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

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

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

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.

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.

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

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.

Facelift surgery can look bad and unnatural if it is not done well. I advice that you discuss this with a surgeon in person and ask how they avoid unnatural looking results and ask specifically what their approach to your face will be. Ask them what they think a good result is and what a bad result is. Looking at before and after photos with your surgeon is a good idea as well.
Based on your photos you are a good candidate for a facelift surgery with a neck lift.
After having a face lift it is recommended you have an adult with your overnight unless you are staying at the surgical center. We see our patients back in the office the following day to assess how they are doing. Close follow up is necessary to catch post op complications early. Vigorous exercise can be started 6 weeks after surgery, however you should be up and around right away and likely will be out for walks by about a week. Going out in public depends on how bruised you become. A week is usually sufficient if you don't mind using a scarf or turtleneck and sunglasses, however you may be bruised for a few weeks.
You can continue Botox with facelift surgery. With respect to fillers, if you are planning a face lift, you could stop them now. The soft tissues will be adjusted with surgery and you can make a decision with your practitioner 3 months after surgery as to whether there are any areas that can have the contour touched up with filler after surgery.
All the best to you,
Dr. Nancy de Kleer

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.

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!

Your pictures present a lovely face with some loose skin around the lower face and neck and skin-texture changes. I would most likely recommend a facelift and neck lift with laser resurfacing, but a physical exam and full medical history would be needed to be sure. Absolutely the best way to ensure that you don’t end up “looking bad” is to study the surgeon’s before-and-after facelift photos. In addition, it’s a good idea to determine if the surgeon performs a “quick” facelift using easy closure techniques, or if the surgeon is painstakingly careful with sewing the incisions so that they are camouflaged with time. In my practice, I carefully hide them along the tragus of the ear and place them behind the ear as well to disguise any telltale signs of surgery. For this reason, I perform only one facelift per day! You have many excellent questions, and for that reason I always book my consults for a full hour (or longer!) so that every question is answered, and the whole process can be discussed from start to finish. Every surgeon is has a different protocol for Botox and postop care. In my practice, my facelift patients -- regardless of where they reside -- stay in a lovely hotel across the street for the first two nights with one of my personally trained overnight nurses so that they received the best care possible, and I am reachable the entire time. After these two nights, the nurse removes the bandages, allowing the patient to shower and shampoo before going out into the world. You will need to refrain from heavy exercise and anything that raises your blood pressure for two weeks. You do not necessarily need to be “Botox and filler free” but it depends on the amounts injected and the products used. I recommend consulting with a board certified plastic surgeon who has decades of experience with sophisticated facelifting to discuss all your concerns and expectations. This is a big decision – one that warrants much time and research.