Please advise any procedures recommended to correct and restore my lower/mid/upper face
(i.e. facelift and/or fillers)?
I have just had 1 syringe of Juvederm Ultra Plus, 1 syringe of Juvederm Ultra and 1 syringe
of Restylane Silk divided between my nasolabial folds, marionette lines, chin and lips.
Side note: The doctor put Juvederm directly in the corners of my mouth and "fanned outwards"
which seems to be giving me even more of a "side jowl" looking appearance.
A hard lump also developed in my upper inner lip that I've had to go back and have dissolved
with Vitrase twice now.
Thank you for your question!
You’re asking a very broad question on what to do to help your upper, mid and lower face
and you’ve described your experience recently having had Juvederm Ultra plus, Juvederm Ultra
one syringe and Restylane silk, one syringe.
Unfortunately, you developed a lump that needed to be dissolved with Vitrase.
Well, let me give you a little bit of my background.
I’m a board certified cosmetic surgeon, I’m a cosmetic oculofacial plastic surgeon
practicing in Manhattan and Long Island for over 20 years.
I’ve written a book on facial rejuvenation and I have certainly come to a lot of conclusions
about the different options we have when it comes to rejuvenation the face.
So to begin with, with the photos you submitted, it’s clear that you have a relative thin
face.
Now the question that you posted whether or not you need a facelift, the only way to really
answer that question is physical examination.
I try to avoid when a patient has a relatively thinner face and minimal jowling.
And this is usually someone who is in their 40s, a woman who is fit and who is in her
40s.
Very often they can do this and it may look better but with a facelift, you have a limit
on how much you can pull.
You don’t want to take someone who is in their 40s and do a lift and they look good
naturally and someone looks at them and maybe see an incisional scar something that they’ll
think like, oh, they look good because of the facelift.
You see, there are two basic issues and I think you clearly understand them because
you are getting fillers.
There’s volume loss and there’s descent.
And in terms of descent, when the descent is significant enough, the volume correction
is not going to be effective then lifting is indicated.
Now in our practice, we do something called the Y lift.
The Y lift is a very interesting procedure in that it kind of straddles the benefits
of a facelift with the benefits of injectables.
Essentially without surgery, the Y lift procedure is able to accomplish some structural volumizing
in a way that is not done typically with the way fillers are placed in general by cosmetic
surgeons, dermatologist, plastic surgeons.
When you described that you had 3 syringes and each syringe was done with the intention
of using a certain viscosity level, it’s very well thought out.
But what you are probably experiencing is that you’re still frustrated by the lack
of integrity of the structure and for the outcome that you desire.
In our practice, we have done a lot of similar things for patients where we I would put a
filler like Radiesse in the mandibular notch and then use a filler like Restylane in the
submalar area.
We would also routinely use platelet-rich plasma (PRP) to help stimulate skin quality
and glow.
But what I think that you might find of value is learning about this procedure called the
Y lift.
It’s not an advertisement for the Y lift but I think the basis for the success of the
procedure is that when you are in that middle zone, there is certainly a point of no return
where you put fillers and you put fillers in a certain way where you might actually
start to weigh down the tissue.
Where Y lift works very well is it is the strategic placement of the same fillers, Juvederm,
Voluma but in a deeper level and in a very specific way where the structure of the face
is actually enhanced and that structure creates very remarkable definition and in many ways
can look like a facelift without the facelift.
So I certainly understand and respect the frustration that you have.
This is something that many people like yourself has.
And although this is one solution that I’m suggesting to you, I think you have to also
understand what are the most important aspects of your facial anatomy that you want to see
improve.
Everyone comes to the table with a different set of values but I think there is a certain
consistent value that many people share which is why I suggested exploring the Y lift.
So I hope that was helpful, I wish you the best of luck and thank you for your question!