Want to address sagging/loose neck skin: why such a difference in advice from consultations? (photo)

Question

I’d like a procedure to correct sagging around my mouth, Lisa of cheek volume and lose neck skin. Dr#1 suggested lower facelift and fat transfer about $8.000. Dr#2 said I needed there was no such thing as just a lower facelift that was just a marketing technique and that fat transfers don’t last as long as artificial filler.. about $12,000. So who do i believe??

Brian K. Machida, MD, FACS · Answer

A lower facelift is in effect the equivalent term for a facelift and is not a marketing term but more a descriptive term. If you pay $12000 for fillers, you would be better off paying for a facelift. If you are not certain about fat, just do the lift first. Your next line of questioning should be whether or not the procedure lifts the neck and what type of lift, SMAS or deep plane?  I would recommend a deep plane lift as fat grafting may not be needed after a deep plane lift.

Jonathan Kulbersh, MD · Answer

Thank you for your question. Based on your photo, you would be likely to receive the most benefit from a full facelift coupled with a neck lift and facial fat transfer. When performed correctly, fat transfer can be very long-lasting, as opposed to dermal fillers that typically last up to two years at the most. However, it is impossible to accurately determine your exact needs without an in-person consultation. It sounds like you have gotten a couple of opinions, so I would go with the doctor you feel most comfortable with. For the best results and safest procedures, please make sure your doctor is board certified and specializes in facial plastic surgery. Best of luck!

Richard G. Schwartz, MD · Answer

Your photos shows significant saggy skin and fat in the cheeks creating the jowl bulges and deep nasolabial folds, along with saggy muscle and skin neck bands.  I think a standard facelift would include tightening and lifting of neck muscles and skin, and lifting of cheek skin and fat to smooth out the jowls and reposition some of that jowl fat higher into the mid cheek hollows.  This should create a smoother, more youthful looking face and neck.  You might not even require fat grafting in the upper cheeks if enough fat is moved upward, although that can always be added if needed.  Regardless of that, generally speaking grafted fat that survives the first few months should last permanently, as opposed to fillers that last from one to a few years.

Vasileios Vasilakis, MD, FACS · Answer

Thank you for the question. Based on your photos you need a face and neck lift, in order to pull/rejuvenate the neck, lower face and mid face. I personally prefer adding fat at the time of the facelift as adequate amount typical stays, which is natural and permanent. All filler products are foreign to the body. I wish you the best of luck. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

George Yang, MD · Answer

Hi, If you ask 10 surgeons/cosmetic doctors, you will likely get 10 different opinions. Both have good points, but I worry that those options will still not meet your expectation. In my experience improving the loose neck skin with a lower facelift alone has not been successful in my hands. I tried going tighter, and tighter on the facelift portion, but it never seemed to fully address the sagging of the neck. When I added the corset platysmaplasty to my surgical options to go along with the lower facelift, did my patients get predictable results. The corset platysmaplasty is the foundation for a necklift. A necklift lifts the neck. A facelift lifts the lower face and cheeks to some degree. A browlift lifts the brow. If I told you a browlift would improve the neck you might have your doubts (it won’t affect the neck), but when showing a patient how a facelift might appear in a mirror during a consultation, you will see some improvement in the neck. However, look even more closely to how much improvement you actually get with the facelift. If you are in the bathroom, try to catch a glimpse of your profile view. Then try pushing the skin under your “sideburn” hair in an upwards and backwards direction. You will like that it improves the lower face, jawline and marionette lines. However, you will note that the smile lines or nasolabial folds are not eliminated. Note that the neck waddle may improve 20-40%, but still be hanging in the center. Just operating on the sides of the face without actually performing a necklift, is the same effect as what you can do in the mirror by lifting your face. However, the real result will be less than what you can show with your fingers. I will have the patient lift up their face to their satisfaction, then relax their fingers down 50% and explain that when everything is fully healed and settled, that will likely be the final result. When performing the facelift, we may actually lift and tighten the tissues and remove skin to get the lift that you desire, but as the swelling comes down and the skin relaxes a bit over the first 6 months the results are more subtle. Even if you pull/lift your face super hard you will note that the nasolabial folds are still not gone. For this reason, both surgeons were still recommending some kind of injectable volume in the form of fat transfer/grafting or injectable fillers. Sorry the answer is getting so long, so I’ll just stop here. I hope you got some value out of this answer. Keep doing your research. Realself is a good resource for both doctor’s opinions, but also look at the Realself reviews from verified patients in your area, as well as the “Worth It vs. Not Worth It” for certain procedures to gain a more realistic expectation of these procedures which is independent of what the surgeon’s pitch. If you have a good rapport with the surgeon as well as like the before and after photos (which should be at least 6-12 month results, immediate results do not show how much it relaxes over time.) Best, Dr. Yang

Andrew Campbell, MD · Answer

First of all, the is a lower facelift and fat transfer can last a lifetime and quite consistent at giving very long term volume. You will definitely need a lower facelift to address the jowls and neck. Most facelift techniques will not improve the nasolabial fold, unless it's a well done deep plane facelift. Fat grafting to the cheeks can improve the nasolabial fold, and the combination of the two would be my personal recommended technique for someone that wants to improve the midface and lower face.

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

Farhan Taghizadeh, MD · Answer

Hello, thanks for your question.  A lower facelift (in my experience) generally means that we are not doing anything to the temple or brow.  In my lower facelifts I comprehensively treat the neck, mid face, and jowls by creating a short incision around the ear and into the hairline behind the ear.

Fat transfers can be permanent; the only challenge is that depending on how the fat is processed before it is injected impacts results.  It is possible for fat to die on one side and not the other, so some physicians prefer artificial fillers as they are more predictable.  There is a filler, Belafill, that is a "permanent" filler lasting about 8 - 10 years.

Both physicians presented reasonable options; at the end of the day it is important to pick a physician you are comfortable with and whose results you like at a price you can afford.  Look for a Board Certified Facial Plastic Surgeon, as they have specialized training.

Hope this is helpful!

Thanks, 
Dr. Taghizadeh

S. Darrell Lee, MD · Answer

Doctors have different terms for facelifts; upper, lower, mini, full and many other names that they have coined as their own. When I perform a full facelift this will correct the sagging skin around the mouth, restore the lost volume of the cheeks and will eliminate the neck platsymal bands by incorporating a platsymaplasty. By using the technique of a SMAS plication, I give you a natural and youthful appearance. Sit on the edge of your bed and look at yourself with a handheld mirror, then lie down flat on your back and look at yourself again; this is the appearance a full facelift will give you.

Patrick Flaharty, MD FAACS · Answer

A lower face and neck lift is the best way to lift the cheek, tighten the jaw line, and improve the neck. Adding volume to the cheek area can be done with either fat transfer or fillers depending on your preference. Fat transfer is best for global volumizing of the entire face while fillers are practical for smaller areas of volume loss. Based on the information provided and your photograph I agree with the recommendation of doctor #1. Combining a lower face and neck lift with fat transfer can result in a comprehensive rejuvenation of the entire face and will certainly address your concerns and more.

William Portuese, MD · Answer

To address sagging and loose neck skin requires a lower face and neck lift procedure. In our practice, this accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, removing fatty deposits in the neck which also includes a platysma plasty,  lifting the jowls and tightening the SMAS. Choose your surgeon wisely based on extensive experience producing natural results. Study your prospective surgeon's before and after facelift photo Gallery and make sure that it is extensive

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