Thank you for question. You submitted a single photo showing the lower
part of your face and neck and you stated in your question that you have a scar under
your chin after having Mohs surgery, and that you’ve gone through several consultations
and you’ve been essentially overwhelmed by the different names and the terms relating
to the best face and neck lift procedure for you which results in of course confusion and
you’re looking for some guidance. Well I can certainly help you with this question.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years. Face and neck face lifting surgery has been
a significant part of my surgical practice over the many years I have been in practice
and I can certainly share with you, many of the challenges there are in how people make
these decisions and what the options are in front of them. So let’s begin with just
understanding what the essential problem is and in the absence of a physical exam there
is still a certain limit in what recommendations can be provided but the reality of face and
neck lifting surgery has been kind of an evolution over the course of the past 20 to 30 years
in what the outcomes will be and how to get the most longevity and do it the safest way
in the most predictable way. Now on top of that I would also add that there
is really a much greater awareness and understanding of facial aging that is not just the result
of sagging. That also there is a greater understanding of the volume loss that is related to bone
loss, muscle, fat, soft tissue and skin. So I can tell you that in my own career that
when I first was training in facial cosmetic surgery, for a surgeon the goal was to lift
as significantly as one can while maintaining a natural appearance and understanding that
a certain amount of tissue elasticity would cause a certain degree of regression. And
I think one of the things about being an experienced surgeon is that you want to understand that
regardless of the technique regardless of the name regardless of the plane or the level
in depth of the technique there’s a certain amount of relaxation that invariably occurs
and that there’s a certain amount of tissue stretch skin soft tissue.
And so it’s very important to also understand that in the end, what has been basically the
evolution. In my practice I do my procedures to get the maximum amount of lift with minimal
surgical time as well as quickest recovery for the patient. And I think that has essentially
evolved a lot not only just for myself, but for many of my colleagues. And I’ve noted
for myself how many of the people who are let’s say a couple of decades older than
I am who I learned a lot from, kind of went from doing more aggressive surgeries to kind
of coming back to what I see are very similar methods that I do. And so that we’ve kind
of all arrived to a place where essentially we have to meet the needs of a modern person
and understand that surgery is one part of the overall solution.
So I would say that from the way I would approach a patient like yourself, after physical examination
and evaluation. I would say that I would do as appropriate face and neck lifting surgery,
without any name or brand name or anything like that, under local anesthesia with LITE™
IV sedation. And that I would also communicate with you and understand that there are certain
areas in the face that has volume loss that you just can’t lift aggressively enough
to hide. So I would say there’s a kind of a twofold approach you approach the lift to
restore position of sagging tissue, you then do volume correction to restore volume loss.
So I’ll try to explain that now there’s certainly ways to do that but I would say
my goal with volume correction is to do things that are predictable consistent and are able
to allow for minimal downtime. And so generally I show my patients that area of like the jowl
is a very important area to understand when you lift the skin and you still see the notch
or the indentation, people think the jowl is still there, but no It’s called the mandibular
notch in that area where the bone is a little bit deep or resorbs. That’s an area where
a filler can be of benefit. When you look at the midface the cheeks tend to be more
hollow so you don’t want to just lift but to restore volume so there’s an art.
There’s an art to doing this and with your situation a scenario where there’s a little
bit of skin shortage to a degree after undergoing Mohs surgery that also has to be factored
in. Last but not least is also understanding the best way to improve skin texture, tone,
and quality that’s not about lifting. That’s where technology such as the use of platelet-rich
plasma, this is derived from your blood, or other ways to help regenerate skin quality.
So now we are differentiating skin quality from skin quantity and the use of possibly
thermal energy devices and lasers. So essentially I feel like in my own practice to help my
patients understand and what I provide is a more comprehensive and solutions for the
different elements of what a patient needs. So thinking in terms of overall philosophy
yes face and neck lifting for repositioning, then volume correction to restore volume where
volume is lost, and improving skin texture tone and quality with the many tools we have
for that. And so it is understandable that you have
saturation and brand confusion, but when you understand these basic principles of reposition,
re-volumize and then improve texture and quality of the skin then you kind of understand the
global strategy and that one operation or one procedure is not the solution to all elements
of facial aging. So I think what you should do is meet with doctors, and you’ve already
done that, but with this kind of approach look for an approach that I feel from my perspective
is going to be the safest for you have the most predictable surgical result and give
you the recovery time so that you go back to your normal life as quickly as possible.
I think gone are the days for most people who actually work and have many responsibilities
where you can have a very long prolonged like one month plus recovery time. In the modern
world even for my patients that I do face and neck surgery and laser and other things
people need to get back to work and so I would tell them to give yourself a week to ten days
and depending on the extent of the face and neck lifting surgery I am doing so they should
get back to work and not draw attention. So I think that is also very very important guiding
principle which is why some of these short scar and other procedures have come about
but at the same time you would still want the longevity and benefit of good quality
procedure. So again think repositioning, volumizing and then skin quality and texture improvement.
So I hope that was helpful I wish you the best of luck and thank you for your question.