme (10:32):

But if you’re dealing with somebody say in their 40s, 50s, or something like that, you can tighten things. It looks very natural and you can prevent those wrinkles from coming. So then by the time they’re in their 60s and maybe even 70s, they don’t have any wrinkles and they’ve gained a permanent advantage, really.

Monique Ramsey (10:54):

I think that’s a great way to say it because the permanent advantage that, you know, you might think, oh, is it too early?

Dr. Johan Brahme (11:02):

It’s much more of a question, is it too late?

Monique Ramsey (11:05):

And I think generations ago people would retire and then they’d go on a cruise and then they’d get the facelift and things were a little more regimented and they would wait too long and now people will think, okay, how do I look better all the time.

Dr. Johan Brahme (11:22):

Right.

Monique Ramsey (11:22):

And preserve what I have now today, if I’m 37 or I’m 47, to get to looking better in 20 years.

Dr. Johan Brahme (11:31):

Right. And also, you know, people are working longer and so people want to be competitive. And so you see patients who come in a bit earlier because they are planning ahead, which I love. I think it’s the right thing to do.

Monique Ramsey (11:47):

Mm-hmm (affirmative). And I think, speaking from my own experience, you know, I was 37 and my friends thought I was nuts, even though they know I work with plastic surgeons, they thought I was really like, “Why are you doing that now?” But it made a huge difference. And now, however many years later, I’m 53 so it’s been awhile. Now, you know, I can go to Khanh, I can go have fillers. I can do some laser things. I can do some other things to enhance the result that I have from that original lift. And so some people might think that’s backwards. They think, oh, I need to start with non-surgical and then work to surgical, but it can go the other way.

Dr. Johan Brahme (12:25):

Absolutely. I think the maintenance and, you know, not to forget skincare.

Monique Ramsey (12:30):

Mm-hmm (affirmative).

Dr. Johan Brahme (12:31):

Because that is a huge thing that we do. And that’s maintaining all of the supple nature of the skin. And skincare is not just a little rub with some moisturizer. It’s become quite sophisticated with the hydrafacials and things that we offer here.

Monique Ramsey (12:50):

And why would somebody choose surgery over non-surgical treatments? Or at what point do you say you’re not a candidate?

Dr. Johan Brahme (13:01):

Well, you know, I think that we have a wonderful situation here at LA Jolla Cosmetic because we do both nonsurgical and surgical. And we do a lot of both, and we can be very honest about things. You know, I can see a patient who’s not ready for surgery and say, “I think that Khanh has some things that he can really offer you to improve your appearance.” And it goes the same the other way. You know, Khanh can say, after having injected and done threads and all the things he’s going to talk about, “I’ve reached the limit of what I can do. You really need to talk to a surgeon and, you know, I’m going to send you to see Dr. Brahme.”

Monique Ramsey (13:43):

Mm-hmm (affirmative).

Dr. Johan Brahme (13:44):

And then work symbiotically that way. And honesty is always, always the best policy. And there are, unfortunately, offices where they only do non-surgical. So, in that case, that’s what they’re going to offer because that’s what they do. We do both. So it doesn’t behoove us to do something that’s not really the right thing for the patient.

Monique Ramsey (14:09):

That’s a really good point. Having somebody tell you truly what you need, and maybe some people come in, don’t need anything at all. They can just go back home.

Dr. Johan Brahme (14:19):

That happens.

Monique Ramsey (14:19):

Or get some skincare or get a diamond glow facial and come back in a year. So, one last question, Dr. Brahme, if somebody is interested in seeing you for a neck lift consultation or a face and neck or some facial rejuvenation, what’s their first step?

Dr. Johan Brahme (14:35):

So usually the calls come in, you know, just to our general office. And then as they speak with a coordinator who tries to figure out, you know, what it is they want and so on and gets to know them a bit. And then they come into the office, we have two options for being seen. One is a Zoom consult for people who don’t live here, or for people who, you know, maybe have not been vaccinated yet, or they’re not venturing out, but we are really seeing patients mostly in the office. And whether I see somebody on Zoom, I always need to see them in the office because I need to pinch the skin. I need to feel how elastic is it? What are the fat layers look like? And all of that stuff. And I would never operate on somebody who I hadn’t seen in person. You know, I can show them my scars and my nurse’s scars and demystify and go through the consultation, but more and more people are just coming in now. So, but the first step is just call the office and, and talk to a coordinator.

