From your photos, it appears that your lower facial/jawline concerns would be best addressed with a face and neck lift. When filler is placed along the jawline (mandible) in front of the jowls (pre-jowl area), it can provide the illusion of a straighter jawline. But the filler does not help address the lower facial and neck skin laxity as well as neck contour. A deep plane face and neck lift with platysmaplasty (midline neck muscle tightening) would provide you the most definitive and long last longing result. Best wishes. Amit Bhrany, MD
From your photo and description of your concerns, it appears that you could benefit from a variety of treatments. These include facial skin resurfacing to improve skin texture (smooth fine lines), adding volume with filler or fat to improve hollowing and a face and neck lift to reposition skin and tissue of your lower face and neck to provide a more defined jaw line and improved neck contour. The best choice for your depends on how much each aspect bothers you and balancing that with the types of procedures you are willing to undergo. Best wishes. Amit Bhrany, MD
Whether or not any face or neck surgery will worsen your melasma is a good question. Melasma is typically not worsened after undergoing a face and neck lift. But to help prevent a flare up, it may be useful to prepare your skin with topical treatment prior to undergoing the surgical procedure. It would be best to discuss this concern with your surgeon to ensure you both have a good plan to minimize the risk of a flare up. Best wishes. Amit Bhrany, MD
From your photos, it appears that you moderate neck laxity, jowling, and submental fullness. Botox treatments are not helpful for these issues. While a shortened scar “mini” facelift could be performed, your concerns would be most definitively treated with a deep plane face and neck lift as “mini lifts” yield results that are often not as long-lasting as a traditional deep plane face and neck lift. With regard to downtime, most patients feel comfortable returning back to normal social outings and work after the first week. Incisions typically heal well to allow the hair to be worn “up” even when the incision is taken along the occipital hairline behind the ear. Hope that helps and best wishes. Amit Bhrany, MD.
I am sorry to hear of your stroke and hope you are recovering well. Also, sorry to hear about your disappointment with your neck asymmetry. Some asymmetry is normal in everyone, but since it sounds as if the asymmetry in your neck is significantly bothersome to you, you likely would benefit from a revision face and neck lift to improve laxity and symmetry of your lower face and neck. The asymmetry in the area of the previous endarterectomy is likely due to deep tissue scarring in the area, so the release of the scar and perhaps excision of the scar may improve the appearance. If you do choose to move forward with revision surgery, given your history of a stroke and the possibility of being on blood thinners, your surgeon would want to obtain medical clearance from your neurologist or primary care physician to ensure you are in the safest position to undergo your rejuvenation procedure. Best wishes. Amit Bhrany, MD