Brent Moelleken, MD

Buccat fat pad reduction is best when there is a disharmony between the cheekbone area and the cheeks themselves. Facial liposuction is risky for causing facial irregularities that can be difficult to repair, and may miss the actual problem, namely excess Buccat fat! A well done facelift with bidirectional vectors can give predictable, natural results. There is little need to remodel your bones in my opinion.

Three things can cause a soft saggy neck: extra fat, looseness of the deep layer (SMAS and platysma muscle) and… drum roll… loose skin. The dreaded three signs of an aging neck! An incision under the chin alone can address extra fat and tighten the platysma… but it can’t tighten loose skin, and it can’t raise up the SMAS. Tightening the skin and raising the SMAS itself is best done through incisions inside the ear and behind the ear. Patients who have had weight fluctuations often have extra skin, so a lower facelift, mini lift or facelift which also elevates the SMAS often give superior results. Is it wrong just to do the neck? No! But patients may want to do the lower facelift at a later date to obtain a more complete result, especially if they lift also want skin removal and an elevation of the SMAS, the deep layer of the face. So what are the pitfalls to avoid? If a patient tries to solve all the problems with only an under-the-chin lift. The doctor, with all the best intentions, may overly defat the neck with aggressive radio frequency tightening or aggressive liposuction, but can’t remove and lift the skin and SMAS, the neck can still look loose! Why? Because excess skin can’t be removed with just an incision below the chin! And if the beck is aggressively defatted, it may appear ‘stringy’. So… good results start with a well done nack lift that help the skin as well as the platysma and the removal of the right amount of fat. Better results may also involve elevation of the SMAS. And great results, making the face less square and more oval or heart shaped, also treat the midface, the area below and to the side of the eye area… but that’s a whole other discussion!

There is a technique that can help, by reducing the downward projection of breast tissue, redoing the lift. Feel free to schedule an in person or Zoom consultation and we can discuss.

In the submental region, there are three basic main causes that can be treated (and lots of additional smaller causes that can't): fat, looseness of the underlying muscle (platysma), and extra skin. While liposuction will reduce the fat below the chin, unquestionably a better solution would be weight loss. In your case, the platysma muscle is also likely involved, and there is also subplatysmal fat at fault as well, and possibly a low-positioned hyoid bone (not much you can do about the underlying anatomy). Tightening the platysma muscle and possibly defatting the subplatysmal area can great enhance the cervicomental angle in many patients. Subplatysmal dissection is tricky because of risk of damage to the marginal mandibular nerve in particular, not to mention a few pretty large blood vessels as well. While minimally invasive tightening devices make great promises- and we do use them in my practice when appropriate- they just don't tighten the skin that much. If you are expecting surgery results, you will likely be disappointed with the minimally invasive techniques. The reason for this is that when the skin is heated too much, by any technique, the subdermal blood supply becomes damaged, circulation is affected and skin can change color, become stiff (like radiation) and even become necrotic. I have seen many such cases, especially with laser liposuction or aggressive radiofrequency tightening. If significant skin excess is present, most patients are best off with a lower facelift or facelift. I have a busy facelift practice, and almost everybody I see now has tried Kybella, Ultherapy, FaceTite, submental liposuction alone, etc. etc. etc. only to need a facelift in the end anyway. And many of these techniques excessively defat the neck while not significantly tightening the skin, causing a premature aged appearance. So before you spend your hard earned money, make sure you're getting the right procedure by selecting a surgeon who can do and frequently does both minimally invasive and surgical procedures.

An excellent question for a very confusing area of the body! There are two primary areas of the mid face to rejuvenate: the area below the eyes and the area to the side of the eyes. In my practice, we rejuvenate the lateral mid face with a high-SMAS facelift, and the area below the eyes with a superficial checklist, about which I have written several papers (drbrent.com). Volume replacement is accomplished with autologous fat fascial grafts, which are alive and do not require injection, centrifugation etc. Brent Moelleken MD FACS Associate Clinical Professor, UCLA Private Practice, Beverly Hills The subperiosteal space is unforgiving with respect to healing times, and does not directly accomplish elevation of the soft tissues, since the periosteum is unyielding.

Irregularities after liposuction are most common in aggressive liposuction procedures, such as high definition liposuction 'hi def' or in the presence of already loose skin. The best treatment for these issues is an abdominoplasty, preferably a Hybrid Abdominoplasty (Hyprid Tummy Tuck(R), to keep the horizontal incision low, in which the skin is completely elevated, evened out as much as possible, and the entire deep fascial is addressed, if necessary. It's also a good time to address any diastasis present or hernias.

I would definitely see a board certified plastic surgeon to assess your mole, especially if it is a large one. Larger pigmented moles, even those present at birth, do have a potential for degeneration to cancerous moles. It is not appropriate in such a case to laser or treat the mole for its appearance alone. Imagine missing a melanoma on a young patient! In the case of very large moles, there are various options to remove all of the mole, or part of it in combination with a biopsy.

The analogy of various procedures to work in an auto body shop may illustrate the point. No shop will give you an answer. Is it a chip on the paint? A ding that can be fixed with paintless technique? Does the accident involve deep damage to the frame? Is it a reputable factory authorized body shop where you won't even see where the repair was done, or is it Uncle Jimmy's with a can of Bondo and some spray paint? Nasal surgery is much more complex than fixing a car. There is the shape, breathing, the underlying anatomy, the history of work on the nose, and the patient's expectations to consider. Any price estimate you get prior to a thorough consultation is at best an attempt to get you into the door for a real consultation. Only when you have a realistic consultation can you get a feel for the practice, the reputation and work of the doctor, and, of course, the price.

You have pretty eyes and there are normal asymmetries between the two eyes, a very mild version of orbital dystopia. Be careful of having surgery for things that aren't necessary. Either the results will be so subtle that you'll be unhappy, or perhaps a real problem will ensue after the surgery. This is especially likely if your perception of the problem is greater than the problem actually is. I hope you won't join the ranks of patients who are unhappy with their barely necessary surgery!

We have many patients , male and female, who are bald. They have had excellent results with a facelift. There are a several tricks to hiding incisions while preserving normal anatomy, ie ears, direction of pull, tragus etc. Also, while you have had a nice weight loss, you have lost volume in key areas of the face. This should ideally also be addressed during your facelift.