What would you recommend for a natural looking enhancement? Realistically how long is downtime? (Photos)

Question

Hi- i am worried about surgery. What if it looks bad? What if it's not natural looking? My friend recommended a surgeon where i need to travel so i would need to stay there for a week? What if there is a complication and I am alone? How long until h can go out in public? Exercise? How long do i need to be botox and filler free?

Jigar Sitapara, MD · Answer

Good morning fellow Marylander,
Your list of questions hits what's on 99% of patient's minds when they are considering this surgery. The top concerns I hear are #1: I want to still look like myself, just refreshed #2 How quickly can I get back to my normal life. 
I would advise you to find a surgeon who's results appear consistently natural. I would recommend finding someone you can trust to guide you on the best option for your primary areas of concern. Find someone that really listens to your concerns and not just suggest a menu of surgical procedures to add on. If your neck and jawline are your primary concerns, go for the deep plane lift. If you are bothered by your lower lids, maybe fat grafting will help soften the lid-cheek transition. Allow your primary goals to guide the decision making. Computerized morphing can also be helpful to see what your result should look like. 
As far as recovery, when I am operating on out of town patients, I prefer them to stay within an hour of my office for 7-10 days. That way, if there are any concerns about the healing process, I can see my patients more frequently to ensure the very best result. At two weeks, most patients would feel comfortable going to their neighborhood coffee shop with their hair down. At three weeks, most patients can go to their favorite restaurant feeling great about how they look. 
After sutures are removed (1 week), I give my patients the green light to start longer walks. At two weeks, most people can return to moderate exercise. At three weeks, there aren't any restrictions on physical activity. In the early stages of healing, I ask my patients to listen to their bodies - if they do a hard workout and notice the next day their swelling is slightly worse, maybe take it easy for the next couple of days. 
In my opinion, going Botox free is only of concern if you are doing your brows. I would not advise doing filler in the lateral face/jawline for 3-6 months before surgery. 
I hope that helps! As always, an in-person consultation will help you find the best surgeon for you. 
I wish you all the best,Dr. SitaparaChevy Chase Facial Plastic Surgery

Gianfranco Frojo, MD · Answer

I would recommend seeing a plastic surgeon with 6 years of plastic surgery residency training and a year of aesthetic fellowship training to ensure that you find an individual with adequate training in this very important area of the body. Any well-trained plastic surgeon in this area would be able to answer all of your questions extremely well. I would recommend a facelift, necklift, facial fat grafting and chemical peel. This tends to require 1 week of downtime. I would recommend seeing a surgeon that you like and are willing to start this journey with.

Suleyman Tas, MD, FEBOPRAS · Answer

Dear rexyboy,

As per your pictures, you need to choose an expert to who does not deal with artificial and unnatural appearance postsurgery. In my practice we utilize vertical facelift in order to give that naturally young appearance without the pulled apearance. Additionally, I recommend you to have full face lift procedure starting from necklift and then onto midfacelift and then the upper part of the face to help to reduce the saggyness in a stepped way which targets the whole face. Consequently, fat injections into the deep wrinkles to fill in lack of volume and treat smile lines cases.
In addition, for my patient they are presentable post surgery after 2 weeks and they can actively exercise 2 months later. You can be approx 6 months filler and botox free before the surgery.

Best Regards,
TAS TEAM

Peter Lee, MD, FACS · Answer

You did not specify what surgery was recommended to you, so I cannot answer your questions in that regard.  However, looking at the photos you shared, I can tell you what procedures we would recommend: 
An endoscopic browlift to address your brow ptosis 
Bilateral upper blepharoplasty with ptosis repair to remove excess eyelid skin and raise the lash line so you do not look quite so sleepy 
Bilateral lower blepharoplasty with lateral canthopexy and fat transfer to the tear trough to remove excess skin from the lower eyelid, improve eyelid support, and address the hollowing at the lid-cheek junction 
Facelift to elevate the soft tissues of the midface, soften the nasolabial crease, treat the signs of early jowling, and deliver a sharper jawline 
Necklift to address the platysmal bands and tighten the redundant skin of the neck 
Rhinoplasty to correct your drooping columella and bulbous nasal tip 
All of these procedures could be performed concomitantly if you wished.  Surgical time would be about six hours. Or you could have them done in stages, if you preferred.  You would be out of bed and walking around in about a day or two after the surgery. You would be ready to appear in public about two weeks after the surgery.  You would be ready to gradually resume exercise about six weeks after the surgery.

