Thank you for your question. You've submitted numerous photos and you stated in your question
that you underwent face lifting surgery in 2012 then you had revision surgery done in
February of 2014 where as you described the doctor performed above the jawline aggressive
liposculpture to address some bulging in the area and now you feel like your face is sagging
and it's not looking as good as you like.
Well, I can certainly give you some perspective about your concerns. My background, I'm a
Board-certified cosmetic surgeon certified by the American board of cosmetic surgery
I'm also an Oculofacial plastic surgeon, fellowship trained through the American Society of Ophthalmic
plastic and Reconstructive surgery or Oculofacial surgery so face lifting is a very big part
of my practice and I been in practice for over twenty years.
So it's important that when you are looking for additional opinions and you submit photos
to understand that the limitations of the opinions are based on just the photos themselves
and in the absence of a physical examination, it is difficult to be comprehensive.
But it is also not my role to disparate what other people do of what they would be thinking
when they're doing what they're doing. With that being said I think that from one set
of photos where you described a quote bulge that bulge I think that my initial impression
is that bulge probably represents something called Herniated buccal fat, now that is something
that is often seen in people as we get older that the fat that used to provide some volume
and shape to the face can become atrophic or thin out and you can also push outward
in the lower part of the face.
It is something that I do during routine face lifting surgery is to reduce that buccal fat
during the face lifting surgery to help improve that contour. Now it might have been your
doctor's opinion that the buccal fat was maybe not as prominent but that there was fat in
that area that needed suctioning. From my experience, suctioning above the jawline has
limitations, I don't usually do that if I'm going to do any resection of fat above the
jawline or even below the jawline I actually don't do that much suctioning during my face
lifting surgery.
I find that I get better results by doing direct excision during the surgery. I feel
that basically fat under the skin is such an important layer even as we get older particularly
as we get older because it has a very important role metabolically and in terms of its cushioning
effect on the skin. So in a situation like yours if you still feel like this volumetric
loss there are some options and you will get lots of opinions and you described that you’re
getting conflicting opinions there's a lot of reasons for that we any clinician with
experience relies a lot on their own experience to make recommendations and in my practice
I always think of what is my highest values is has to do with safety, predictability and
likelihood of patient's satisfaction.
So with that being said a lot of my colleagues may feel that what you need is some type of
fat grafting I personally feel that fat grafting isn't predictable enough and consistent enough
to be justified to help fill out the areas that you feel are sinking in. In our practice
for people who've had facelift in the past and who feel like they need volume we perform
something called a Y-Lift and this is a procedure which is not a surgery but rather the use
of hyaluronic acid fillers to be placed at the structural level, under the muscles of
the face to restore definition of the jaw line and the cheekbones, In a way that actually
add structure. I find that a lot of people are very satisfied with this who've had facelift
in the past with the understanding that as we get older we don't just have sagging but
we also have volume loss and so bone muscle and fat being lost and in your situation may
be more fats being lost from a surgical procedure, there is an opportunity to maybe restore some
structure to try to help you look better without having to do another surgery.
I think that your original Doctor probably have some opinions about what the changes
are and I'm sure these photos have been presented to the doctor, so getting additional opinions
certainly yes it's going to be confusing but ultimately you have to make a decision.
I'm not sure if you've heard of Y-Lift and whether or not this may be worth trying I
feel that it's an opportunity because in the worst case scenario on like a surgical procedure
Y-Lift uses hyaluronic acid fillers if someone doesn't like it and we can always dissolve
the filler with hyaluronidase which makes it to fully reversible procedure essentially.
So I think that that's something worth exploring and learning about just to add more confusion
to the conflicting opinions you've already received, but I certainly understand your
concern and distress. So since you're putting your question out there I think that it's
something that help from my perspective and what I do in my practice giving you some idea
of what my first thoughts are when I see someone with deflation whether it's surgical or age
related.
Because it's certainly not about lifting anymore for you it's really about creating better
structure I would also add that we do also recommend Platelet-rich plasma to help improve
skin quality and texture to help people who've lost fat and skin is very thin and that's
also been very successful for us.
So I hope that was helpful I wish you the best of luck. Thank for your question.