Jill Hessler, MD

You can definitely have a facelift despite having 3 theramge treatments 6 years ago. I have frequently performed facelifts on patients that have had thermage, filler, ultherapy, morpheus and other facial treatments with great results.

As we age it is common to see the 'inverted triange'. In youth, the upper face is wider and as we age the lower jaw region becomes wider. You are a beautiful young woman and therefore have multiple options. You could consider filler, fat transfer, skin tightening devices or surgery. The deep plane facelift is the best way to rejuvenate both the mid face and the lower face as well as the neck.

In general a facelift should lift and rejuvenate the tissues and skin of the face but not change the underlying skeletal structure. It would be helpful to see your before and after photos side by side to provide the best evaluation and feedback.

What age is right for a facelift? While 38 is on the slightly younger side for a facelift, we do find when patients experience significant weight loss as you have then often surgery is the best option. Since you are on the younger side, you could consider starting with less invasive options such as Ultherapy or radio frequency skin tightening. I recommend you see a provider that offers both surgical and non-surgical options to understand the pros and cons of each route.

Any cosmetic procedure is elective so we want to make sure patients are healthy and there is minimal risk to healing so you can achieve the best outcome. Your transplant surgeon has followed your healing and your bloodwork so they would be the best gauge is you are a good candidate for surgery. Any plastic surgeon would require the approval and a letter of clearance for you to undergo cosmetic procedures from your transplant physician. They may ask- if you have had other surgical procedures of any kind and how you healed from these procedures.

A transconjunctival approach to a blepharoplasty is able to remove or reposition fat but by itself does not remove skin. This procedure can be combined with a laser resurfacing to tighten the skin or a skin pinch to remove a small amount of skin. A transcutaneous approach to a blepharoplasty is performed usually when more skin needs to be removed. The fat pockets are accessed via this skin incision. There is more manipulation of the tissues and slightly greater scarring and risk of ectropion with this approach. I will often perform a muscle suspension to better support the lower eyelid muscles to minimize the chance of any eyelid malposition or ectropion during healing.

What treatment you choose really depends on what your concerns are now. If you want to address laxity to the neck and face, this is best treated with a facelift. As we age we lose volume in the face and we develop hollowing. Fat transfer can replace the last volume but it does not significantly lift the facial tissues.

In order to fully assess your result from surgery it would be helpful to see your 'before' surgery photos and a description of what was surgical procedures were performed. There are multiple ways to perform eyelid surgery: fat removal only, fat repositioning or fat transposition. I would recommend you have these items when you go in to speak with a surgeon so they can discuss the best options for you.

Sorry this has been a challenging recovery for you. Hollowing under the check area can occur with buccal fat removal. I would check with your surgeon if this was performed as it is sometimes combined with facelift surgery.

Fat transfer is a great option to restore lost volume in the face. It can improve cheek volume, temple hollowing and improve hollowing around they eye region. It does not significantly lift lax or sagging skin. To treat this laxity a facelift is the best option. Fat transfer can often be used as an adjunct to facelift to enhance the overall results .