Monique Ramsey (15:39):

Wonderful. Well, thanks. And we’re going to stay right there because we’re going to talk to Khanh and then we’ll kind of do a summary at the end. So Khanh, you’re up in the hot seat now. So tell us a little bit about yourself first. How did you get into aesthetics?

Khanh Nguyen (15:52):

Yeah. Thanks Monique. I love joining and appreciate Dr. Brahme, gave a lot of good, good info. So I spent most of my years in the family practice, um, I also spent many years in hospital management. I had an artistic side to me. I did a lot of photography. I did a lot of artwork. And then when the opportunity presented itself to jump into aesthetics, I took a quick medical conference, found out I was pretty good at it, decent at it, really enjoyed it. And here I am ever since.

Monique Ramsey (16:15):

And what led you to La Jolla Cosmetic?

Khanh Nguyen (16:17):

Well, the prestige of La Jolla Cosmetic kind of goes far beyond just San Diego. So I knew about you guys, Dr. Brahme and Marie from years on end now. So again, when the opportunity, and for some reason, people always tell me I land on my feet, but when the opportunity presented itself to jump onto La Jolla, I was all over it.

Monique Ramsey (16:33):

Oh, that’s wonderful. So I’m assuming you hear the same complaints from patients that Dr. Brahme does about their neck and especially maybe in the last year with the Zoom neck effect.

Khanh Nguyen (16:43):

Yeah, absolutely. You mentioned that the Zoom neck, Dr. Brahme said it used to be called the turkey neck. And then the other one we used to hear and still hear about is tech neck. So it’s those wrinkles that go from side to side with the neck, which happened with cell phones, happened with computers. Now you amplify that with being extra time on a computer, your neck is always bent down. So we’re amplifying those wrinkles. Now we’re also looking at our own wrinkles when we’re looking at ourselves in Zoom.

Monique Ramsey (17:06):

Right. So tell us about some of the things that you do in the med spa, what tools you have in your toolbox in particular. Give us the range of choices, maybe from least, well, maybe, I don’t know whether you want to put it as least to most extreme or how you want to, or just different choices depending on the person.

Khanh Nguyen (17:23):

Yeah. Good question. Dr. Brahme mentioned this as well. So for me, everything from the chin up, I consider the face. Everything from the chin down, I consider body. And everything from the chin down, we’re limited on what we can do. In the face you can pump it full of Botox, fillers, whatever the case is. But from the chin down, all we have is collagen and elastin and good quality of skin. So when you start losing that, when you’re aging, the only thing you can do is throw as many philosophies at it as you can to improve collagen, improve that elasticity. So you have two major philosophies. You have devices such as lasers, radio-frequency, ThermiTight, ultherapy, which all heating devices we’re heating up the skin so dramatically that were causing control damage and through that control damage, your body heals itself, thus improving the collagen, the elastin over time lifting and tightening.

Monique Ramsey (18:10):

Mm-hmm (affirmative).

Khanh Nguyen (18:11):

The other side of this is injectables. So Dr. Brahme mentioned over and over at PDO threads is probably my go-to treatment because one, it gives you more of an instant gratification with the lifting. Secondarily, long-term it also produces collagen as well. Now the other injectable is just traditional injectables. You can do sculpture, which I’ve never done there. I don’t really recommend that in the neck area, but that is a biosimilar. And then you have dilute radiesse, which radiesse again, also promotes collagen production, but through an injectable. So you have devices and you have injectables. Those are the two main things you can do.

Monique Ramsey (18:42):

And what about KYBELLA, which is an injectable as well? Do you like KYBELLA for the neck?

Khanh Nguyen (18:47):

Yeah. So if you have an extra fat pad or if you have a little, carrying around a little extra weight there, good question. No amount of lifting and tightening is going to correct it until you remove that fat from that area. So for us, we had the two major devices CoolSculpting again, and then we have sculpture which are devices. And then KYBELLA, which is an injectable, which the medication itself breaks down the fat in that area so your body can expel it.

Monique Ramsey (19:09):

So all three of those are really working on the fatty parts.

Khanh Nguyen (19:12):

Yes.

