Marcelo Hochman, MD

Yes, you read that right. I had a full face/neck lift under local anesthesia while wide awake on 4/21/17. Not a "mini-lift", "Lifestyle Lift", "Short Scar Lift", "Biltmore Lift", or whatever the catch phrase of the day is. I had a full, traditional, high SMAS facelift which entails incisions in front of and behind the ears, and a 3 inch incision behind the ear in the hairline, and a chin incision. Not to mention the lifting and anchoring of the SMAS itself. I have photos, and will post them because people seem to like to see the visual down and dirty, but can't be bothered at the moment. Will get to that in a few days.

Why, you ask? I have read practically every facelift review on this site and was struck by the number of patients who awoke from general anesthesia to find that procedures were done to them that they (1) did not authorize - fat grafting, fat removal, injection of foreign materials, lipo in areas that should not be lipo'd, incisions in misplaced areas, etc and (2) suspicions that medical interns or residents actually did procedures while the surgeon merely looked on or was not even present for. After reading all of that (and the complications that ensued), the first question I asked my surgeon was if he was willing to do a full facelift under local anesthesia. I wanted to be awake and aware of exactly what was being done and 100% certain it was my surgeon doing ALL of it. No interns, no residents, no inexperienced person so much as touching me. And no additional on-the-fly procedures I had not authorized or researched.
Don't get me wrong - I love my surgeon. He's done procedures on me before. All wide awake with local anesthesia. See, I'm a control freak and I trust nobody unconditionally. This is my face we are talking about. My face. I am not the kind of person that can just go to sleep and trust people to do what they say they are going to do. I watch them every step of the way.
Having said that, I am not going to lie - it is not easy to be awake when someone is cutting your face open. There are all manner of sounds, sights and sensations that can be extremely unpleasant to deal with. The local anesthetic injections in your head, neck, ears and face are extremely painful and I wouldn't wish that experience on my worst enemy, but for me, there was no other way. My doc was great about it and was also great complying with my request that he tell me everything he was doing before he did it.
Yes, I am aware I sound like a paranoid crazy person, but I simply cannot allow another person to render me unconscious and have their way with me unless absolutely necessary. And general anesthesia is NOT necessary for elective facial procedures. Comfortable, absolutely. Necessary, no. Luckily, my surgeon agrees with me, even though it is more difficult to operate on a patient who is awake. I'm sure it's much easier for the surgeon when the patient is an anesthetized blob on the table, easier for the patient too, but for me being awake and alert, while harder on me and harder on my surgeon, absolutely assures I don't awake to the unpleasant surprises some patients on here have heartbreakingly described. In my opinion, being awake and aware adds assurance that what you ASK to be done, IS done. Yes, it's painful. Yes, it's freakout worthy. But, in my opinion, the pain and freaky awareness assures that your surgeon (or his inept intern) is not doing anything he/she should not be doing or doing things not discussed at pre-op. *I* decide what is happening, or not, during continual dialog with my surgeon as we go along.
This approach is not for the faint of heart, I won't lie. It's painful, scary and freaky, but it assures no one is doing anything to me I do not want or did not ask for. If you choose this route, be prepared for some surgeons to balk. They do not want the hassle of an awake patient and will either try to talk you out of it, or flatly refuse to do it. I am here to tell you full face/neck lift can be done local as can blepharoplasty (been there, done that), lip lift, lip implants, chin implant (been there, done those, too) can ALL be done under local. Don't let them tell you it can't. I'm living proof that it can. I plan on having a brow lift in the next few months and will do that under local as well.
As I said earlier, this is not a review of my full face/neck lift - I will post that - with photos - but I just had to address the many reviews I've read here of patients awakening to find unauthorized, on-the-fly, procedures their surgeons did while they were unconscious. I find that absolutely appalling and it should NEVER happen. I figure if you're awake it makes it much harder for surgeons to slip in extra procedures or not to do procedures they are supposed to do (ie, skin only lifts when SMAS is supposed to be done; adding fat grafts; using thermal lasers; adding lipo, using staples instead of fine stitch work, etc).
Again, not a particularly paranoid person, but it helps to be AWAKE to keep an eye on these guys/gals. There are too many stories on here of surgeons just going rogue and doing whatever they feel like at the moment. Tragic stories. Don't let that be you.

