Jen Yuan Chow, MD

You ask an excellent question, which looks at the difference between volume loss and changes over time due to gravity. As we age, we lose facial volume and have the skin stretch due to gravity. 

Jowls can form over time, often because of both volume loss and gravity. Having Restylane is a temporary way to fill the volume loss of the marionette lines, but does not treat the sagging skin and soft tissues that form the jowls. 

For long-lasting results, a facelift with fat transfer to the marionette lines will provide much more complete correction of the area. 

In my practice, most patients spend the first 10-14 days after surgery recovering before spending significant time at work or social settings. If you have hair that covers the incisions around your ears, then you will be able to return to work even earlier. Adding other surgeries with the facelift, such as brow lift, eyelid lift (blepharoplasty), or lower eye bag surgery, can make the recovery period slightly longer.

Seeing your dermatologist may help. You might also want to see the surgeon who did the revision rhinoplasty. 

The major purpose for Asian blepharoplasty is to create or alter a crease in the upper eyelid in order to have a "double eyelid." You appear to have a natural crease, and if you are happy about the height of this crease, removing excess skin should provide an excellent result. 

Anchor blepharoplasty is used to create a crease, which you already have. However, this can be very useful if you want to alter your crease (make it higher or lower, or change its shape). 

One other factor is the level of your brow/forehead. If you have a very low-hanging brow, with eyebrows set well below the rim of bone above the globe of your eye, this will also make excess skin appear to hang over your crease. Be sure this is evaluated before any surgery!

Best wishes!

When done for the appropriate reasons (e.g., excess skin of the lower lid, as well as good lower lid "tightness," on exam by your facial plastic surgeon, among other things), the skin pinch does not commonly cause rounding of the lower eyelid. That said, over-aggressive skin removal can lead to problems, including change in the shape of your eyelids. 

There is certainly no contra-indication to having Botox injected while one is taking anti-depressants. That said, you should always share with your doctor any and all medications you are taking (including vitamins and supplements and non-Western medications, such as Chinese medicine) during your first visit. On follow-up visits, you should let your physician know about any changes in your treatment regimen. This will help ensure higher quality care. Good luck! 

Dr. Chow in Arcadia, CA

Being worried about looking shocked or surprised after brow lift surgery is a legitimate concern. However, contemporary brow lifts generally tend to shy away from pulling the eyebrows too high during surgery. In fact, the goal is often to maintain your eyebrows in the correct position while they are at rest. As most of us age, we begin to use the muscles in our foreheads to raise our eyebrows so that we can see. This worsens over time, and we develop wrinkles in the forehead. A brow lift rejuvenates the forehead and brow by lifting the eyebrows to their original position without using the muscles in your forehead. This eliminates many of the "active" wrinkles that were formed and, when done properly, should not create a shocked appearance.

Speaking to your facial plastic surgeon about your specific cosmetic goals will certainly help you decide what works best for you. I wish you the best of luck!

If your pain is caused by sinus pressure or inflammation, a brow lift should not improve your pain. The principal objective of any brow lift is to raise the brows, which is most commonly a cosmetic goal. If you are interested in an aesthetic improvement of your upper face, including the brow and forehead, a brow lift is a good idea. However, if you are primarily interested in pain relief, you should first have a thorough evaluation of your sinuses by a qualified physician.

Given that you had the surgery four years ago, the numbness and discomfort associated with the surgery you have in your scalp is unlikely to resolve. This is one of the possible disadvantages of the coronal browlift. Seeing a pain specialist or a neurologist may help you reduce the discomfort with heat, cold, and stress. Visiting your surgeon may be of benefit as well, as only he or she knows the exact procedure performed and may have recommendations based on this knowledge.

Dry eyes and numbness around the incisions made for your blepharoplasty can persist for several months. Numbness usually resolves in a matter of months. However, dry eyes are more variable, depending on your personal medical history (e.g., if you had dry eyes before surgery), the technique used for your surgery, and the tightness of your eyelid skin and associated muscles. 

The best way to find out if the dry eye is more serious is to see your doctor. Often, patience is rewarded by resolution of the problem, but having regular contact with your physician is always a good choice. Best of luck!