I have ridiculous rippling after facelift swelling went down, except for neck jowl lift, I look worse than before? (Photos)

Question

Can a chemical peel correct this . I cannot afford another facelift and he only volunteers to do chemical peel at no charge. I am so depressed.

Mark Karolak, DO, FAOCO · Answer

Facial Plastic surgery is as much an art as it is medical. In order to make a facelift look natural, there are many details that need to be taken into account when your surgeon is planning his or her approach, such as the condition of your skin, presence and direction of any skin wrinkles, the direction of muscle laxity, the amount of volume loss, and the change in position of your facial volume to name a few.  A facelift should be tailored to each patient's unique aging pattern.  It's best to discuss these concerns prior to your procedure. The surgeon that you choose should be able to explain how and why your results will look natural with the approach that's been planned. A board certified facial plastic surgeon who performs these procedures on a weekly basis will be able to help you understand your aging pattern and why the procedures will benefit you. See my link below for a discussion on the importance of the direction of muscle tightening in a facelift as well as benefits of combining  a fractionated CO2 laser to address the significant aging component of the skin.

Anita Patel, MD, FACS · Answer

A chemical peel will help, but it will not fix this. There are 2 things going on in these photos. 1-There is an unnatural sweep to the skin. It would be really helpful to see before photos to give a more detailed answer or explanation here. 2- The texture of the skin needs to be addressed. I always discuss the condition of the skin with my facelift patients, because while a facelift can be an excellent way to reposition or lift tissues, a facelift does not change the texture of the skin surface itself, and it does not change the elasticity of your skin. Over time skin loses elasticity, so even when the skin is lifted and tightened during surgery, there will be some degree of relaxation that depends on the characteristics of your skin (based on age and genetics and sun damage, etc). The photos show extensive wrinkles throughout, which would need to be addressed whether or not a facelift was being done. Typically this is through a combination of a series of lasers, peels, Botox, and medical grade skin care products. Regarding the condition of your skin, the good news is you can still do these things, but may have to budget it out to something that makes sense for you. Regarding the unnatural sweep to the skin, I would have a discussion with your surgeon. Also, I would make sure you seek out only a board certified plastic surgeon or facial plastic surgeon for this revision, so if your surgeon was not in one of these specialties, I would recommend a second opinion, and take your preop photos. Also, if you do trust your current surgeon to do a revision, check your paperwork for the surgeon's revision policy. Often surgeons will revise suboptimal results for a limited time without charging a surgeons fee, though you would likely still pay for the operating room and anesthesia fees. I'm sorry you're going through this. The good news is it can be made better :)

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  I am sorry to hear about your experience.  The
best advice you can receive is from an in-person consultation. It would be very helpful to be able to compare your before and after pictures.  You will likely benefit most from a revision.  I would recommend that you either follow-up with your surgeon or seek a second opinion consultation.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Andrew Campbell, MD · Answer

Unfortunately, you have the classic "swept" appearance of a standard facelift. With the amount of wrinkles that you have and the quality of your skin, the only way you could have avoided this would be if you had undergone a deep plane facelift technique with or without volumization (such as with fat grafting). Now that you have these ripples, the best option is a revision facelift using the deep plane technique. I understand that this is not affordable. Treating the wrinkles with a "peel" may work, but only if the peel is incredibly aggressive (a Baker-Gordon Phenol peel). Any other peel will not provide the wrinkle reduction and skin tightening that you need and will not really effect the problem you have. The only other option would be a laser such as a full field CO2 (fractionated won't tighten enough) or full field erbium laser. The last option would be a series of fractionated CO2 or Halo laser treatments. I would discuss your very significant concerns with your surgeon.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Steven Wallach, MD · Answer

You have very poor quality skin that could benefit from peels/lasers/skin care etc.. But, it does look like the facial skin may have been vectored too superiorly causing those swoop like lines.

Beth Collins, MD · Answer

While it is difficult to comment with a great degree of authority since I don't see a preoperative photo, I have to agree with you that your postoperative result is suboptimal. A chemical peel will not fix this as it has to do with skin laxity and an abnormal vector of lift on your skin. If I had done this facelift, I would not want you to be walking around like that and I would offer you a revision at no cost. This is my policy in my office and is clearly stated in the paperwork before I do any surgery on any patient. You should look in your paperwork and find out what your surgeon's policies are. Also be sure that your doctor is certified by the American Board of Plastic and reconstructive surgery or facial plastic surgery. Without this qualification, you should not be trusting your face to anyone. If you have no luck with your surgeon, get a second opinion from an adequately qualified surgeon. You do have a lot of sun damage to your skin that will not be fixed by a facelift. This is the texture of your skin (for example the wrinkling around your mouth and deep creases in the skin of your cheeks). Again, I did not see your preoperative photos, but I would have expected a bit more smoothing of the skin over your cheeks and your nasolabial folds.

Robert H. Woods, MD · Answer

You can definitely get some improvement in the quality of your skin with a phenol peel or laser resurfacing. Even with the most aggressive of peels, the depth of your wrinkles will improve, but not go away all together. You certainly would have needed a fairly aggressive approach for your original face lift to "pull out" some of these wrinkles. That would have entailed an extensive amount of undermining of the skin and the SMAS (deep tissue of the face) resulting in a large amount of repositioning of deep tissues, skin removal, and longer incisions. It is possible to do an aggressive laser resurfacing at the same time, but the risk of poor healing increases. Sometimes, it takes more than one procedure to accomplish your goals. Trying to hit the home run at your first at bat can have poor results, A couple of doubles can still score a run.I have had a similar problem when I was first starting out as a facial plastic surgeon. My patient had severe rhytids, huge laxity, poor quality of skin from 70 years of sun exposure, and not a lot of money. I did a face lift without treating the skin too and she ended up with similar curtaining of the wrinkles as in your case. I was not happy, and neither was she. I felt so bad, that I allowed six months to go by and then did a revision lift with extensive undermining after doing an ablative laser resurfacing two months prior. No cost to the patient. Expensive lesson for me. The patient looks good and is happyNow, I just tell the patient that it is going to take more than one simple procedure to achieve a satisfactory result and let them decide the value proposition. Hang in there, get the peel, and see what more can be done.

Walton Montegut, MD · Answer

This is a good question.  Looking at your photos, it would appear that you did not get the best result.  When doing a Face and Neck Lift, there are key elements necessary to get the best result.  There is a shift in the deep tissues and there is a shift in the skin level.  Both of these maneuvers are critical in achieving a good outcome.  When a Facelift is performed utilizing both layers in the same direction, you get a result similar to your photos.  I cannot be certain, but most likely this is what has occurred.I perform revision facelifts so it is possible to improve this result.  It can be performed under local anesthesia as well.  The face just needs to be taken apart and the tissues draped properly.  The out look is good if you would consider having another surgery.  The surgeon must be experienced in Face Lifts and preforming secondary face lift as well.  I hope this helps....

Barry M. Weintraub, MD, FACS · Answer

My best advice is to make another appointment with your original surgeon to discuss your results. A good surgeon is not just there during the surgery, but practices important followup with his (or her) patients, because we, as surgeons, should care that our patients are happy with their results. I would speak to your original surgeon again, making sure to express that you are depressed and upset. I wish you all the best.

Kouros Azar, MD · Answer

I am so sorry that you are not happy with your results. Based on your photo, you look as if you have suffered from years of severe sun damage. A chemical peel could help but be careful about managing your expectations. Best of luck.

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