Updated on 3 May 2017:
I'm on day 12. My sutures were removed on day 7, which did not hurt at all, thank heavens. I went to work for a few hours afterwards, so I do have make-up on in my day 7 pictures. A lot of my swelling has gone, but I still have pretty dramatic bruises on my neck. All in all, so far, so good.

Updated on 3 May 2017:
So the actual procedure and recovery. I've known for a while that I really needed a facelift to fix my major problem (lower face, jawline and neck) but the thought kind of scared the crap out of me. So, in Aug 2015 I had a lip lift, lip implants and a pre-jowl implant to at least improve the situation a little. That went really well and helped a lot, but my lower face and neck were still getting to me. I had a full face and neck lift on April 21, 2017, almost two weeks ago. The morning of surgery I started antibiotics and a 7 day Medrol pack. I was given Arnica and pain meds (Nucynta) for post-op swelling and pain. I had the actual procedure done under local anesthesia. I did take 5 mg of valium about 30 minutes prior.

I was changed into a gown and went to the OR about 8:30 a.m. The first 5 minutes were pretty awful. My surgeon injected lidocaine in my temples, in my head behind my ears, in front of my ears, under the jaw and chin and in the neck and it hurt like hell. But after that first 5 minutes everything went numb and stayed that way for about 12 hours. He made an incision under my chin and messed around under there for a while. He then made an incision starting in my right temple, down the front of my ear, continuing around and up the back of my ear and then a few inches into the hairline. He repeated that on the left. He then peeled the skin back to expose the SMAS layer, lifted it, sutured it, redraped the skin and then sutured that. When he was finished, he wrapped my head (no drains, yay!) like a mummy. I was finished around noon. My ride was waiting (my daughter; she's a sweetheart) and off we went. I had absolutely no pain, nausea or drowsiness.

When I got home I took my meds (antibiotic, Medrol, Arnica). I don't like pain meds, so I didn't take any, which was fine until it wasn't. The local started to wear off late in the afternoon and the first thing I felt was *extreme* tightness in my neck from ear to ear. It felt like someone was strangling me. Very unpleasant, but expected. Took some extra strength Tylenol, thinking everything was cool. Then the pain kicked in. A lot of pain, mostly around the incisions and perimeter of my cheeks. It hurt really bad, so I caved and took a Nucynta, but it was too late. I really should have started taking them every 6 hours as soon as I got home to head off the pain before it arrived full force. The bottle said I could take 1-2 every 4-6 hours, so I took another about an hour after the first, along with more Tylenol. I waited 4 hours, then took 2 more. The pain finally started to subside after that, and I was able to get some sleep.

The next day (Saturday) I met my surgeon at his office at 10:00 a.m. He removed the wrapping on my head, which was a serious relief. He checked all my incisions, which looked fine. He put me in a lighter face-bra thingy, which I was to wear 24/7 until my next appt the following Friday. I was allowed to take it off to shower and to clean my incisions. I had two, so I wore one while the other was washed and allowed to dry. I cleaned my incisions 3 times a day. I did have to take Nucynta a couple of times on day 2, but was fine with Tylenol after that.

Days 2, 3 and 4 I swelled up like a balloon and the perimeter of my face was hard as a rock. My neck was really tight and uncomfortable but I was able to turn my head from side to side without much of a problem. It hurt to chew, so I mostly just drank protein shakes, ate soup, yoghurt, applesauce, scrambled eggs. I had very little bruising until about day 6, when my neck turned glorious colors. I had no bruising on my face at any time.

Day 7 I got up, showered, did my hair and make-up. I was careful not to put any make-up near my incisions. I drove to the surgeon's office and he removed all my stitches. My ears and the area about 2 inches around them were still numb, so the stitch removal did not hurt at all. He was impressed that all my suture lines were spotlessly clean. I continue to clean them about 3 times a day, followed by a thin layer of Aquafor.

