I want a defined jaw & tight neck again! I'm 60, have large glands & a lax jaw. What's the most effective procedure?

You write in your brief narrative that you had a "botched LSL" ten years ago.  Although they have now gone out of business, the "Lifestyle Lift" was really nothing more than an abbreviated and attenuated face and neck lift, usually a skin only lift.  At Wave Plastic Surgery, we believe that facial rejuvenation should be performed in an holistic and integrated fashion, systematically addressing each component of facial aging, without taking short cuts.With this in mind, we can examine each third of your face sequentially, outline some of the issues revealed by examination of your pictures, and briefly describe some of the maneuvers we might employ to correct these. Starting from the top, you mention that your forehead is lined. This is most likely due to the fact that you are unconsciously compensating for your brow ptosis by firing your frontalis muscles. The AP and lateral views of your photographs confirm that you have some brow ptosis with lateral hooding. You would benefit from an endoscopic browlift, but this must be done conservatively, because you also have an "A-frame" deformity of your orbits that could be further unmasked by an overly aggressive browlift,. At the time of your endoscopic browlift, we would perform fat transfer to augment the supraorbital fat and reduce the hollowed appearance f your upper orbit. You also have mild ptosis of the upper eyelids, and a moderate excess of skin on the right upper eyelid, and bilateral blepharoplasty and ptosis repair could be performed at the same time to address this.Moving on to the midface, you do exhibit all of the classic stigmata facial aging, including descent of the soft tissue of the cheek, deepening and prominence of the  nasolabial folds, and significant jowling.  We would perform an extended SMAS facelift to elevate the soft tissues in this area, while avoiding a tight, pulled look. You would also benefit from conservative fat transfer to the cheeks and lid cheek junction. However, in addition to these, you also have the obvious stigmata of a previous facelift, including highly visible, widened scars at the facelift incisions,  and poor inset and definition of the lobule of the ear.  A serious effort should be made to correct these when you undergo your revision facelift. Lastly, your neck demonstrates multiple creases and poor redraping of the skin. I suspect you have plastysmal banding, although  you do not have proper photographs to demonstrate this.  In some areas of your neck, there is residual subcutaneous fat that has been left, whereas other areas look like they have been oversuctioned, and the skin appears to be directly adherent to the muscle.  You will need to have the full breadth of your neck skin re-elevated and a corset plastysmaplasty performed. In some areas, the excess subcutaneous fat will need to be removed, but,  in other areas, fat transfer may be helpful. I do think you would benefit from a full-breadth transection of the platysma bilaterally.  After these maneuvers are performed, the digastric muscles and submandibular glands will be evaluated as the neck skin is pulled with a posterosuperior vector to evaluate whether a partial excision of these structures would improve the profile view of the submentum and jawline.  These structures are never completely removed as you implied the surgeon in Philadelphia told you. This brief summary was intended merely to give you an overview of some of the maneuvers we might employ at Wave Plastic Surgery to address the issues you cited in your email, and which are revealed in your photographs. However, a definitive surgical plan for you can only be delineated after a formal facial rejuvenation consultation in person.

Thank you for your question and photos.  It appears that you would benefit most from a full cervical facelift and neck lift.  Please be sure to see a surgeon that is an expert in performing these procedures and is board certified.All the best,

I would recommend a SMAS flap face lift and neck lift with neck plastysmal plication.  I would also recommend a canthopexy of your lower lids and a revision upper lid blepharoplasty.  Finally, fat grafting to address forehead, glabella and tear troughs, nasolabial folds and lips.  

You appear to be a good candidate for a real facelift/ neck lift. Also, one of your upper lids appear to have more excess skin than the other- so I'd recommend upper lid blepharoplasty at the same time. Seek an experienced Board Certified PS who specializes in revision surgery. For more info - you can view this link:

Based on your photographs, an expertly performed revision lower face and neck will provide you with a good results. You have some upper eyelid laxity so an upper eyelid surgery would improve it. You're doing ok on your lower eyelids. But I would recommend fat grafting with PRP to your cheeks. All of these procedures can be performed with local anesthesia and twilight sedation without the need for general anesthesia. Please see the link below.

Thanks for your question.  I think you could benefit from a expertly-performed redo facelift with neck lift.  I would try to shift your scars to a tragal-edge position to hide better, and tighten the platysma muscle as well as the SMAS.  Simultaneously, some fat grafting to the cheek area and nasolabial crease area would help re-establish more youthful contours.I don't think you have prominent submaxillary glands - so I wouldn't recommend resecting those.Best,

It looks as though a well executed facelift should yield an excellent result. There some hollowness around the lower lids that can be dealt with filler or with transposed fat from the lower medial fat compartments if a blepharoplasty is performed. The modest redundancy of skin of the upper lids can be addressed. Botox in the forehead should be considered.

The attainment of a favorable neck contour is dependent on the patient's desires, the patients anatomy and the skill set of the surgeon. Most of my comments will have a caveat like  "usually", "frequently" and "sometimes" since everybody's anatomy is usually different and what they want is sometimes different.  Saggy soft tissues and skin can usually be corrected, skeletal deficiencies can frequently be corrected.In looking at your pictures I believe you have a great potential to achieve a really meaningful result.  Keep in mind facial aging is a complex thing so it is usually not a one modality fix.  There is usually a benefit to combining several techniques such as lifting, resurfacing, fat transfer, etc.  Please read the attached article.I think you are on the right track.  Good luck.Fred G. Fedok, MD FACS

I have treated patients like you in the past with a TCA peel first, followed by a good skincare regimen including Vitamin C, retinol and SPF.  Once your skin quality is improved, I would perform liposuction to your neck, a face and neck lift, and an upper blepharoplasty to take out the excess skin and allow for botox of your forehead in the future without making your eyelids droop.  Best of luck!

In my opinion, the major aesthetic issues are the jowls, platysmal bands,
cervical skin laxity, and hypertrophic scarring from your previous
procedure.  The best procedure for you will be a revision facelift with a corset platysmaplasty. Although a physical examination would be more helpful, I don't immediately see the need for submandibular gland excision, which is rarely performed during facelift surgery.  The right upper eyelid looks like it might benefit from a small amount of skin removal.  A consultation would provide more definitive information.