I'm looking for a complete surgical makeover plan to restore the beauty of my features, youth, and femininity to my face (Photo)

I have had face lift, nose, chin implant, and a LOT of filler. Hormonal imbalances caused me to lose a lot of fat in my face and giving me a masculine look. I am only 34. I currently have filler in my upper eye, cheeks, jaw, chin, and lips. I would like to have a more feminine and youthful look and am looking for a complete surgery make over and am looking for a surgeon who can recommend a specific plan to restore my more feminine features and a more youthful appearance. Price is not an issue.

Doctor Answers 10

Current surgery techniques will unlikely achieve your goal, and you may need some filler dissolved before proceeding forward

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Hi comradekitten,

I don't know if I would be that surgeon you are looking for, since I don't believe you need a complete surgical make over, and you probably are not that far off as you believe.  There is a recent article in New Beauty Magazine which shows examples of younger celebrities who look older than their actual age because of the the fillers and procedures which they have done.  They also have examples of some older celebrities who look younger than their chronologic age.  I suspect that too much fillers on a younger patient makes them look older, because you can tell that they have filler in them.  This tell-tale sign that they have filler, is also seen in older patients who look pretty good for their age, but clearly they also have the same tell tale signs of filler injections.  This makes the younger patient who make look good, look like an older person who is actually trying to look younger.  The article's prime example was Brandi from the Real Housewives of Beverly Hills.  They show photos of her when she was younger, and over the years with more fillers on her cheeks, she appears filled.  Yet she is actually still pretty young, and the softness of her younger self has been overshadowed by the harshness of the filler placement, which creates unnatural fullness of the upper cheeks, which is most apparent when she or other people who have had filler have a big authentic smile.

One of my special interests is reviewing younger photos of patients and comparing them to their current appearance to figure out what exactly changed and then try to reverse those changes, based on where exactly we (the patient and I) think the volume loss occurred.  I think there is room for improvement (in the current techniques) in this regard, since the standard techniques in filling cheeks, etc appear to not be working.  We frequently see people who you can tell have had filler, and less people who simply look young.  If our current techniques worked well, then all celebrities would be looking like they did at 25-30, but clearly this is not the case.  Of the people who are aging well, they simply are not gaining or losing weight or have not been pregnant (Jennifer Aniston vs. Courtney Cox.)  With standard techniques, Courtney Cox still does not look like she did in Friends, while Jennifer looks very similar, but with a little less "plumpness" and softness as she did back then.

Typically fillers or botox injections do not require a lengthy consultation, because the patient already knows where they want their fillers or botox injected.  It is financially more lucrative to simply inject the product where the patient wants it and not spend any time analyzing the patient's face.  Less talking or listening, more injecting = more money both for the doctor (money in) and the patient (money out.)  This actually works well if the problem is localized.  Frown lines between the eyebrows, smile lines, fuller lips, assuming everything else is holding up well, and they simply want those areas treated.

I think when there is global aging or noticeable facial aging and not a single problem here or there, then time spent on a consultation before starting any procedures is important, so that there are not missteps or unnecessary procedures.  For example, my family and I went on a walking tour of the Washington D.C. monuments.  If you stick to the tour path recommended, you will be able to see all the monuments from the White House to the Capitol building in 5.8 miles.  We ended up walking nearly 9 miles and we even skipped the Jefferson Monument.  The same can be said for these cosmetic procedures.  Sometimes having multiple procedures performed without a plan or a template (such as younger photos) will end up spending more money and doing more procedures, while still not achieving your goal.

Another mistake I frequently see is some patients routinely going back for more filler or botox, based on a calendar schedule or doctor's office reminder to come in for more filler.  The doctor has not looked at their face and filler can last differently in different patients, so how can routine injections "maintain" their appearance, when in fact it may start to distort their appearance and make them look a like a caricature of themselves.  In our practice, the patients are educated on the overall philosophy of what makes them look better, and they come back based on their own periodic analysis of their face.  In a way the patient becomes empowered with the ability to analyze their face critically, and know if they really need more filler.  If a mechanic tells you, that you need a certain thing fixed, my initial thought is whether or not I believe the mechanic, and whether they are trying to recommend an unnecessary repair.  If I knew more about the workings of the car, I would be better equipped to know if my car really needed that repair.