After he took the stitches out, I went to work for a few hours to tackle a deadline I had to meet. My hair completely hides my ears, so that was not a problem. My neck was black and blue and no amount of make-up was going to hide that, so I didn't bother to try. I got a few questions from co-workers about the neck bruising and I told them I'd just had my wisdom teeth cut out. I then got lots of stories about wisdom teeth removal and the awful swelling and bruising and pain they had. Lol. I haven't been back to my office since then because I normally work from home and only go to my office a couple days a month.

I'm day 12 now and have been "back to normal" for the most part. I still have a lot of swelling and my outer face is rock hard and numb from the tops of my ears down into the posterior neck region. The numbness is slowly fading, but my ears still feel really strange. I look pretty normal at this point, except for the bruising that is still pretty visible on my neck. I may be able to hide it (I have to go to the office for a couple of hours tomorrow), so hopefully I can conceal them with make-up and hide behind my hair. We shall see.

So that's where I'm at today. With the exception of the first 24 hours, recovery has been much easier than I anticipated. I had the surgery on a Friday, took it easy on Saturday and Sunday, but was able to work (from home) starting on Monday (day 4). If I didn't work from home, I probably would have taken 2 weeks off in order to hide. I was physically fine by day 7, but I still looked pretty odd. I'll try to remember to take pics once a week or so and upload them to track my progress.

If anyone is anywhere near Charleston, SC, I highly, highly recommend my surgeon, Dr. Marcelo Hochman. He only does head, neck and face surgery, and has done for many years. His staff is fantastic and very responsive to any needs or questions you have. His fees are also very reasonable.

So, that's my review of a high SMAS full face and necklift, done under local anesthesia. I know it will take many, many months for everything to settle down and I'll be able to see the end result. So far, I am very, very pleased.

Updated on 5 May 2017:
Today is exactly two weeks post-op. My neck still feels uncomfortably tight, especially when I turn my head or look up or down. It's really swollen and bruised as well. Perimeter of face and ears still swollen and numb as well. The incisions from the back of the ears into the hair/neckline are numb, too. The bruised areas along my jaw and down into my neck are still pretty bad, but it doesn't hurt. I'm back to my usual activities, except running. Cut the grass this morning, in fact. Other than still feeling really tight and generally numb, so far so good.

I already did a lip implant review in the implant section, but I also had a bullhorn lip lift so I thought I might as well put that here. I'm 54 years old and the rest of my face is still pretty great, but my lips were just shriveled and gone. Not a pretty look. I did the Juvederm thing which didn't help much at all because my other problem, besides lack of volume, was excessive philtrum length. I found my surgeon on the Surgisil website and decided to consult with him because he only does facial surgery and very complex reconstructive surgery at that. He brings children from all over the world and fixes severe facial tumors, hemangiomas, cleft palates, etc. He knows what he's doing when it comes to constructing a face. He's a lovely, lovely man as well. He spent a lot of time with me exploring and explaining my options and was frank that implants would not achieve the fix I was looking for.

He explained that my philtrum was excessively long and that placing an implant would do nothing to help that problem; an implant would only create projection under my top lip since the implant is placed at the wet-dry border and in my case that border was hidden under my lip. He recommended a lift instead - which was $1300 cheaper than implants, btw - so I elected to do both. Lift to shorten the philtrum and expose the wet-dry border, and implants to create volume. The outcome is nothing short of amazing. The procedure was painless, except for the shots. That did hurt, I can't lie. I was premedicated with 10 mg of valium and 50 mg of Nucynta (a narcotic) and pretty much dozed through the operation after those killer shots.

I've had little swelling and bruising because the doc started me on a Medrol pack and Arnika Forte the morning before the procedure which I found amazing. The incision from the lift is painless as are the lips themselves. They are tight and feel odd, but they don't hurt. I haven't needed pain meds or ice. I did have a chin implant as well and that's a whole other story - it really, really hurts, so I have taken narcotics for that.

