I know the jowls aren't bad yet, so I'm not sure what options I should consider. I'm 51
and am in excellent health and don't smoke. Many thanks.
Thank you for your question!
You’re 51 years old and you want to get a sense of what’s the best option to deal
with some sagging skin under the neck from the two photos you submitted. Otherwise, you
are in great health. So what I’ll do is share with you my general approach when we
meet patients like yourself in our practice.
I’m a cosmetic oculofacial plastic surgeon. I specialize in facial aging procedures such
as all the different types of face lifting procedures and I’ve been in practice for
over 20 years in Manhattan and Long Island. So when we look at someone like yourself,
during a physical exam, I generally find that vertical lifting is usually the ideal solution
to deal with this limited amount of skin under the neck. For someone like yourself, there
has been a proliferation of thermal devices that attempts to replicate what’s done with
surgery and those devices are not only disappointing but they’re actually causing a lot of damage.
I’m seeing this in our office every week. We’ve seen this patient who got this latest
greatest heating device that’s supposed to lift your skin without surgery and what
I’m finding that instead of lifting, they’re actually losing volume in their face in terms
of the fat under the skin. Now that may sound in first impression to be a good thing. It’s
very important to understand that in the face, in the skin or body or anywhere, a certain
layer of fat is very important to maintain a quality to the skin and the health of the
skin. There is more and more evidence that the fat directly under the skin is more than
just padding. That it has stem cells and has so many beneficial and important communications
with the skin that we, in other areas of our practice, we use that to our advantage. When
we use platelet-rich plasma and other things actually, enhance the fat. So we discourage
you to begin with from doing the thermal energy devices. I just don’t think they work.
When we talk about different kinds of lift, there are a lot of options. Over 20 years,
I have seen facelifts go from general anesthesia procedures with multiple drains and overnight
hospital stays to quick recovery facelifts that take only an hour. And in between that
range, there’s a variety of options. Different ones named by anatomy, others named by incision
style. Let’s understand some basic principles before we just jump on what that procedure
is.
But just to also state that when I examine a patient, I will have them look in the mirror
and I lift their skin and see what the end result be. Underneath the skin is an important
muscle called platysma. And sometimes, although it’s not seen necessarily on your photos,
there are things called platysmal bands. And what we do, when are dealing with platysmal
bands, we have to address them as part of the overall lifting procedure. So the impression
that I’m going to give you is based really on the limited amount of information with
the photos but also give you some conceptual ideas.
So when it comes to lifting someone who’s young, who’s got a good bone structure as
you do and decent skin quality, usually some type of vertical lift is appropriate. And
we want to do this in a small incision as possible. This way you don’t have the obvious
sign of having facelift and at the same time, you have a less invasive overall experience
in terms of the surgery. Let’s understand some basic principles. In facial aging, there
are two things that happen: we lose volume. In other words, we lose bone, muscle, fat
and everything goes inward and then there is descent. There’s descent of skin and
descent of a very important structure of the face called the SMAS. The word SMAS in an
acronym for a term called superficial musculoaponeurotic system. This is the layer under the skin which
transfers the activity of the muscle to the skin. It’s a communication and layer. And
so these layers get weak and thin as we get older and sag. So, any procedure involves
not just skin but also some type of maneuver to address the SMAS. Now this can be anything
in the range of plication to suspension sutures to flaps and a lot of different variations
of all those.
What’s most important is that you do a procedure that’s going to last and that you do something
that isn’t a shortcut. A very well publicist company that was doing large scale volume
of facelifts recently closed their doors and amongst of most of my colleagues or many of
my colleagues I should say, we all anticipated this demise because they were promising something
very aggressively that they were claiming that they can do, in a way that none of us
can do. We all know how to do surgery but what they were doing is that they were claiming
that they can get effects of a 3-hour full face and necklift in 1 hour under local anesthesia
without sedation or monitoring. And so ultimately, these companies had to close their doors.
Meet with cosmetic surgeons who do a lot of facelifts. Look at the examples of before
and afters. Get a sense of their aesthetics. This is a very important decision. In my practice,
my style is more about natural. I feel like everyone has a unique character to their face
and when I see them and have these facial aging changes, I say to them that what we
try to do is get you back to where you were about 5 to 10 years ago. In other words, restore
the definition of the jawline, improve the angle of the neck. Basically look like yourself
but a younger version of you. Now there are other colleagues who prefer a more exaggerated
appearance. And I’m not saying that’s bad, I think that’s a matter of the aesthetics
of the patient and the doctor have to in sync.
So in our practice, when we do a procedure like this, it will be something relatively
short scar face lifting procedure possibly with plication or suspension or flap depends
on what I see while I’m doing the surgery. And this is an art. Not everybody needs a
deep plane facelift. This is a commonly used phrase these days and because a couple of
doctors are claiming that they do only deep plane lifts. Reality is that any experienced
cosmetic surgeon who does a lot of lifting can do all these procedures customized to
each patient. So just be aware of an all or none type of approach. One size definitely
doesn’t fit all.
In our practice, when we do a procedure like this, it takes us about 2 hours to do. It’s
done under local anesthesia with LITE™ IV sedation. That means we avoid general anesthesia.
The patients are able to recover very quickly. We generally don’t use drains. And once
it’s done, it tends to hold very well and we always say that it can last anywhere from
5-10 years depending on a lot of factors which I can control and factors I can’t control.
You have to take care of yourself, you have to eat right, sleep properly and avoid toxic
exposures that I should say such as excess sunlight or smoking or severe stress. These
are all things that age you and accelerate the aging process. I always say that in the
50s, we have to make very good decisions everyday so that you maintain that youthful appearance.
So understanding that your procedure should be a relatively limited procedure, it doesn’t
have to be an extensive full face and necklift. But you need a physical exam to make this
decision and you also have to feel comfortable with the doctor, aesthetics and the style
to understand and anticipate what you can expect. In addition, as I said, in my practice,
we do this under local with sedation. I feel there’s a distinctive advantage over general
anesthesia in terms of patient experience and quicker recovery, and take it from there.
So I hope that was helpful, I wish you the best of luck and thank you for your question!