Monique Ramsey (19:13):

And so that’s assuming somebody has fat, but if their problem isn’t fat or fullness, but if their problem is more just loose skin, then maybe you’re thinking, could you talk about threads a little bit?

Khanh Nguyen (19:26):

Yeah. So threads have been around for a long, long time. I want to say Dr. Brahme did them back in the day as well. I’ve seen a couple of his patients. Recently they’ve gotten more traction. When I brought it to San Diego around… Well, I didn’t bring but when I mentioned it about three years ago, everyone was like, “What do you want to do with me? You want to put sewing threads in my face?” So three years ago it was in its infancy in San Diego. Now people actually search us out for it because of YouTube, because of Instagram, people see it all over the place. So the ones we use here, specifically our PDO, which, um, has been used in surgery since 1970s, in cardiac surgery, that’s where they came from.

Khanh Nguyen (20:00):

So with PDO threads, we can actually approximate or lift areas of skin within reason. And then for me, more importantly, especially from the chin down, we will want to promote that collagen, promote that quality of skin. Because no matter how much we lift and tighten, if you don’t correct that upper surface of skin, you’ll never really truly look correct and look good.

Monique Ramsey (20:20):

Hmm. And the other thing you mentioned real briefly was ThermiTight. Could you explain what that’s all about?

Khanh Nguyen (20:27):

Yeah. So with skin tightening, again, someone can correct me on this, but you have radio-frequency which many, many companies make. And then you have ultherapy, which is a standalone treatment with ultrasound. So with the radio frequency you can do topical, which feels like hot stone massage. We’re heating up the skin on the surface, until you’re about 42 to 45 degrees Celsius. And that’s the limit of it because your body will say, “Hey, Monique, that’s way too hot. I can’t take any more.” So with that one, you’re coming back to us every week or so. And we’re doing it for six to eight sessions. ThermiTight, we’re taking a radio frequency probe, and we’re putting underneath the skin. So because it’s underneath the skin and because we have to numb the area with a bunch of lidocaine, you don’t feel the heat.

Khanh Nguyen (21:05):

So we can heat up the skin anywhere to about 62 to 65 degrees Celsius. So 20 degrees Celsius higher than where you do a topical radio frequency. And with that control damage, hurting the body, your body is saying, “Hey, I’m hurt, Monique heal me.” So it just sends in messengers to promote tissue, regeneration, collagen, and elastin. And that’s how you lift and tighten over time.

Monique Ramsey (21:26):

So if someone is thinking, okay, I just, I really need help with this neck. They come to you, you’re going to use one of these devices or treatments, or you might, how would you maybe combine them?

Khanh Nguyen (21:38):

I love to gauge their feel of it. So when we come up with a plan of action, it’s not just me saying, “Hey, this is your plan.” I want to get their understanding. What they think is going to help them. And they may say, “Hey, I’m ready for ultherapy.” And I’ll say, “Okay, great. Why did you pick ultherapy? How did you come about choosing this?” Because then that will let me gauge, “Hey, don’t put a needle near me,” or, “Hey, I read about ThermiTight, but I believe in ultherapy,” whatever the case is. So I always want to gauge their comfort, gauge their knowledge and see what they want to do. Now after that, if they’re open to, Hey, what’s going to be the best plan for me. Then I, typically what I recommend is let’s do some type of skin tightening first, let that work in the background for the next six to 12 months, because we’re going to see improvement over time.

Khanh Nguyen (22:19):

Now, if you’re ready for more instant gratification, come back to me a month later. We’ll do PDO threads, get that more instant gratification, but also get that long-term collagen production as well. And you compound that with the skin tightening that’s working in the background, you’re going to look amazing at year’s end.

Monique Ramsey (22:34):

Mm-hmm (affirmative). So sometimes it’s a multi-step process.

Khanh Nguyen (22:36):

Yes.

Monique Ramsey (22:37):

So if they’ve got a wedding next month, you might be saying, okay, let’s do a thread lift because that’ll be the quickest. And it will still give them long-term benefit. Because ultherapy, am I right, that it takes a couple months for people to see that collagen building?

Khanh Nguyen (22:53):

Yeah. Depending on the research that you read, anywhere from about six to 12 months. So 12 months, we always tell people, “Well, that’s your final result. So come back to us every three months or so we can take pictures and we can compare together.”