Anyway, this is turning into a novel so I'll stop for now and upload some pics. Let me know if you have questions. I'm happy to answer!

Updated on 7 Sep 2016:
I had my 7 day follow-up yesterday and my stitches were removed. It stung a bit, but wasn't too uncomfortable. My cell phone camera sucks (sorry about that) and you can't see it too well but the incision is healing well and the bumps between the sutures will flatten over the next few days as the fluid can now absorb into the surrounding tissue. There is, as I thought, a lot of swelling in my chin and jowl area from the chin implant and it makes my jawline look really really weird. Doc said it will take several weeks for my new jawline to emerge. My chin is still entirely numb on the right side and probably will be for some time to come.
I do have make-up on in the pic, but nothing on my lips or the incision. For anyone that cares, I am wearing Too Faced Born This Way foundation in the shade Vanilla. This is seriously the BEST foundation ever for us more mature ladies. Highly recommend!

Hi, all. I started researching a permanent solution for my aging, thinning lips about six months ago. I tried Juvederm, which wasn't bad, but didn't help all that much or for very long. I thought about silicone injections and had a consult with a local plastic surgeon. I liked his results, but then I found out liquid silicone is not FDA approved for injection into the lips or face, so I decided against that option. The only approved permanent lip augmentation/implant I found here in the US was the Surgisil PermaLip implant. Their website has a list of trained and authorized surgeons and one happened to be in my city. I did a check on him and found out that all he does is facial reconstruction and cosmetic surgery. He brings children here from all over the world to fix their facial deformities, tumors, hemangiomas, cleft palates, etc. So I made an appointment for a consultation. His staff is great and his offices are lovely. After listening to my goals he informed me that an implant would not be an improvement over my disappointing filler experience because I had two problems - a long philtrum (about 2 cm; should be about 1.1 cm for a female), and also since my upper lip was essentially rolled under an implant wouldn't have much of an impact because it is inserted at the wet-dry border of the lip and wouldn't really be seen. He didn't think implants would be worth the cost or down-time.
I had never heard of a lip lift so he spent a great deal of time educating me on the procedure. He told me to research and think about it a let him know what I wanted to do. After looking into it, I realized he was right - I needed a lip lift for sure and decided to have implants as well since a lift doesn't help with volume. I had both procedures done on Aug 30th.
On procedure day the nurse gave me 10 mg valium and 50 mg Nucynta (a narcotic) about 45 minutes prior to my surgery. I was taken to the procedure room, covered, draped with only my face exposed. An automatic blood pressure cuff was placed on my right arm and my face was wiped down with betadine. The surgeon then came in and asked if I was comfortable and ready to proceed. I was kind of loopy by then, so I was like "sure, go for it!". The numbing injections hurt like hell, I can't lie. But I had three different procedures (lip lift, lip implants, chin implant) so that was A LOT of injections. As for what happened after that, I don't really know. They covered my eyes with a soft cloth and I drifted in and out of sleep while he did his thing. The only thing I felt was the scraping of my jawbone for the chin implant pocket - that woke me up for sure. Before I knew it I was done.
I'm now on day 3 and haven't really had any pain from the lift or lip implants. It's just kind of stiff and tight. The chin is another story altogether. And a different review. All in all, it was an easy procedure and I've only taken pain meds for the chin pain. The swelling is not as bad as I anticipated and I have little, if any, bruising so far.
I'm posting pics from before and from the last three days. Good luck to the rest of you and let me know if I can answer any questions. (:

Updated on 3 Sep 2016:
So, my surgery was on Tuesday and the new pics are from Friday. I've been counting Tuesday as day 1, but the pics are actually 72 hours post-op. I haven't had any pain and very little swelling or bruising from the lip lift or implants. I think that is because my doc started me on a 6-day Medrol pack and Arnika Forte pre-op. My chin hasn't even bruised and from the reviews I've seen chin implants usually produce some stunning bruising. The chin DOES hurt quite a bit and I have had to take some pain meds for that. All in all, the lips really feel no more painful than the day after a round of Juvederm injections, though the incisions at the corners of the lips are annoying. The subnasal incision from the lift doesn't bother me at all. Here are some day 4 pics (72 hours really). I'm happy to answer questions, so fire away.

