Philip S. Schoenfeld, MD, FACS

There are a couple of issues with your neck at this point. The first issue is that I don't think that a neck lift alone is going to remedy the excess skin that you currently have. I think that the proper vector to remove that skin and improve your jawline is up, not back. I feel that you are a facelift candidate and not just an isolated necklift if the first surgeries were performed correctly. The second issue is the scarring and skin quality. I think release of the skin from the underlying muscle needs to be performed. Exploration of the status of the digastric muscles should be evaluated as I do not think this is a gland issue. Fat grafting may need to be performed after the skin is redraped and the underlying platysma and digastric muscles are corrected.

Your doctor is not incorrect. You can have micro fat transfer to this area very conservatively, but unlike the cheeks and peri orbital area, the submalar region is all soft tissue without any bony framework support so significant volume in the form of fat or filler placed in that area tends to not work well.

In a trichophytic browlift the incision is placed just inside the frontal hairline. When the forehead skin and muscle are elevated, both skin and muscle are removed but that has no bearing on forehead mobility. I think what your surgeon is alluding to is removal of muscles at the "11's" between your eyebrows. I would check with them to see if that is what they have planned for you.

There is not a lot of information provided to effectively answer this question. I don't know when you had your facelift. I do not know what you looked like prior to your facelift. There are no profile photos showing neck, jowls, and cheeks. From what your photos demonstrate, I think that you are fine and do not need additional facelift surgery.

You are really asking many different questions. My first thought is that one week following facial fat transfer is way too early to worry about being over filled. Give it about 8 weeks and I suspect the swelling will have subsided and it will look much better. My second thought is why you didn't simply have a deep plane facelift if you were worried about the appearance of your midface, lower face, and neck? Having your lower face and neck done surgically will in no way create an abnormal relationship between your mid face and lower face. A well performed face and neck lift will create a beautiful neck line and reduce your jowls. If necessary, elevation of your mid face fat pad can also be performed with a deep plane face lift.

Knowing that you had a prior liposuction procedure, I would say that your issue at this time is excess skin and loose muscle. I have many patients come to me who are interested in neck rejuvenation and believe that liposuction alone will help with this. Given the degree of laxity of your neck, a surgical neck lift procedure will absolutely help. I would strongly caution you about employing energy devices to tighten your skin as they are not going to come close to what a well performed surgical neck lift can do.

A couple of thoughts. First is that more time will not necessarily mean more volume and less hollow. However, waiting a few more months will let the tissue settle down to give the most potential for the best revision outcome. I would use PRF or nano fat to help with the hollowness. I have found both of these solutions profoundly effective and very long lasting.

The short answer is that there is a technique that can elevate the lip without creating a larger lip and more red mucosal show. A photo of you smiling is going to be of more benefit than one with just your mouth open as that will also help determine the degree of tooth show.

To start with, I am not clear how addressing your inferior turbinate, nor reconstructing your inferior turbinate for empty nose syndrome would have lead to the collapse of the external nasal valve. With that said, an alar batten graft or lateral crural strut graft will be able to address this defect with a great deal of success. Fillers are not going to remedy this issue.

It is a bit difficult to comment on all the changes that I might suggest to the appearance of your nose without other views, however, I would suggest creating a bit more tip definition and narrowing, It appears that a subtle lift to the nasal tip and slight lowering of the nasal dorsum would also be of some benefit.