Having said all of that here is what I could make out of the photos and comments you posted:

The biggest clue you gave in your question is that "Hormonal imbalances" caused facial fat loss. For this reason you have had a lot of filler to try to replace the fat loss, which makes sense, but perhaps the filler is not injected at the same depth as the place where the hormonal fat loss occurred (google an image of facial muscle anatomy.) If the filler is injected in the wrong depth, it can look pretty normal when the patient is not smiling, because that is how the filler was injected (when the patient's face is relaxed). But when the patient smiles or moves their face then the filler can be seen moving on the patient's face. In your case, when your face is relaxed, the overall shape looks pretty smooth, but when you smile there appears to be a ledge that forms under your eyes which may be a touch too much filler in that area, while below your cheek bone on the right side, you have "dimples" or hollowing below that right cheek bone. On your front view, your jawline appears slightly different. I think your left jawline is the better side (the wider jawline) than your right side. This may be correlated to hollowness under your right cheekbone, with overall more volume loss on your right jawline and under the cheek bone. On your diagonal view inside your car, your mouth protrudes past your cheek, which reveals the volume loss again on the right side. On the front view in the car, I like your left side more since there is overall less shadows forming on the left side than the right side. Is it a coincidence that the excess fullness under the eye is on the right side? Maybe not. Since you have more hollowing on the right side, your injector probably injected more filler on your right cheek to try to address the issue, but the hollowing is under the cheekbone, and not on top of the cheekbone. The extra filler bunches up under the eye where in comparison to your younger photos 7 years ago there was no ledge. The left side is acceptable, but the right side might need a little bit of filler dissolved, assuming you have had hyaluronic acid fillers (Restylane/Juvederm). The aim of my filler injections is to soften the appearance of a woman's face. In general, a youthful face and feminine face is more "shadowless." The goal is less hollows which makes dark, harsher shadows on the face. A softer face has less hollows and shadows. Additionally, a feminine face is not puffy either. So the goal is to add volume to get rid of concave areas, without trying to make the face convex, unless it is expected to be convex in that area. I hope that makes sense, but it is hard to explain these things without diagrams and examples of before and after photos to make sure the patient and I are on the same page.

You stated that you have already had a facelift, at age 34. I think that more surgery may not be the right thing for you. The lifting will may the face more angular and pointier from chin to ear. If you look at fashion magazine of models, there is some width to the face at least an inch to and inch and a half below the earlobe, before it forms a jawline to the chin. Again a diagram and examples will better help to explain this.

Consultation Process:  

Our typical cosmetic consultation is 1 hour ($150) and during the consultation I go over treatment options, risks, and recovery as well as answer the patient's questions and concerns.  These patients typically have not had any work done on the area of concern, and they are not there due to an untoward result from prior surgeon/doctor.  The consult is straightforward, and if it is an injectable procedure which they may want during the initial 1 hour consultation, they can simply pay for the procedure, and have the consultation fee waived, since the procedure is actually more expensive than the consultation.  If they are there for a consultation for a surgical procedure, the consultation fee can be credited toward a surgical procedure if scheduled within a month of the consultation.  

Post-operative Counselling:

In cases where the patient has had work done by other surgeons and doctors, this makes things a lot more complicated, and we have a different type of consultation called "post-operative counseling."  Within post-operative counseling we have second opinions, post-operative care of other surgeon's patients (for example the patient had surgery overseas, but does not have anyone locally to remove sutures or drain a hematoma), and revision surgery consultations.  The details of this are on our website.

A straightforward cosmetic consultation is like asking someone to knit you a sweater and you pick the yarn colors and the pattern you would like. For the post-operative counseling, it is like bringing a sweater which was started by another knitter, but it isn't turning out as you would hope. Additionally the ball of yarn has become tangled, and the knitting pattern may not be as nice as you had hoped, so before starting the knitting of the sweater from scratch with a new ball of yarn, the half-knitted sweater needs to be undone and the ball of yarn needs to be untangled, before moving forward. For this reason, post-operative counseling is charged by the half hour. The first half hour is $200, and subsequent half hour increments are $150. If the sweater is not really that bad and you like most of it, and it turns out the ball of yarn is not really that tangled, then the consultation will be shorter. If it turns out that in addition to everything you have mentioned, you have had even more procedures which you have not mentioned such as non-surgical skin tightening such as (Thermage/Ultherapy) which can melt some fat on your neck, the ball of yarn becomes even more tangled than we originally had thought, and this will take more time to figure out the best plan of action for you.

If during a post-operative counseling appointment, it becomes clear to the patient that I am not the right cosmetic provider for them, they can simply end the consultation early at the initial half hour mark, so they do not incur additional cost. It is also possible that during the entire process, we discuss other options which I may not provide (hair transplantation, lip lifts, etc) and at the end of the consultation process, if we determine that the reason for the lack of femininity and youth is that your XYZ is causing the change in appearance, but I don't offer XYZ surgery, then we will discuss who may be the best at XYZ surgery and I will wish you good luck with the other surgeon(s.) 

