PS consultations all offer different advice. What do you think would be my best option? (photo)

Confused on Litelift vs. SMAS. Also, is it necessary to have upper part of face done if most wrinkles are on lower portion? Consultations with several PS in Mpls and all give different advice. I'm very confused as to what would be most been ail for my 63 year old wrinkled Irish skin.

Doctor Answers 12

Laser Resufacing Not Facelift Better To Remove Wrinkles

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Thank you for your question.From your photographs and your statement in your question it seems to me that wrinkling around the mouth and cheek areas is what is bothering you most and what you hope to correct with plastic surgery.

If that is the case then a facelift is not the best procedure for you. The best facelift will certainly tighten the skin and improve jowls and loose skin but the severe wrinkling that you have will still be present after your facelift.

My recommendation would be that you consult a plastic surgeon who is certified by the American Board of Plastic Surgery and experienced in facial rejuvenation surgery and laser procedures with a good local reputation.

Inquire about the possibility of laser resurfacing. The best, most modern, safe, effective laser resurfacing technique is called Combined Laser Resurfacing and uses a combination of a 2940 Fractional Erbium Laser Resurfacing with 1540 Fractional Erbium Non-Ablative Laser Resurfacing.

My guess is that a combined laser resurfacing will

Three major components of aging

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Comprehensive facial rejuvenation usually involves addressing the three major components of aging—loose skin, fine lines and wrinkles, and volume loss.In order to address all three components, a combination of surgery (facelift), laser resurfacing, and volume replacement (dermal fillers or fat transfer) is necessary.The degree to which all of these procedures are needed depends on the individual.

I would recommend consulting with your local board certified Facial Plastic Surgeon for more information.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews


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Thanks for your question - you definitely need a full facelift. The fine points and specifics would need to be elucidated during an in person consultation - best of luck.

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Litelift vs SMAS

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Sometimes trying to plan the best procedure is impossible, or at least very difficult. Reviewing pictures of patients who have similar problems with your surgeon will give you a better feel of what can be accomplished . If you like the results for that patient, then if things go as expected, you should also be pleased with your results. There is no perfect answer, perfect surgery, or perfect surgeon. As a prospective patient, you should find a doctor that you relate well with, and then formulate your own plan with him. It is very common to find different solutions to the same problem.

J. Kevin Duplechain, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

What is my best option?

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After reviewing your photos that you submitted, there are several issues which I can point out that are noticeable. I cannot fully access the brow position from this photo so I will leave it alone, and you can get excellent brow elevation with botox. You have loose skin of both the upper and lower eyelids. You have significant fatty pockets in the lower eyelid also. You have jowling with neck laxity. You have volume loss of the face with prominent nasolabial folds and marionette lines. There is also perioral rhytids with hyperpigmentation of the face. To get the best result I believe you would need the following:

1. Facelift and Necklift

2. Upper and lower blepharoplasty with lateral canthopexy/plasty (depends on lid laxity)

3. Fat grafting to the face to restore volume

4. Several months after the facelift/necklift I would do a full face fractionated CO2 laser to help with perioral rhytids and hyperpigmentation.

Typical recovery is 2-3 weeks for most patients to have the majority of edema resolved. No exercise for 4-6 weeks post procedure.

Jeffrey LaGrasso, MD
Miami Plastic Surgeon
4.4 out of 5 stars 114 reviews

Full facelift with perioral laser resurfacing should give a good result.

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  • It is unlikely that you are going to get a consensus on a specific approach. I think you're an excellent candidate for a well executed facelift. I would consider perioral resurfacing at the same time for the wrinkles around the mouth.

Facial rejuvenation options

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It is said that if you want 10 different opinions, than you should see 10 different plastic surgeons! Because that is what you are going to get, everyone's approach is based on training, experience, goals, esthetics, fees, etc.

When you visit your surgeon, tell them exactly what you don't like and what you are willing to put yourself through:

  1. Financially (big budget or low budget)
  2. Recovery wise (no recovery time tolerated, or lots of recovery time available)
  3. Scarring-no scars please, or let me have it!

Once you have established these parameters then a rejuvenation plan can be formulated, which will probably consist of a variety of recommendations; lasers, lifts, peels, tucks, implants etc. Ask to see before and after pictures from that surgeon with people who look like you, is that what you want? Can you work with this doctor and his staff? Do your research, is he/she board certified in plastic surgery, look on the internet and read recommendations. We are talking about your face, no short cuts are allowed!

Based on the one picture submitted you could benefit from a full facelift with a brow lift, upper and lower eyelidplasty and either a chemical peel or laser skin resurfacing around the mouth. Autogenous fat grafts can also be added to the marionette lines and nasolabial folds.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 83 reviews

Litelift vs. SMAS

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Given the photo that you've submitted, it's difficult to tell about your brow because your hair is covering it. However, in my opinion you would achieve your best result by having an endoscopic brow lift, upper and lower blephs (eyelids), and full facelift which includes a necklift. In addition, I would address the wrinkles around your mouth with laser resurfacing. A "litelift" would not benefit you. The results are very temporary and there is a strong chance that you would have to have a facelift with tightening of the SMAS and proper skin re-draping later on anyway. Best of luck to you.

PS consultations all offer different advice. What do you think would be my best option?

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Face and Neck lift. Find a plastic surgeon with ELITE credentials who performs hundreds of facelifts, necklifts facelift revisions, and facial procedures each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

PS consultations all offer different advice. What do you think would be my best option?

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The common issue is to improve your appearance you must consider doing staged interventions. I might start with a full face/neck SMAS lift/quad blepharoplasty/maybe some forehead surgery. Than consider after 3 months a full face peeling ablative type -fractional CO-2 or phenol peel.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.