Earl Stephenson, Jr., MD, DDS, MBA

Dear Trustworthy, Great question—and one I get more often than you'd think as patients consider moving from non-surgical to surgical options. Yes, you can absolutely still have a facelift after Thermage treatments—even if you had three sessions, and even if they were years ago. In my professional experience, having performed facelifts on patients with a history of Thermage and other energy-based treatments, this does not complicate your facelift procedure. In Summary: ✅ Yes, you can safely undergo a facelift after Thermage.

Dear teenreb, Thank you for your question and the image—it offers a helpful visual context. It’s completely reasonable to notice changes under your chin following a sliding genioplasty, especially when paired with chin implant removal. Let’s look at what may be causing the fullness and what your next steps might be. What Could Be Causing This: Residual Swelling: At six months post-op, low-grade swelling—particularly in the submental area—is still possible. This can cause fullness or a subtle "bump" under the chin that gradually resolves. Step-Off Deformity: A "step-off" refers to a palpable or visible ridge where the advanced chin bone meets the remainder of the jaw. It’s a known possibility after genioplasty, especially when the transition isn’t perfectly smooth. Submental Fullness from Soft Tissue or Fat: In some cases, lingering fat or minor skin laxity can give the appearance of a bulge, even when the bone work is technically sound. A thorough clinical evaluation by a board-certified plastic or maxillofacial surgeon is essential. They’ll assess whether the fullness is bony, fatty, or soft tissue-based—and imaging like a CT scan can help clarify whether a bony step-off exists. Treatment Options: Observation: If the concern is swelling or soft tissue settling, continued healing over the next 3–6 months may result in natural improvement. Surgical Revision (If Bone Is the Cause): If a true bony step-off is confirmed and is significantly affecting your contour or confidence, surgical contouring to shave the excess bone may be considered. This is a targeted procedure and typically well-tolerated when needed. Soft Tissue Solutions: If the issue is soft tissue rather than bone, options like radiofrequency-based skin tightening (e.g., FaceTite, Morpheus8) may help. These treatments stimulate collagen production and improve skin contraction, leading to a smoother profile without surgery. In your case, the result shown in your second photo is absolutely realistic—but identifying the source of the irregularity is key to achieving it. With the right evaluation and tailored treatment, refinement is possible without rushing into unnecessary or aggressive revisions. All the best, Earl Stephenson, Jr., MD, DDS, MBA ESJ Aesthetics

Thanks for sharing your story and photos—they clearly show some contour irregularities and asymmetry under the chin and along the jawline. At one year post-op, your result is considered stable, so it’s a good time to evaluate options. These dents and unevenness may be due to over-removal of fat, residual fat, or scar tethering where the skin sticks to deeper tissue. At age 45, reduced skin elasticity can also exaggerate these effects. Potential Solutions: Fat Grafting This is often the best option to soften dents and fill hollow areas. Fat is taken from another part of your body and grafted into the areas of irregularity, helping to restore smooth contours. Revision Liposuction If certain areas were undertreated, precise, small-volume liposuction can help balance things—though it must be done carefully to avoid overcorrection. Microneedling with RF (e.g., Morpheus8) For surface-level dents or mild tethering, this can stimulate collagen and improve texture, especially if skin tightening is also needed. Subcision In deeper scar-tethered areas, this minor procedure can release tight fibrous bands, often done with or followed by fat grafting. A consult with a board-certified plastic surgeon experienced in facial contour revision will help determine what’s causing the irregularities—volume loss, tethering, or skin laxity—and create a custom plan. Most often, fat grafting combined with light skin remodeling yields excellent results. You’ve done the healing. Now it’s about fine-tuning—and you’re absolutely on the right track. All the best, Earl Stephenson, Jr., MD, DDS, MBA ESJ Aesthetics

Thank you for your question and for sharing your photos—what you're describing is a fairly common concern after chin liposuction, and your hesitation about another procedure is completely valid. What Could Be Happening: That small bulge on the left side may be residual fat, but it could also represent part of your submandibular gland, which sometimes becomes more visible after fat removal. The skin tethering you’re feeling—especially when talking or laughing—could be due to contracture or scarring in areas where very little fat remains, creating those visible contour irregularities. Non-Surgical Options: If you have true skin laxity, there are non-invasive treatments that may offer some improvement: Radiofrequency (RF) skin tightening Ultrasound-based treatments like Ultherapy RF Microneedling However, these are only effective if loose skin is present. If your skin is already tight and the issue is volume-related or structural, these treatments won’t address the deeper problem. Surgical Options to Consider: Fat Grafting A small amount of fat can be transferred from another area to smooth out indentations and balance the contour. This is a good option if there’s too much volume loss or tethering. Submandibular Gland Evaluation If the bulge is gland-related rather than fat, a skilled evaluation is crucial. In rare cases, a submandibular gland reduction can be considered, but it carries higher risk and should only be done by a surgeon experienced with neck anatomy. A thorough, in-person assessment with a board-certified plastic surgeon will help confirm the source of the issue and guide the best treatment plan—whether surgical or not. You're asking the right questions, and with careful planning, improvement is absolutely possible. All the best, Earl Stephenson, Jr., MD, DDS, MBA ESJ Aesthetics

Dear Brnsuga, Thank you for reaching out—your concern is valid, and you're not alone in what you're experiencing. What You’re Noticing: The bulge along the side of your right breast and rippling at the top of the left breast are most likely due to implant folding or wrinkling, commonly referred to as rippling. This is more common in thinner patients or in areas with less tissue coverage—especially laterally. Though less common with silicone implants, it’s not unusual and often considered within the range of normal variation. Why It Happens: Rippling occurs when the implant's edges or folds become visible or palpable due to thin overlying tissues. It can be more noticeable over time, especially with tissue changes or aging. My Professional Insight: Lateral rippling is not uncommon and doesn't necessarily indicate a problem with the implant itself. There are no universally accepted techniques proven to eliminate rippling long-term. Some emerging strategies like fat grafting or acellular dermal matrix (ADM) reinforcement may help, but these lack robust long-term data. Revision purely for rippling should be weighed carefully. Potential Solutions FAT GRAFTING Transferring fat from another part of your body can add volume and camouflage implant rippling. This method can improve contour and feel, but multiple treatments may be needed, and results vary. ACELLULAR DERMAL MATRIX (ADM) These biologic materials add structure and thickness over the implant, especially in revision cases. While they can reduce rippling, they are more commonly used in reconstructive surgery and may not be ideal for every patient. IMPLANT REVISION Options include: Switching to a higher-fill silicone implant to reduce folding. Changing implant placement (e.g., under the muscle for better coverage). Using a different implant type or size to improve breast balance. However, these options involve surgical risks and should be considered only if rippling is significantly affecting quality of life. Moving forward, I recommend seeking consultations with board-certified plastic surgeons who have experience in revision breast surgery. A tailored, in-person assessment will give you a clearer picture of what’s possible for your body and goals. While complete correction may not always be attainable, thoughtful surgical planning can often offer meaningful improvement—and you're already on the right path by advocating for yourself. All the best, Earl Stephenson, Jr., MD, DDS, MBA ESJ Aesthetics