Mitchell Hagen, MD

I am sorry you weren't given the follow up that every patient deserves. That is not acceptable. To answer your question, often times patients have significant skin laxity and volume loss in the face after weight loss that creates an aged appearance. Your cheeks have had volume loss that has created a midfacial crease that can be treated with fat grafting to that area. Your lower eyelids still appear to have some excess skin that could be removed as well and possibly fat needing to be repositioned in your lower eyelid - I would need to examine you in person. The way to treat the jawline, jowls, and neck would be for a facelift and necklift unfortunately. I wish there was a quick fix but the only way to address the significant laxity is surgery. Sorry you have been through the ringer! I encourage you to schedule consults with multiple surgeons that specialize in facelift and aging face surgery. You will find someone you feel comfortable with and someone who will address your concerns after surgery!

Thank you for your question! I get this question a lot in my practice so I will tell you my approach. Once a patient has decided they want to go the surgical route with a facelift or necklift within the next year or two, I tell them they should stop all invasive treatments. Morpheus and Profound are great tools but the results take some time to show and there is still significant healing that has to occur with these treatments. I do not believe they provide enough results to make it worth the hassle for a patient that has decided they are having surgery in the near future. If a surgeon tells you differently, they are trying to take your money. That being said, there are some other treatments that are great in the meantime such as botox, facials, filler (typically lip filler only), and quality skin care. Another option that patients do not always recognize and surgeons often fail to discuss is laser resurfacing at the same time as a facelift. Laser resurfacing with a CO2 can improve skin pigmentation, skin quality, and some of the fine lines and wrinkles that a facelift is not able to address. I always recommend seeing several surgeons to get their opinions. You should always feel comfortable with your surgeon and their explanations should make sense to you. I hope this helps and good luck!

Thank you for your question! I am sorry you have not been satisfied with your results. You do not have any pictures posted, but I can discuss what I typically see in patients who have had these type of lifts. When only the skin is lifted, there tends to be tension on the incision lines and scarring can be a problem. Additionally, most of these skin only procedures have a horizontal pull and do not adequately reposition the tissues vertically giving patients a "pulled" appearance. My solution to this situation often times is a deep plane facelift to reposition the deeper layers more vertically and support the skin so there is less tension for a more natural result. If there were widened scars from the first surgery these can sometimes be removed during this procedure - really depends on the case! I am sorry you are going through this but there are a lot of great surgeons out there that you can see. I recommend seeing several before deciding who you feel comfortable with. Good luck!

Hello and thank you for your question! Multiple procedures in one day are very common in my practice and very safe as long as the surgery duration is not too long and we have a healthy patient. The main risk is having anesthesia for a prolonged period of time, so your surgeon should be comfortable performing these procedures in a reasonable amount of time. Being able to perform multiple procedures along with a facelift comes with experience so you should find a surgeon that focuses exclusively on facial rejuvenation procedures. That being said, the procedures that you are talking about are not adding significant amounts of time. Laser resurfacing and fat grafting should not add a considerable amount of surgical time. The best part about having all these at once is that you only have one recovery time and these additional procedures will not prolong your recovery. You have not shown pictures of yourself, but I do love this combination that you are discussing. I feel that laser resurfacing could be performed in almost all patients getting a facelift since it has such dramatic results and very few risks with modern techniques. Fat grafting is also a wonderful addition to add volume to areas that are deficient such as the temples, cheeks, and lips. Alternatively, you could separate these procedures and there would be nothing wrong with that other than several recovery periods and possibly added expense (depending on the facility). Occasionally there are surgeons who do not have access to laser resurfacing technology in their surgery centers and therefore are unable to do it on the same day as surgery. I would consult with several surgeons and get multiple opinions before deciding who you are comfortable with. I hope this helps and good luck with your decision!

Hi and thank you for your question. This is a very difficult topic and most often comes up in patients in their 30s and 40s. Many patients begin to see changes in the neck early or maybe congenitally they have never had the sculpted neck they have desired, but do not feel they need a facelift. The decision is very nuanced and really depends on a patient's specific anatomy. It largely depends on skin elasticity, neck volume, and if there are any changes that need to be addressed in the lower 1/3 of the face. Some patients have good skin elasticity and simply need some neck volume removed with liposuction. Other patients benefit from sculpting deeper neck structures, removing some volume in the neck, and tightening the platysma muscle (plastysmaplasty). Typically these patients will have redundant skin since the excess volume has acted like a tissue expander to the skin. The redundant skin can be removed through an incision curved in the crease behind the ear that bends into the hairline so you can still wear your hair up. Additionally, some patients will benefit from lifting a portion of their lower face in addition to the necklift portion. These patients typically have some degree of jowls that they would like addressed which a necklift alone cannot accomplish. That is my typical thought process from a surgeons perspective and I'm sorry I cannot give you more specifics on your case without pictures. This is a complex and very personal decision so you should take your time when deciding. I would consult with several surgeons specializing only in facial rejuvenation procedures to find someone you are comfortable with. Make sure to look at several before and after pictures to ensure your surgeon can meet your aesthetic goals! Good luck!