Information Overload - what kind of Facelift would be best for me and how to choose? (photos)

Question

I'm in good health (exercise, don't smoke), don't look my age (early 60's) but I'm noticing saggy neck skin, and jowls, some excess eyelid skin. I'm struggling to decide which surgeon, what kind of facelift (deep plane, natural, fat grafts) & where to have it (ie. go out of the country)? There many doctors, & many reviews. How do you choose? Any opinions on highly rated Drs, procedure type & locations would help? Checked surgeons in my area not many to choose from. Help - information overload!

Jeffrey M. Darrow, MD · Answer

Your overall facial shape and contour is excellent.  The areas of your concern, the irregular jawline, loose platysma neck muscle and neck skin plus excess eyelid skin can easily be addressed.  The excess skin of the upper eyelids can be well-managed with a skin only upper blepharoplasty.  Rejuvenation of your face, jawline and neck contour would be best corrected with some form of a SMAS elevation and tightening (there are several options, and none has proven superior to the others), plus modest skin resection.  The best correction of your neck contour would require a small incision just underneath your chin so that the medial edges of the platysma muscle could be suture together to give you the most useful neck contour possible.  Although fat grafting is used nowadays, I do not find it reliable nor the results predictable.  Regarding choice of doctors, it would be in your best interest to find a board-certified plastic surgeon who has an excellent gallery of before and after photographs as well as good reviews and excellent reputation. This may require some travel but it may be well worth it to you regarding the final result. I don’t believe that it’s necessary for you to travel out of the country as there are so many highly qualified surgeons in country.  Any major metropolitan area would have several highly qualified plastic surgeons who you may wish to consult with. Best wishes.

Brian K. Machida, MD, FACS · Answer

You have a very large platysmal band and will need a tremendous amount of vertical and posterior pull which is typically achieved with a deep plane lift with possibly a platysmaplasty in the submental area.  I would not jump to fat grafting until you see the results of the deep plane lift.  A SMAS lift with a platysmaplasty might do it but the pulls from a deep plane are much greater.

Ronald J. Edelson, MD · Answer

Personally I think deep plane is no better than standard. As for fat grafting it is a total waste of money. Go to someone who has a good reputation without all the bells and whistles.  I'm sure Vancouver has plenty of good plastic surgeons. You shouldn't have to travel to get a good facelift.

Steven A. Hanna, MD, FRCSC · Answer

Thanks for the excellent question. I would encourage you to seek out a Royal College certified plastic surgeon who performs a large volume for facial rejuventation procedures. Many of the classic signs of facial aging (jowls and neck skin laxity in particular) can be addressed with a facelift. There are many ways to perform a facelift. My preferred technique for facelift surgery is the deep plane facelift as I feel it provides a durable and natural appearing result when compared to skin-only facelift techniques. I will often combine this with facial fat grafting and laser treatment to address facial volume loss and skin degradation respectively -these are signs of aging not addressed by facelift surgery alone.

Romy Ahluwalia, MD · Answer

Deep plain facelift surgery addresses excess skin as well as tightens the muscle in a meaningful long lasting fashion. It produces a natural result. Given the severity of muscle laxity particularly In the lower face as well as excess skin I think this would be your best bet.

Edgar Torres, MD · Answer

The following are my recommendations based on the comprehensive analysis of each of the structures of your face seeking its complete harmony. 
Face LiftI will eliminate sagging and reorganize the tension of the Lower, Middle, Upper third of your face. This will smooth out as much as possible (and could even eliminate) the wrinkles and furrows between the nose and mouth (nasolabial fold), lip corners (marionette lines), and will eliminate the bulge due to sagging skin on the sides of the chin (jowls).I am also known for making incisions that leave minimally visible scars, whose path I make within (not in front of) the ear, behind it, and outlining and deepening within the hair. 
Neck LiftThe neck is the pedestal of the face, with a great impact on the overall youthful and attractive appearance of the face.I'll have the angle of the neck remarked.I will remove the flaccid and excess skin but without direct injuries, that is, the scar will be camouflaged in the hairline at the nape of the neck. 
These procedures are carried out through maneuvers at two depth levels. At the level of the SMAS (Superficial Muscular Aponeurotic System) and at the level of the skin, pulling these structures following the personalized tension vectors for your case with great precision, based on the meticulous marking of the foot before starting the surgery. 
I recommend :Blepharoplasty (Upper and Lower Eyelids)Upper Blepharoplasty (Upper Eyelid)I will rediscover the groove by removing a linear portion of the skin. With a minimal scar, practically imperceptible, camouflaged, making it coincide with the bottom of the groove.Lower Blepharoplasty (Lower Eyelids)I will eliminate the bags of fat and extra skin, with the reorganization of the local skin tension to neutralize the furrow of the dark circles. 
Brow Lift (Side Lift)Soft and natural stretching of the tail of the eyebrows with high impact on the lateral tissues of your eyes, enhancing the appearance of your eyelids, achieving a more beautiful and youthful appearance. 
I suggest:Fat Transfer to CheekbonesI will recover the volume giving uniformity to the appearance of the cheekbones, printing a more attractive and youthful appearance. 
Fat Transfer to LipsRecover freshness and beauty on your lips. Rejuvenation without volume exaggerations and without the risk of strange reactions or rejection.

Patrick Flaharty, MD FAACS · Answer

There are as many different facelift techniques as there are physicians who do them. Very confusing indeed. Your best bet is to ask around and find the name of 2 or 3 surgeons who specialize in facelift surgery in your area. You can then google each of the doctors and set up a consultation with each to see what they have to say. Based on your photographs you will need a full lower face and neck lift to adequately address the laxity. This is why it's important to see a specialist who does these everyday and who can show you pre and post operative photos of patients similar to you. There are differences in technique, anesthesia, facilities, support staff and price all of which may factor into your decision. With a few consultations you will likely find a practice that feels right for you. That's really the key. Finding a practice which makes you feel comfortable and where all your questions and concerns can be answered to your satisfaction.

William Portuese, MD · Answer

In our practice, we perform a high-SMAS lower face and neck lift procedure. This accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, removal of the fat deposits in the neck, a platysma plasty, and lifting the jowls. It is very important have natural results. Study your prospective surgeon's before and after facelift Photo Gallery.

Information Overload - what kind of Facelift would be best for me and how to choose? (photos)

Answers (8)

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