Facial rejuvenation procedures in stages or all at once? (photos)

Question

Dear doctors, I am turning 50 this year and I am starting to see some sagging in my facial tissues. I am looking for a harmonious facial rejuvenation, addressing all areas of my face, i.e brow lift, upper and lower blepharoplasty, deep plane face and neck lift, fat transfer where needed and possibly a lip lift. Would you recommend a staged approach spanning over 2-3 years (say, starting with a brow lift) or would you recommend waiting another 3 years and having it all done at once? Thank you!

Stephen Prendiville, MD · Answer

The answer really depends on what you want, your schedule, and what degree of recovery(ies) you are willing to have.  I would say that in my practice, most patients are now opting for a single recovery as opposed to multiple anesthesia events and multiple recoveries.  However, I have patients who feel that incremental changes are best for them, so neither answer is completely right or completely wrong. Find a Facial Plastic Surgeon with who you are comfortable and whose results you like.

Alan Gonzalez, MD, FACS · Answer

Hello @frenchdressing, thank you for your question. When considering facial rejuvenation, it is advisable to do so in conjunction with the signs of aging that exist at the time and to perform the procedures in the same surgery. It is advisable to do an eyebrow lift, upper blepharoplasty, and jowl lift at the same time so that that same tissue can age together. Otherwise, you would experience an aging process in stages. Doing it in a staggered manner would not make sense. This is unless you have health problems such as very low hemoglobin or the doctor decides that due to a clinical condition you cannot have everything at once. To determine what the best course of action is, a personalized consultation is required, in which all aspects are considered. Best wishes! Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Donald Groves, MD · Answer

Hello and thank you for your question. Generally, your risk for complications increases after your surgery length exceeds 4.5-5 hours. Although there are exceptions, it takes most surgeons longer than that amount of time to perform all the many procedures you have listed. Therefore, it is possible to do all these procedures together during one surgery, but given the unnecessarily increased risk for complications in these elective procedures, I would not recommend it. 
The safer option would be to stage these into likely 3 separate surgeries to shorten the operative time for each surgery. It would make sense to perform the browlift first if this is your area of greatest concern. As the browlift can affect the amount of upper eyelid skin redundancy, I would recommend waiting at least 6 months after the browlift before performing the upper/lower lid blepharoplasty- this would give you the best result for your eye region. Then stage 3 of the facelift/necklift with facial fat grafting (and possible lip lift) can be performed 6-12 months later as the final stage. I hope this helps!
Best,
Dr. Donald Groves
Plastic Surgeon

Selcuk Inanli, MD · Answer

Hello ! Thank you for your question first of all you have beautiful face ,It can be more aesthetic if done in some procedures l recommend you midface lifting + lip filler + with jaw line filler with jaw line you chin will look with these procedures, your face and tight lips will be fuller and your jaw lines will be more pronounced.
Thank you ! regards

Gurkan Kayabasoglu, MD · Answer

Hello. Thank you for your question. First of all, I want you to know that you look very good for your age. But unfortunately, with human nature and gravity, it starts to sag after a certain age. The only way to delay this is plastic surgeries. Therefore, I recommend you not to wait at all. The surgeries you want are exactly the surgeries I would recommend. You are a very suitable candidate for all of them. But I recommend you to have all of these surgeries together, not one by one. You can go back to 35-40 years old. Please check our Instagram account and RealSelf photos. You can get more detailed information about me, ask all questions about your case and sending your photos to my assistants at the number on my profile. You can also book an online consultation and discuss your problems with me. With all respect.

Jonathan Kulbersh, MD · Answer

Thank you for your question and the photos you provided. It is a common practice to perform multiple procedures during one surgical session. This allows for a single recovery period while also producing more comprehensive results. Many patients undergo two or more surgical procedures at a time to achieve their aesthetic goals sooner while requiring less downtime in the long term. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to discuss your goals with you and create an individualized treatment plan that is catered to your specific needs.

Cory Bovenzi, MD · Answer

Hi and thanks for the question with photos! In short, if you can do them at once that will simplify things so you have one recovery, one session of anesthesia, and one period of downtime. They are safe to do at the same time. 
Many times, budgeting is what causes people to stage procedures. In that case, I would make sure to explain your goals to your surgeon since a browlift and upper blepharoplasty need to be considered together as to leave enough upper eyelid skin for proper eyelid function in closing your eyes (if you have an upper blepharoplasty and later try to have a browlift, your eyes may not close well if both surgeries are too aggressive, and overresecting in an upper blepharoplasty can prevent your from being able to have significant change in a browlift later on)

John Reilly, MD, FACS · Answer

Hi, You recover from multiple procedures at the same time so you can certainly reduce the overall recovery time by doing multiple procedures which is often commonly done. I would personally rethink the Deep plane facelift. Any facelift for you could  put off for a bit. When patients look in the mirror they tend not to look at their eyes first. When people speak with you they do. A brow lift is a possibility but certainly an upper lid blepharoplasty would make a very nice difference with minimal scarring. The photos are not clear enough if you need a lower lid blepharoplasty for me to comment. Some soft tissue fillers can help especially with the upper lip to bring it into balance with the lower and help define its anatomy. Good luck

Richard G. Schwartz, MD · Answer

The decision whether to have staged facial procedures, with each one focused on a particular problem area of the face, or a more comprehensive combination of procedures depends on how much you are bothered by the various problems.  Certainly, having multiple areas improved at one time saves you recovery time out of your daily life.  However, there is nothing wrong with focusing on the area that bothers you the most first and waiting with other procedures until those aging changes worsen.  That approach usually creates a more subtle improvement over time, keeping you looking more youthful without a sudden dramatic change.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

To start with I would say that you do not need a necklift procedure and that you are very likely to maintain your weight which will reduce the likelihood of needing a necklift procedure in the future. As long as regular sun block (daily) is part of your routines, ageing of the skin is delayed.

The next consideration is about what would the most likely to provide you with a significant aesthetic benefit in the short-term and the long-term.

If you lie down completely flat and look in the mirror you will notice a number of changes that include:
smoother contour around the corners of the mouth
- increased fullness in the midface and decreased fullness above the jawline
- improved contour of the lower eyelids
- higher position of the eyebrows and improved appearance of the upper eyelids

If you feel that you need to reach all these goals, a combination of temporal lift or brow lift, lower eyelid blepharoplasty and deep plane facelift would be a relatively close match to the appearance lying down.

The upper eyelid surgery may be warranted but for a more in-depth advice you would need to discuss with your surgeon the appearance of the upper eyelids when the eyebrow is elevated. 
In person consultation would also be beneficial for decision about the lip lift intervention and fat transfer.

For the fat transfer decision, evaluation of the shape of the face line down and also gives you a reasonable evaluation whether you have enough volume in the face to require only redistribution or whether supplementation would be important.

Facial rejuvenation procedures in stages or all at once? (photos)

Answers (16)

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