Monique Ramsey (23:03):

So if someone is listening and is thinking, well, how do I know? What do I see Dr. Brahme, do I see Khanh? So let’s say they start with you, look to see what’s not invasive. At what point would you send somebody and say, “You know what? You really need to see Dr. Brahme instead.”

Khanh Nguyen (23:21):

Again, it’s that open conversation first to see where they’re at. For me, most people what I tell them is take one finger, put it anywhere on your face, put it anywhere on your neck and give yourself a gentle lift with that one finger. Most of the things that we do in a medical spa setting, we’ll give you that one finger lift. Now, if you’re taking all four fingers and if you’re pinching a bunch of skin, when you lift to get to your happy point, then your time to go to Dr. Brahme. So it’s really that extra skin that gets pinched. So if you’re pushing your skin back and there’s not a mound of skin back by your ear, sure. We can do something about it. But if you have this whole mound of skin back there, it’s time to see Dr. Brahme.

Monique Ramsey (23:58):

Interesting. So if someone is listening today and wants to know their first step to reach out for you, what would they do?

Khanh Nguyen (24:05):

Yeah, like Dr. Brahme said, reach out to La Jolla. Um, you’ll set up with one of our great coordinators. And at that point, they’ll have that open conversation with you. They’ll set you up with me. They’ll set you up with one of our surgeons downstairs, including Dr. Brahme. We’ll have that Zoom consultation. And at the end, Hey, if I’m sending you to Dr. Brahme, fantastic. If he sends you back to me, at least you have an open conversation into all your choices.

Monique Ramsey (24:27):

You talked about skincare. Tell me how you incorporate skincare into the plan.

Khanh Nguyen (24:34):

I do that for everyone, whether you’re here for Botox, whether you’re here for threads, because I will see you one hour out of every three months. It’s those 23 hours throughout the day that you’re taking care of your skin. So if you were causing all this damage at the beach, all this damage out the sun, and you come up to us to try to correct it, sure, we can correct it, but you’re going to inflict all that damage again. It’s just like, um, the analogy of the trainer and going to the gym. You may have that trainer for that one hour of the day, but it’s how you take care of your body the rest of the time that’s going to make the biggest difference in the world.

Monique Ramsey (25:06):

And so you routinely then, sort of, prescribe. Like, I want you on this serum or this for dark spots, or I want you to see Cameron for, uh, oxygeneo treatment or a diamond glow treatment or a hydrafacial. Do you sort of make it a whole plan for them of what your recommendations are?

Khanh Nguyen (25:25):

Yep. Every patient. So every patient I see when you get my follow up email, I lay out a basic skincare routine that everyone should be on. Once you have that basic skincare routine down, then we can play with it and add on other stuff. But let’s just make sure we have the basics down. Protect during the day, correct at night.

Monique Ramsey (25:40):

Protect and correct. I like that. Yeah. And so one of the things that our patients have found about us is our brand is where dreams become real. We’re going to help you make that dream and turn it into reality. And one way that we know we’re fulfilling that promise is through the reviews that patients write. And everyone has a personal brand that comes through in those reviews. So a patient said this about her neck lift with Dr. Brahme. She said, “Dr. Brahme gave me back my lips, as well as created a natural look around my mouth, which was very wrinkled. He also refreshed my neck area. I’m very pleased with how natural my face looks.” So Dr. Brahme back to you. In your reviews, what, we see that that word appears most often is natural. Why do you think that is?

Dr. Johan Brahme (26:33):

I think that’s because that’s what people are looking for. They don’t want their neighbor or their friends saying, “Oh, you had a facelift, who did it?” That’s way too personal. They want to look good, but not draw attention to it. And, you know, I think that that’s the natural. And the biggest fear that people have about a, quote unquote, facelift is that, “Oh, I’ve seen so many and they look so terrible”. And I tell them, “Yes, but you’ve seen thousands and you don’t even know that they had them because they look so natural.” And we have hundreds of before and after photos that they can look at. And I don’t think I’ve ever had a patient who said, “Oh yes. All my friends noticed that I had a facelift.” But it’s much more common they say, “Oh, nobody has said anything except, oh, where did you go on vacation? That’s where I want to go.”

