I have sagging skin beside the nose as a result of another operation. On the picture I'm looking down so it's more visible. I've consulted with several surgeons but I don't like their suggestions: -minilift+smas:I can't hide the scar in front of the ear -macs:it can't really adress this area -endoscopic midface lift:too risky -threads:too much skin to pull -filling of the upper cheek: wouldn't help when looking down Maybe an endoscopic lift but not on subperiosteal plane but only smas?
Midface Lift, Alternatives?
Doctor Answers 7
A lot of men are concerned with the scars of a Facelift- I do not think that is an unreasonable concern. I do think a safe, mid face lift could help your situation but would need to see your entire face and hairline. Good luck!
You have very valid concerns. I would want to know what the previous surgery was that resulted in skin sagging in the midface. Was there soft tissue removed? Also, have you had significant weight fluctuation in the last 5 years with recent weight loss? If you are concerned about scarring from a face lift, which I don't believe would address your problem adequately anyway, then you may want to consider medial submalar cheek implants which will replace volume and lift the tissue without any facial incisions. Generally the face lift incision in a man is not hidden inside the ear as such a design will bring hair-bearing skin into the ear and it is difficult to manage even with LHR. Also, most men wear their hair short, and the incisions have a tendency to be more conspicuous. The blepharoplasty incisions can be well camouflaged but can cause ectropion or tension on the lower lid from the suspended cheek tissue and cause rounding of the eye. The endoscopic approach is technically difficult and in your case may yield only limited results given heavy midface soft tissue. You can also discuss autologous fat transfer as an option with your surgeon.
Looking for face lift answers
Boy, this is a tough one for the simple reason that I just don't see anything that's capable of giving you a good result not including an incision, of some kind, around the front contour of your ears. The NLF and Jowls do contain excess fatty tissue that could be reduced locally with micro-liposuction and the cheeks can be shaped using fillers like Perlane and Radiesse with an incision but these won't tighten the SMAS.
Here's the kicker, IMHO...any procedure that tightens the SMAS... will create excess skin in front of the ears. To remove this exces skin, an incision must be opened and the skin trimmed. There's no way around it whether you use threads (agree these don't work) or a subperiosteal approach which I don't like for a number of reasons.
If you really can't tolerate an incision around the ears, try the other procedures mentioned above and see if they give you enough of a result. If not, at least you know what's required to move forward.
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A facelift does not leave obvious scars that have to be camouflaged! When done properly the scars are not noticeable.
Look at before & after pictures with your surgeon. It may not be the procedure you choose, but the scars should not be the reason.
Mid facelift or alternatives
Based on your concerns I would suggest a combination therapy. Consider a subciliary approach (directly under the eyelashes) in combination with a midface lift to re-suspend the SOOF fat and SMAS in that region to the infraorbital rim. Also consider filler (juvederm, restylane) to the nasolabial fold, inferior to the fullness to efface (camoflauge) the area completely. If this is unacceptable to you, you might want to consider an Endo Brow approach in the lateral hairline, extending over your zygoma for a subperiosteal lift (with a combined intraoral incision) that will conceal the surgical scars and give a solid lift for that region. This should address your concerns.