Jonathan Kulbersh, MD · Answer

Thank you for posting your question and photos. When performed by an experienced facial plastic surgeon, a facelift can provide favorable, natural-looking results. The area of the face that contains layers of deep fascia tissue and muscle is identified, then lifted upward in the cheek and outward in the neck area. The tissue is then secured with barely-visible sutures and any excess skin is removed.

Recovery from a facelift can vary. A dressing is generally kept in place for at least a week, and swelling and bruising can last for up to two weeks. It is also suggested that patients avoid strenuous activity such as exercise during this two-week period. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can answer all of your questions and help you feel comfortable and prepared for what your procedure will entail.

Jeffrey Lisiecki, MD · Answer

Find a surgeon you like and discuss it with them! Find someone who has results that you like and that fit your natural goals. Facelift results can and should be very natural-looking, but certain techniques help this goal over others. For travel, discuss it with your surgeon--I ask that my patients stay in town until at least a week, if not 10 days. The purpose of this is for frequent early visits, suture removal, etc, but also to be close if a complication arises. You should be supervised by an adult (for me, private duty nurse for at least the first night). I typically tell patients they will look obviously postop for about 2 weeks after surgery, and to hold off heavy exercise for about a month. For botox and filler, discuss with your surgeon and it matters where the botox and filler are going!

Ronald Schuster, MD · Answer

Facelifts are generally very successful with low risk. You are asking all the right questions which should all be answered at your consultation. The short answer is that the chance of getting a bad result or something even worse is very low as long as you choose a surgeon who is experienced and does this type of surgery on a regular basis. Your photos would suggest that you should get a great result because the shape of your face is good and your tissues look like they will move well. In general you should be able to get back out in public after two weeks though it will continue to improve for three months. Some limited exercise Evan usually start at 4 weeks. You can do Botox and fillers right up to surgery though in general it might be best to back off on the fillers starting 4-6 months before surgery so the surgeon has a better idea of what’s going to be needed. Good luck.

Andrew Miller, MD · Answer

Based on the photos, you are a great candidate for a lower face and necklift. It is important to go to a surgeon that specializes in facial plastic surgery to have your highest chance of a natural appearing result. You will need someone with you for at least 24 hours after surgery in case there are any issues, but after that, you should be OK. Recovery is usually about 2 weeks for bruising and swelling. Botox and fillers don't interfere with the procedure.

Dilip D. Madnani, MD, FACS · Answer

Thanks for the pictures. You are a wonderful candidate for a face lift and neck lift and all the questions you are asking are perfect and will easily be reviewed with you during a consultation.

Typically there is an initial 10-14 days recovery, most of my patients that travel from out of state stay for 7-10 days and those that travel from abroad stay for 2 weeks.

Your surgeon and clinical team should be available for you during the initial week of recovery and most of them will require you to have a responsible adult with you for the first 24 hours after surgery.

I don't require my patients to stop botox or filler before surgery, however every surgeon will have their own preference

Ahmad H. Ahmadi, MD · Answer

The best way to assess a plastic surgeon's work is to look at their before and after photos. Ensure you consult with a board-certified plastic surgeon and not a ‘cosmetic surgeon.’ It is a good idea to visit with a few plastic surgeons to see if there is a consensus on the treatment plan. Word of mouth and reviews can narrow down your choice. Depending on the procedure, ‘social’ recovery time can vary from one to two weeks. It is advisable to stay local unless you cannot find a suitable plastic surgeon that you are comfortable with.

What would you recommend for a natural looking enhancement? Realistically how long is downtime? (Photos)

Answers (17)

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