Christine A. Petti, MD

I have been very pleased with the natural result of rejuvenating the lower face and neck with--combined procedures-which I describe as a Lower Face and Neck Lift with SmartLipo/ SmartLifting of the Neck (laser-assisted surgery to melt and sculpt any fat on the neck and tighten the skin by controlled heating of the neck skin using the Cynosure SmartLipo MultiPlex) and Affirm Fractional CO2 laser resurfacing of the Face and Neck. This surgery can be safely done under use of 2 oral meds for pain and relaxation, then using local anesthesia with cardiac, blood pressure and oxygen monitoring.  The patients are very comfortable and can go home immediately following the procedure with none of the risks of general anesthesia.  The outcomes are very good and the patients are very satisfied.  It is a modern trend for patients to desire "natural" over----- "done and distorted".  Since you have scars already from your first necklift, it is likely that no new scars will be required.  I use tumescent fluid to deliver the lidocaine which numbs the surgical areas, then the SmartLipo MPX laser is used to dissect the tissues, control any bleeding (which is common when operating on the face)  and liposculpture any excess fat in the neck and along the jawlines.  The playsma muscle of the jawline and neck can be tightened with internal support sutures to give a more well-defined angle between the jawline and neck.  In many circumstances, the SMAS layer, which is a supportive layer overlying the muscles of the face, is tightened with a focus on the vectors of the jawline and lower face.  The skin of the entire face, eyelid skin, and neck is then resurfaced with the Affirm fractional CO2 laser (treats wrinkled skin and sun damage, tightens skin as well) to give a uniform, balanced, fresh and natural appearance to the entire face and neck as a unit.  It does not look like patch work.  To keep the mid and upper face full and supported, dermal and subcutaneous fillers, such as Juvederm Ultra Plus (also Sculptra, Perlane and Radiesse) can be used to lift and volumize the cheeks and tear trough area.  Botox can be used to soften the lines in the upper face.  The patient can have a very natural appearance, look fresh, but not scream--- "done".  My patients and I have been very pleased, but patient SELECTION is key and this procedure is not for everyone.  From what you have stated, it may be good for you.  However, all patients need to be seen in consultation, examined, medical and surgical history reviewed and photographs taken and analyzed to make a unique plan that is customized for each patient to give them the best outcome.  I hope this helps! 

Christine Petti, M.D., F.A.C.S.