Updated on 3 Sep 2016:
I made a side by side illustration of the difference in philtrum length from the lip lift. You will NOT get this result from implants alone. Implants are placed well below the vermillion border and will not decrease the space between the lip and base of the nose. Implants will project the lip outward, but not upward. I really want to be clear that the results seen in my photos are in large part due to the lift, not implants alone.

The chin implant I had inserted is a pre-jowl implant. If you look at the picture you can see that there is very little material augmenting the chin itself; the implant is meant to fill in the pre-jowl sulcus where bone has been absorbed due to natural aging and creates the look of jowls in the area just behind the prejowl sulcus. I did not want an invasive neck lift (which would have left the prejowl dent anyway) so I opted to fill the depression with an implant instead. Make no mistake, the recovery from this procedure is painful indeed. I did not use pain meds after my breast augmentation (500cc under the muscle) or my lip lift/implants, but I have had to take narcotics for the chin pain and am still taking them 4 days later. Also, I did not have any treatment to the wrinkles around my lips/chin area. Will have to evaluate that situation once all the swelling is gone, but the difference is unbelievable.

Updated on 3 Sep 2016:
No problems to report. As you can see from the pics my smile is still tight and pretty wonky. Eating is getting better, but I can't open my mouth too wide yet, not because of the lip surgery but because my chin still hurts like a beotch. I had my daughter go out and buy the smallest baby toothbrush she could find because brushing hurts (chin again). Neck is massively swollen under my chin. Hoping that subsides soon! I'm wearing no makeup or lipstick in any of these photos, so be kind, lol. I know I look a wreck. :)

Updated on 3 Sep 2016:
I had to run out to the store and there was no way I was going outside looking like the last pictures I posted. I didn't put makeup anywhere near any incisions but did the rest of my face so I didn't scare small children. Or grown adults for that matter. Overall, I am really, really happy with my results so far.

Updated on 3 Sep 2016:
Sorry about that!

Updated on 4 Sep 2016:
I pretty much slept all day. I finished my Medrol pack this morning and crashed and burned a few hours later - steroids make me hyper, then I crash for about 10 solid hours after I finish them. I took whiterobin's advice and wrapped some frozen peas in a scarf, put the peas under my neck and wrapped the scarf around my head before I went to sleep. That helped a lot with the bone pain from chin and jaw where the bone was scraped to make a pocket for the chin implant. So no pain meds today. Lips are still stiff and tight and I can't smile worth a darn, but they don't hurt. I don't talk funny, either. I know some people seem to have problems with certain letters for awhile, but I'm A-ok there. My incisions are healing nicely, but they do itch at times. I get them out in 2 days but they really aren't bothering me. Doc gave me a special cleanser that I use to clean the incisions twice a day, followed by an application of Aquafor. I'm not allowed to use anything else - no antibacterial ointment or scar gel or anything like that. After the sutures come out I will continue to use the special cleanser and begin using a different product given to me by doc in place of the Aquafor. It's upstairs and I don't feel like going up there to get it, so I'll talk about it tomorrow. He was adamant that I use no other products in addition to the ones given to me, so that is what I shall do. I tell you, I am in love with this man and in love with my results and postop progress. He is amazing and gave my lower face balance that I thought I would never see again. I cannot thank him enough.

Updated on 7 Sep 2016:
I had my 7 day follow-up yesterday and my stitches were removed. It stung a bit, but wasn't too uncomfortable. My cell phone camera sucks (sorry about that) and you can't see it too well but the incision is healing well and the bumps between the sutures will flatten over the next few days as the fluid can now absorb into the surrounding tissue. There is, as I thought, a lot of swelling in my chin and jowl area from the chin implant and it makes my jawline look really really weird. Doc said it will take several weeks for my new jawline to emerge. My chin is still entirely numb on the right side and probably will be for some time to come.

