Thank you
for your question.
You submitted your question with several photos and you state in your question that you went
to a Board-certified plastic surgeon and you underwent a mini facelift and that everything
looked good in the beginning but you’re concerned that 3 months later that the jowls
appear to have reappeared and you’re asking why this happened and whether this procedure
is easy to redo.
And you stated that it looked better in the beginning.
Certainly, I can share with you my philosophy about face lifting.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Facelifts have become a very big part of my practice from the beginning.
And I have participated in the many evolutions of face lifting, everything from minimal or
mini face lifting to advanced deep plane face lifting.
But essentially, we’re talking about some core principles that are important to understand
and I think that there’s an opportunity here for you to also understand something
that may or may not have been brought to your attention during the time of your consultation
to help you give some insight.
So for many years, the gold standard for improving the jowls and the neck skin has always been,
essentially, the facelift procedure.
And with every meeting, there are always doctors showing how their method is always the best
and lasted the most time and had the best outcome.
And I think that one of the realizations that we’ve had over the many years of this pendulum
swinging back and forth over time is that we have to understand that facial aging is
not about sagging alone.
And when you have a facelift, you are addressing the sagging.
What are you not addressing unless it’s specifically addressed at the time of the
facelift?
You’re not addressing volume loss so understanding that facial aging is both sagging and volume
loss.
Now that being said, when you have a little bit of a lift, you’re essentially repositioning
sagging skin and muscle to a better position, restoring that position but you’re lifting
against bone that has actually diminished and this is very important to understand.
Within the plastic surgery literature, it has been very well documented how the bones
actually change over time and that is very relevant when we do face lifting surgery.
So when I talk to my patients about a facelift, I also explain to them that there are certain
areas where it’s very important to focus on to be aware as to what is the limit of
what the improvement can be and one area is called the mandibular notch, the area where
you are looking and seeing a jowl.
In that area, what it looks like it is sagging, you can also perceive that area in front is
indented.
Now that being said, you can at least understand how in our practice and what is now a strategy
in helping people who are not quite ready for a facelift or have had a facelift is to
add volume in the area where there’s volume loss.
So in the mandibular notch, you can add fillers.
Now you mentioned that you have looked better in the beginning.
And I think that most doctors who perform face lifting surgery and this included oculofacial
plastic and reconstructive surgeons, facial plastic surgeons and general plastic surgeons
is that people often do look better early is because swelling restores volume.
And so the appearance of a person can actually be younger because the swelling can make them
look more full.
And as the swelling resolves, then you get to see what is the underlying structural deficits.
So I think it’s important for you to understand that it’s not necessarily a procedure that
would have to be redone because as much as you may pull your skin up and say to your
doctor, “See you didn’t pull this tight enough.”
The reality is that the tissue will always reach an equilibrium and that the doctor,
the surgeon who is experienced knows that they can only lift and trim a certain amount
of skin and soft tissue and expect a good healing scar or well-healing scar as well
as minimize the amount of tension in the other direction to avoid pleating or tension lines
as well as to avoid a widened scar and that is part of the art of surgery, not too tight,
not too loose.
You have to have a certain amount of elasticity.
Understand that you have to turn your head, you have to be able to talk, yawn, move your
skin and so there’s an equilibrium there.
So I think that the point of this is to at least, from what I would probably counsel
you if someone like yourself comes for an additional opinion, is to allow for more healing.
Allow for the skin to heal and understand that there is some degree of tightening that
can occur as part of the wound remodeling phase of healing.
Some things may get a little bit more laxed, some things may get a little bit more tight.
It’s a body in motion.
It’s an act of dynamic process.
And I would propose that you would look at things from a volume correction perspective.
Your doctor may be able to help you by simply placing fillers strategically.
In our practice, we do something called structural volumizing and it has been relevant for patients
who are not quite ready for a facelift or patients who would never have a facelift to
restore volume in some critical areas which are the cheeks, the jawline and the chin where
the bone loss can be significant and it may create the appearance of sagging when actually,
there’s a lot of deflation than there is sagging.
And that being said, with that technique, we’re able to restore an appearance that
in many ways can look like a facelift and I would even argue, in many situations, look
better than a facelift.
So we’re living in a very good time where there’s greater knowledge and understanding
of the basis of facial aging and there are a lot more tools to help people look their
best.
So in my practice, my goal is to do the safest, quickest recovery surgery when indicated and
use fillers as a way to help restore volume where volume is needed to create the optimal
and natural look.
So I think there’s an opportunity here.
I don’t think you need to abandon ship.
You don’t need to expect and assume you need additional surgery.
Typically the person who is a candidate for a limited facelift generally doesn’t need
revision surgery because there wasn’t that much excess skin or elasticity as compared
to someone who needed a more extensive face and necklift who probably has some tissue
elasticity that can maybe progress even further and need a little bit of enhancement.
But discuss this with your doctor and explore the options about volume.
So I hope that was helpful, I wish you the best of luck and thank you for your question.