I hope that makes some sense. I will you the best of luck and a safe facial rejuvenation journey.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Full facial rejuvenation

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I would be very careful bout proceeding aggressively after already doing the things you've done.  I do a lot of revision surgery and you need to remember that many of the unnatural stigma of plastic surgery cannot be reversed.  

The issues I see in the photo are not severe and can get improvement easily with or without surgery although you do have some contour irregularities which may be easy or difficult to fix depending on their cause.  I've treated many patients with features similar to yours with a variety of procedures and or fillers

Ben Talei, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 52 reviews

#facelift and #facialrejuvenation

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Aging and weight changes can affect your facial volume. There a number of ways to address this with both surgical and non-surgical methods. I would recommend scheduling a consultation with a plastic surgeon to discuss your options.

There are three areas that we look at:
  1. skin surface
  2. volume
  3. laxity of skin an muscle

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Facial Feminization

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This is a constellation of procedures that helps to correct problems such as you have mentioned. We analyze your face very differently to determine what bony and soft parts are contributing to the masculine appearance.

There can be remarkable success!

Jeffrey H. Spiegel, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 70 reviews

Restore the young and beauty of the face

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Thank you for asking about your facial procedures.

  • First, you are lovely to start with and have had considerable surgery already.
  • I suggest you find photos of yourself in the past - to show the changes you are seeing.
  • Find a plastic surgeon with the time to compare your face now and then and discuss what you might consider.
  • The photos you posted are good but not comparable so an in-person consultation is important.
  • Rather than a complete re-do of your face, have a plan that balances your goals and what can be achieved.
Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes

I'm looking for a complete surgical makeover plan to restore the beauty of my features, youth, and femininity to my face

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Although you've had a great deal of work done- and I don't believe that further intervention would be warranted-- if our nose were smaller and more refined- my opinion is- it may move you closer to your goals. I would seek a Board Certified PS with demonstrable experience in secondary rhinoplasty.

I'm looking for a complete surgical makeover plan to restore the beauty of my features, youth, and femininity to my face

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Hi... thank you for the question and photos.... To achieve that youth look you are looking for i suggest you a Middle Third  facelift, neck treatment and Fillers... and to improve the aspect an brow lift could be the key. 

Luis A. Mejia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 83 reviews

Options for Facial Enhancement

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Dear comradekitten:

Thanks for sharing your photos! There are so many options and they are dependent on many factors such as recovery from swelling and bruising, your budget, your expectations and YOUR perception of femininity given your beautiful feminine appearance in these photos. I am not suggesting you need any or all of the following but let's go over some options. 

Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of thefillers,RestylaneandPerlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin"Juvederm Ultra Plusare similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Volumais the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!.

Dr. Kane is expert at cheek and cheek-eyelid rejuvenation with fillers. He uses a personally developed near pain free, blunt cannula technique to:
  • Fill the “apple” of the cheek
  • Fill in the tear trough (nasojugal fold)
  • Highlight the mid and lateral cheek prominence
  • Camouflaging the under eyelid bags and
  • Reducing static and dynamic wrinkles and crow’s feet around the outer eye
with the use of fillers.

Non-surgical facial contouring is possible with fillers such asRadiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Scuptrais the latest of the injectables stimulating collagen at different levels of the skin by adding volume but primarily by firming and adding resistance to the formation of wrinkles, folds and descent.

BotoxandDysporttoo have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generationZO Skin Healthprograms may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPLand fractionatedlaserssuch asCO2 and erbium and now RF(radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation.

If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin.

You may consider: a traditional face and neck lift, short scar face and / or neck lift.

The recent resurgence of the S-Lift (created in the early 1900's), also called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. The shorter scar, limited undermining and second layer lift achieve the "quicker" procedure but not necessarily the quicker recovery or the improvement you desire.

Face lift and / or neck lift or any of the other procedures and their combinations should be discussed following a proper examination with a Board Certified well experienced artsy and multi-faceted Plastic Surgeon or ENT Facial Surgeon who performs all of these options so you will not receive a biased approach because he limited in his skills.

I hope this was helpful! All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Facelift candidate. Some advices:

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Thanks for sharing your concerns with us. 

In my practice for cases like yours I recommend a facelift of the third middle of your face with lipofilling of the nasolabial folds and upper lip.

Dr. Emmanuel Mallol Cotes.- 

Emmanuel Mallol Cotes, MD
Dominican Republic Plastic Surgeon
4.7 out of 5 stars 368 reviews

Makeover options

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Thanks for your pictures... I see that you do have some volume loss in your cheek area when compared to your pictures from 7 years ago. 

Options to consider are filler using fat transfer and laser skin resurfacing to improve skin tone and texture. 

You don't seem to need much else.... 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 104 reviews

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