I do have make-up on in the pic, but nothing on my lips or the incision. For anyone that cares, I am wearing Too Faced Born This Way foundation in the shade Vanilla. This is seriously the BEST foundation ever for us more mature ladies. Highly recommend!

Updated on 7 Sep 2016:
So, I forgot this part. I am to continue using the cleanser given to me morning and night, followed by the application of a layer of squalane. Both the cleanser and the squalane were provided by my surgeon and he asked that I use nothing else on my incisions until the scars are fully mature - about a year.

I was SO scared to do permalip! I wasnt even able to sleep at night because I was kinda scared after watching the procedure on youtube but knew I really wanted the look they give after a lot of research and others experience. I had it done today and I can not believe that I was scared this whole time! It was painless and so very quick. The worse part is the numbing needles and even that was finished so quickly. I am swollen but am taking medications for the pain, swelling and a natural supplement called Anika Forte for the bruising as opted and recommended by Dr. Hochmans office. So far I am in love! I would deff recommend this to everyone that wants fuller lips. I did restylane once and was like I cant afford this every 4-6 months. Any questions I would love to answer to the best of my ability and experience. My sister is going to get hers done in 2 weeks. I can not wait to update you guys when my lips are healed up a little bit more.

Updated on 8 May 2013:
Day 3- The first two days my lips felt a little tight which is probably from the stretching of my skin. I also wasnt taking the pain killer because pain killers always give me nausea so I rather deal with the "tightness" than the nausea. I do make sure that I take all the other medication on schedule. All the discomfort has resided. I am still not quite able to smile due to the stitches. Everyday the swelling goes down. I have been using colgate wisp because brushing teeth have been kinda a challenge. I also use listerine. As far as helping the skin stay soft and not cracking, I highly recommend Aquaphor. I am pretty big with tattoos and Aquaphor heals them best also so I saw this to be fit for healing my lips also. I will most deff post another update in about another 4 days!

Updated on 13 May 2013:
Its been a week. Today I have much more mobility (Less tightness/Stiffness) in my lips. There is still some swelling on my top lip in particular. There is also still some bruising on the wet dry line. So far I am still very happy with the results. I am continuing to use the aquaphor because they get very dry and chapped.

Updated on 22 May 2013:


Updated on 22 May 2013:


Updated on 22 May 2013:
My Sister is not the blogging/forum type so I told her Id do it for her lol I want other women (men too!) to see the results and help the best way I can =)

Updated on 22 May 2013:

I wish someone had made a review like this one, before I made the costly decision to go forward with the hair transplant with Dr. Hochman. I informed Dr. Hochman that my main concern was to cover my bald spot in the back of my head. With the first surgery I said focus on the back, then the front, and last in the middle. After a year after the surgery, there was still a huge bald spot on the back of my head. Dr Hochman suggested I do a second surgery, and assured me the back would be fully covered, with no bald spot. I agreed, because like the majority getting this surgery, you don’t want to remain slightly bald, but not bald at all. After a year after the second surgery I went back in to inform Dr Hochman that there was still a bald spot, and he assured me it would be covered. His response was “Well it looks better than it did before, and he’s doing nothing more.” I told him I would make reviews to let others know about my experience. He said I was threatening him, and told me to leave. A couple weeks later I received a letter saying I was banned from setting foot in his practice. I’ve included a picture of what my bald spot looks like a year after my second surgery with Dr Hochman. If your on the fence about doing the surgery or not, maybe this will help your final decision. Also worth mentioning, the doctor does not perform the actual surgery - he flies two women in from TX to perform the procedure. I am expecting a follow up from the office for this review - let’s see if they make it right via a partial refund, offer of additional procedure, or if they just make excuses. The other review follow ups from this office seem to blow their patients off, and say they can refer another doctor. Dr Hochman said he doesn’t want any patient to be unhappy, definitely not the case with me. Really poor customer service. Hope they turn this around and make it right.