BeautyWorksNYC

A: There are as many different opinions as there are surgeons, so your question will likely garner many different answers. From my experience as a surgeon who performs and specializes in revision rhinoplasties, I will share my opinion. I absolutely dislike rib cartilage. To my eye, it looks fake and unnatural, puts a scar on your body, and the rib does not behave in congruity with your other nasal anatomy. Instead, when a patient presents with issues such as yours -- when they are in need of building up that which taken away in surgery by an overzealous surgeon -- I much prefer deantigenized cartilage. Granted, it requires special -40 degree refrigeration, but in my opinion, it's a worthwhile expense when it means that I can give a patient a much more natural-looking revisionary result.

A: You have excellent bone structure. Unfortunately, your skin is beginning to show the signs of aging as evidenced by the normal gravitational descent of soft-tissue structures. This happens to us all. Starting from the top -- and only having the opportunity to judge from your photos -- because of your recessive hair line, I would not advise upper-third or temporal surgery. Your vertical and horizontal furrows of your forehead would best be treated with Botox approximately 3-4 times per year. For the deeper creases, I would augment with two sessions of filler to help restore volume. Your lower eyelids are puffy, which is a result of herniated suborbital fat, easily removed from the conjunctiva with corneal guard in place. Your NL folds and hanging cheeks could be addressed with a midface and lower-midface suspension. I employ a hybrid lift, which is a combination of Deep Plane, SMAS, and Subcuticular. I am not in favor of the submandibular-gland resection or digastric-muscle resection, since the former can potentially lead to your inability to salivate and therefore lubricate your food, and the later can affect the ability to make fine movements with respect to turning your head. Regarding your sun-damaged skin, lasers can work wonders. Facelift surgery in men must be done very carefully to ensure that the result is extremely natural looking, without any telltale signs of surgery. Incisions should be hidden and sewn with the finest suture material in order to produce a very sophisticated result.

A: Thank you for asking your question in this forum. I believe that our duty as surgeons is to know when to say "no." You have absolutely no reason to seek a facelift! Your skin quality and elasticity are excellent. I am sure that others will agree. Please remember that patients often see themselves very critically, as you are viewing yourself.

A: There are certain ages that are most appropriate for facelift surgery. It would be a very rare situation (meaning: someone would have extremely disadvantaged genetics) in order to need a facelift in their 30s. In your case, you are describing an excess of skin. Facelifts fix the deep layers of support, which are fine in your case. (In my practice, I like using Deep Plane, SMAS and Subcuticular lifting in conjunction with each other to address certain issues like midface sagging, jowling, neck laxity etc.) To address skin issues at your age, I would suggest either RF Microneedling or Attiva. I believe this will give you the improvement you are seeking.