Alternatives to Plastic Surgery

If you’re hoping to find your youthful face and lose your double chin—without invasive surgery—you have options for expert care in Hampton Roads. In most cases, you can go back to work the same day. Keep in mind that results will take two to 12 weeks, so plan ahead if you want to look your best at that milestone high school reunion or other event.


For people who want to smooth out fine lines and wrinkles, Ultherapy is a less invasive option than a facelift, says Janine Derkas, registered nurse at Associates in Dermatology in Hampton. Ultrasound waves penetrate deep in your skin layers, deeper than a laser can, to stimulate your body’s natural process to produce fresh, new collagen, Derkas says. Ultherapy lifts skin and improves lines and wrinkles on the face and chest.

“This is for a person who doesn’t want a face lift but would like some improvement,” Derkas says. “There’s no downtime. There’s minimal bruising. It’s a procedure that can be done and no one even knows you had it done. You can go back to work the same day. I had it done and went to a function an hour later.”

Ultherapy, which is FDA approved for the brow, face, neck and décolletage, has been in use in the United States since 2009. Associates in Dermatology began offering Ultherapy in May 2015 and has treated patients ranging from their 30s to 80s, Derkas says.

Results are natural looking over six months. “It’s a gradual change,” she says. “What I like is the tightening—you feel the tightening right away. When I look at my before and after pictures, I’m more tight in the jowl area. In about three months, someone in their mid-30s to 40s can really see it. For others, it takes about six months.”

Treating the entire face, neck and décolletage costs about $3,000, she says. Depending on your need and/or budget, you can pinpoint smaller areas such as crow’s feet, your brow, lips or lower face. Treating the full face, chest and neck takes about two hours.

The treatment itself can be uncomfortable, Derkas acknowledges. “It’s like a contraction. You can actually feel the muscle tightening during the treatment. Then you feel heat—it’s about 160 degrees. But it’s bearable.”

There’s no pain afterward, Derkas notes. “You go home and you’re fine,” she says.

For most people, one treatment is enough. Someone older might get two treatments six months apart, she says.

Ultherapy is not for everyone. The procedure tightens skin but doesn’t remove fat and works best on skin that’s saggy but not excessively so, Derkas says. “It doesn’t take the place of a face lift,” she says. “There are some people who need a face lift.”


For people who have a double or triple chin, Kybella is an excellent choice to remove that fat and restore a thinner, more youthful neck. “The best person for Kybella is somebody who has good skin elasticity but has a fat pad under their chin, says Dr. David McDaniel of the Laser and Cosmetic Center in Virginia Beach. “A lot of people who come in have their mother’s or grandmother’s chin even though they’re in their 30s. It looks like a little bar of soap. If you’re young, have good skin elasticity and have fat, the results can be dramatic.”

Kybella, which was approved by the FDA in April, involves injections of deoxycholic acid to kill fat cells in the neck. The treatment is customized for each person, he says. The cost is $1,400 to $3,000 depending on the amount of fat and number of treatments needed, McDaniel says. Most patients need two treatments about four to eight weeks apart; some need three or four treatments

There’s no downtime and no anesthesia, he says. But Kybella can be painful and often results in bruising and then swelling for two to four weeks, especially after the first treatment, he says. For that reason, McDaniel now often reduces the dose for the first treatment to minimize those side effects and then uses a higher dose for later treatments. The second and subsequent treatments cause less swelling, he says. There is no scarring.

One other after effect is that once the fat from the neck is gone, muscle bands on the neck can show more prominently, McDaniel says. About one in four patients also see significant skin tightening after Kybella; the rest do not, McDaniel says.

Overall, results are natural looking and enduring.

“Patients see fat reduction very quickly, within weeks,” McDaniel says. “It doesn’t take six months—you see it right away. Patient satisfaction is very high if you set their expectations carefully. Some people say, ‘I look younger. I have my neck back.’ They really see a visible difference.”


CoolMini, as the name implies, is a small version of CoolSculpting and is designed to eliminate fat under the chin by freezing the fat cells. CoolSculpting was FDA cleared in 2010, and CoolMini for the neck was FDA cleared in September 2015.

The CoolMini device sucks tissue in and freezes the fat cells, says Dr. John Mancoll of Mancoll Cosmetic and Plastic Surgery in Virginia Beach. Fat cells die over eight to 12 weeks, and patients see 75 percent of the benefit in eight weeks with the full benefit at the 12-week mark, Mancoll says. Most patients need two treatments, four to six weeks apart, he says.

With CoolMini, patients lose 22–25 percent of the fullness in the chin and neck area. The prime age group is people aged 35 to 65, he says. About 90 percent are women, but the procedure has a growing appeal to men because there’s no downtime.

Like Kybella, the ideal candidates have good skin tone—just a little pad of fat under the chin they want to get rid of. Also like Kybella, after the fat is gone from the neck the muscle band can be more prominently visible, Mancoll says.

CoolMini can’t be customized as much as Kybella, but it’s an excellent choice for patients who are afraid of needles.

“When I described the Kybella process to one patient, I saw the sweat build up on her forehead and upper lip about being injected by needles multiple times,” he says. That apprehension made CoolMini the best option for her.

CoolMini does not cause the bruising and swelling that results from Kybella. It’s also less expensive—$800 per treatment, he says.

“Patients love it,” Mancoll says. “It’s amazing. Sometimes the changes are subtle, but patients are thrilled to death because they’re looking at it every day.”

CoolMini, similar to the other procedures, buys people time until they are ready for a bigger step such as a neck lift, Mancoll says.

After you’ve had a procedure to tighten your skin or reduce fat, your job is not done. It’s up to you to maintain that healthy, youthful appearance.

“If you think, ‘I’ve done my time. I can eat whatever I want,’ the fat will come back,” Mancoll says. “If you keep a stable weight, the area will look great.”

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