Monique Ramsey (27:36):

Right.

Dr. Johan Brahme (27:36):

So it has to be a natural change. If it looks unnatural, then I haven’t helped the patient at all. I’ve just created a new problem. And this is one of the most satisfying areas of plastic surgery that I work in because this is what we see in the mirror every morning when we brush our teeth. This is what we see. And to have somebody say, “Yeah, I really like what I see,” and really own that, that is so satisfying.

Monique Ramsey (28:10):

Well, it’s all about confidence.

Dr. Johan Brahme (28:11):

Confidence. Yes, absolutely.

Monique Ramsey (28:13):

That is something that is, you know, such an amazing feeling, when you have confidence about how you look. And it takes away one worry, you know?

Dr. Johan Brahme (28:22):

Yes.

Monique Ramsey (28:23):

You can worry about other things instead because you don’t have to worry about how great you look. And I think to get that natural result, really… And I remember when I used to back up with the patient coordinators, they needed extra help. Patients would say, “Well, I just want my neck.” Their perception was that a facelift with this big, bad thing. And I just need my neck. But if you think about it, and I think one of the analogies is like, if your house needs painting and you just do the front door, it’s going to look even worse.

Dr. Johan Brahme (28:52):

Right.

Monique Ramsey (28:53):

Or you paint the whole house and not the front door. So it’s something that it needs to be done together. Not because we’re trying to sell you something. It’s because we want you to have the best result. And so, I remember Dr. Olesen was, he was in practice, you know, he would call it whatever they wanted to call it, a lower mini, a mini lower, modified mini lower face, you know, because if people just were shy about the whole thing being done.

Monique Ramsey (29:19):

So Khanh, we have one of your reviews that I want to talk about from one of your thread lift patients. And she said, or he said, “I’ve been going to Khanh for a year now, and he always does an amazing job. He listens to my aesthetic concerns and is able to provide results that exactly address these problem areas. I can be fairly picky, but I’ve always been really, really impressed with his knowledge, attention to detail and ability to make minor changes that reap major benefits. He’s also just a really nice and personable guy. LA Jolla Cosmetic is lucky to have him.” So Khanh, what I noticed in your reviews is a common word that pops up is detail. Does that surprise you?

Khanh Nguyen (30:04):

I’m pretty thorough with, uh, my consults and in speaking to them, because again, I let them drive the conversation. Sure, they want to hear my recommendations, but at the end of the day, you have to be happy with the results. You’re looking at yourself every single day so I have to work within your confines and your constraints and in the end, it’s about your choices. So that’s the big thing. I let them drive the conversation and the plan.

Monique Ramsey (30:26):

And then in terms of that, that word in detail is sort of, are you very exacting and precise? I would think that you are.

Khanh Nguyen (30:35):

Yeah. I think people really enjoy the way I speak about it. I come from a medicine standpoint because granted we’re in the beauty game, med spa, but at the same time, I have to treat you with the respect of medicine. So in medicine, you have to be very detailed and concise about how you explain things.

Monique Ramsey (30:49):

Mm-hmm (affirmative).

Khanh Nguyen (30:50):

What I’m putting in your face, what I’m not doing, this is why I’m doing X, Y, and Z. So I want them to have that full understanding of what they’re having done.

Monique Ramsey (30:58):

So along with reviews, you can find the cost of all the procedures we’re talking about and everything else we do on our website. And we really don’t believe in hiding things from you. You know, we want to be transparent and give you at least a price range of what something might entail in terms of downtime and in terms of healing time, and in terms of what the total cost is. We try to have all that on each of our procedure pages so that you can get an idea. And of course, I would probably think threads maybe are the most complicated thing to give an estimate until you really see them. Is that true?

Khanh Nguyen (31:36):

Yeah. It can be. I think, again, it’s the learning curve. The way I do it and the way LA Jolla does is pretty different from the way other people would do it. When people hear a typical face for me, from the eyes to the chin, I’ll put it in 30 to 40 threads, like, oh my goodness, how many? Because they’ll go to another practice and then they’re putting in eight threads. So, like Dr, or like you said, with Dr. Olesen, call what it you want, mini facelift, mini tuck, you put the definition on it. We’re doing a thread lift. Yes. I’m putting in 30 to 40. That may sound a lot to you. But to us, that doesn’t sound like a lot because I want to do the right procedure to give you the right results.

