Lower face saggy and wrinkled, which is best treatment and should I go abroad? (photo)

I've also answered this question on this video in YouTube:The Fundamentals of a Facelift, Why Shortcut Procedures Don't Work, and Cautions for Medical TourismAs a cosmetic oculofacial plastic surgeon practicing for 20
years, facial rejuvenation happens to be an area I specialize in. I wrote a
book called “The Fine Art of Looking Younger” and I can help people like
yourself who are confused about fillers as well as other optimal procedures.



Facial aging is a combination of volume loss and laxity.
Volume loss means loss of bone, muscle fat, collagen and soft tissue. As we get
older, the face gets a little bit older, the baby fat diminishes and everything
gets smaller. That’s why fillers have such a vital role especially in the
earlier decades of facial aging such as 30s and 40s. On the other hand, laxity
or loss of elasticity where tissues such as the skin and the tissue under the
skin called the superficial muscloaponeurotic system or SMAS gets lose, becomes
thinner and sags.



Over my 20 years of practice, I have seen so many procedures
come and go that are supposed to be shortcuts. These include thread lifts, mini
weekend lifts, various heating devices and lasers that are supposed to take
over facelifts. However, there are no shortcuts. There are ways that procedures
can be done to optimize the results but certainly shortcuts never really work.



When you have to make a decision and money is an issue, from
my perspective, that is where people make a lot of mistakes. As a specialist
and as someone who has become well-known, I have patients who come to me from
all over the world and all over the country who have had some unfortunate
results by going for less expensive options. Unfortunately, in the field of
cosmetic surgery, there appears to be two types of doctors: those who do high
volume and low prices, and low volume and higher prices. There are also people
in the middle. Unfortunately, quality does cost: anesthesia, operating
facilities and the art of doing the surgery cannot be rushed so you do get what
you pay for is true.



People have come back after going to different countries for
surgeries where they needed additional aftercare. Surgery is a single procedure
but there are certain percentage of people that need more care whether it’s the
incision, swelling or other areas that need treatment with steroids. The
aftercare process is so important and they missed that by going to another
country. They come to someone like me or a colleague and they are surprised
that they have to deal with all of these issues. Being in the United States or
going to a doctor who has the qualifications, experience and who is accessible
has tremendous value. I always teach my patients that your procedure is an
investment that will pay long term dividends in terms of the benefit after many
years. Being in practice for many years, my patients and I have gotten old
together and at one point, I’ll do their eyes and they’ll come back and I’ll do
their face. I’m always available to my patients and the accessibility and the
ease makes it a very good journey for the majority of my patients.



My advice is to meet with several experienced cosmetic
surgeons and come up with plan. If it’s about the budget, you choose the things
that you are most concerned about and you address them in a particular time. In
our practice, we do everything under local anesthesia with LITE™ IV sedation. If
someone cannot afford everything, they don’t feel bad that they are not going
under general anesthesia and having to go back to it. When our patients do the
sedation, they recover very quickly and when the time is right they’ll come
back and they’ll do another procedure. Anesthesia is certainly a factor in my
experience that has helped a lot of our patients budget their priorities.
Unfortunately, when you go under general anesthesia, there’s pressure to do
more procedures just because it’s not the best experience in terms of the risks
involved.



Have a plan and an idea of what you need to do. You may need
to do a limited procedure as long as you and the doctor are clear on what the
ultimate benefit is. In my experience, shortcut procedures are not the best way
to do things. Most of our procedures like facelifts or face and neck lifts, we
do aggressively enough so that they feel that their jawline is tight, their
neck angle is well defined, cheeks are up and it looks very good. When you do
shortcut procedures, sometimes you get a better jawline but then there’s a
little neck sagging and laxity. I would discourage you from going abroad. There
are many highly qualified experienced cosmetic surgeons here and I think it’s
the matter of you clicking with the right one and figuring how to budget
intelligently. I hope that was helpful, I wish you the best of luck, and thank
you for your question.

There are very good facial Aesthetic surgeons in the United States. I personally don't think it's a good idea to travel overseas for an operation were your surgeon will not be able to follow you.

I believe you would be a good candidate for facelift surgery.  As we age, deep
creases form between the nose and mouth; the jawline grows slack and jowly;
folds and fat deposits appear around the neck.   A facelift will remove excess
fat, tighten underlying muscles and re-drape the skin of your face and neck and
can last up to 10 years.  Be sure to seek
a Board Certified Surgeon who has elite credentials with facial cosmetic procedures
to discuss your options.  Be sure to see
before and after photos and be direct with your questions and expectations. Although cost is a factor when deciding to proceed with any cosmetic surgery, I would not recommend travelling abroad.