Why Are We Still Talking About Toners?

plus, a final word about jowls

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You might’ve thought—even wished!—our jowls talk was complete. But a curious reader wondered why dermatologist Hadley King hadn’t mentioned liposuction as a treatment, when several physicians she visited suggested exactly that. King, ever-patient with “What about…” questions, explained: “I have more experience with Kybella than liposuction, because I don't personally perform liposuction. That's probably why I didn't think to mention it.” But there’s more.

Kybella treatments dissolve fat through injections of deoxycholic acid, while liposuction literally vacuums fat out of an area through a cannula. “I agree liposuction could be a good option for the right patient,” said King. “When I discuss options for submental [below the chin] fat, I include various devices, Kybella, and liposuction. I tell patients liposuction will be the most definitive treatment—and the only option that should be one and done, particularly if there’s a significant amount of fat.” Usually, internal scarring from the procedure also creates sufficient collagen to tighten the skin. But King added, “I would recommend a highly skilled dermatologic or plastic surgeon for this, because the risks include asymmetry and lumpiness, as with liposuction in any area. You also don’t want to remove too much fat, or fat that's located more in the cheek. We generally want that buccal fat as we age.”

I hope Dr. King has now stanched the gush of curiosity about jowling so we can wrap it up and discuss other puzzling topics. How about skincare myths?

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