Monique Ramsey (32:10):

Right. And I think that’s the key is for all of us as consumers is trusting in your expertise to get us the result that we’re looking for. To get us a natural result, something that… you know, and so I get about, I don’t know, 70 units of Botox or something, and other people go, “Oh my gosh, I only get 30.” Well, a full correction is 68 units. So it’s not crazy, but it’s getting everyone to that right space in terms of what’s best for you to get the result that you want. And however you get there, you know, you have to trust in the provider, I think. So the consultations, correct me if I’m wrong, you’re doing mostly still on Zoom?

Khanh Nguyen (32:56):

Yes. We felt that a lot of people enjoyed it. One, I think the comfort level, when you’re in the comfort of your home, own home, you can divulge a lot more information. You’re not in a stressful environment. Also, it limits your time of going back and forth. And then, really it’s, it gives that initial level of what you truly want. Is there something I can achieve for you? Or is there something surgery can achieve for you? It really limits your, your time as well. So it’s been a really, really good change for us in regards to what has been happening. So Zoom has been fantastic.

Monique Ramsey (33:28):

And another patient of yours said, “He seems very knowledgeable about the face and I trust him not to make me look like I’ve had something done. He never pushes me into doing something more.” Is that what everyone can expect when they come to you for consultation?

Khanh Nguyen (33:42):

Yeah. Me, LA Jolla in general. I think my philosophy is similar to everyone else’s in a non-surgical setting. We can always add more Botox. We can always add more fillers. We can always add more threads, but if we overdo it, it’s harder to backtrack. So I’d rather underdo it, keep it natural and build that long-term relationship versus pumping you with thousand fillers and then never seeing you again.

Monique Ramsey (34:03):

Right. Right. And now that we’re coming up on our almost 34th birthday, that’s an important point is that, you know, we want you to be a patient for a long time and take care of you for a long time. And whether you’re starting with Dr. Brahme and then seeing Khanh for the finishing touches or whether you’re starting with Khanh to do some pre juvenation, rejuvenation, getting ahead of the father time, we’re there for you and we’re there for getting your best result. So, thank you both for joining me today. And is there anything I’ve forgotten that you want to talk about?

Dr. Johan Brahme (34:41):

No, I think you’ve been very complete and I think it’s just important for the patients to know that when they come to see us, they get the whole team.

Monique Ramsey (34:50):

Mm-hmm (affirmative).

Dr. Johan Brahme (34:51):

They don’t get just the person who they are seeing. They’re getting the coordinator who has a lot of knowledge. They’re getting the nurse, they’re getting Khanh, they’re getting me, they’re getting everybody. And, you know, we’re all on their side to get them where they want to be.

Monique Ramsey (35:08):

That’s a really good point. So if you are interested in seeing Dr. Brahme or Khanh for something to fix your neck, maybe, you know what you’re thinking of, or maybe you don’t know, and you just want their advice. You can call us at (858) 452-2066, or you can give us a text at (858) 203-2944. You can email us [email protected] and you can check the show notes for all the links. We’ll have links to the procedures, we’ll have links to the before and after gallery so you can learn about the different procedures and the different technologies that Khanh talked about or Dr. Brahme talked about. You’ll see reviews from each of their patients. And so when you go onto, let’s say you’re on the thread lift page, or you’re on the facelift page. When you see the reviews on that page, they are specific for that procedure.

Monique Ramsey (36:06):

So it’s not all the procedures. You’re really going to see how do our patients rate us on thread lifts, or how do our patients rate us on facelifts, that kind of thing. So that’s something important to know as you poke around the website. Like I said, you’ll see reviews, you’ll see reviews for each physician and each medical spa provider. So thank you all again, it was wonderful to have you both and talking about something that we’re all focused on right now, which is our neck and why I look forward to seeing you all again. Thank you.

Dr. Johan Brahme (36:40):

Thank you Monique.

Khanh Nguyen (36:41):

Thanks Monique.

Speaker 1 (36:47):

Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at LA Jolla Cosmetic. LA Jolla Cosmetic is located just off the I-5 San Diego freeway, in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The LA Jolla Cosmetic Podcast is a production of The Axis, theaxis.io.

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