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.
