Rejuvenation of face and neck? (Photo)

Question

I am 67years old. In good health. I've had lower facelift 6,5 years ago. No significant difference before and now. Midface lift done 3 years ago and neck lift. Blepharoplasty twice and failed the second time. Liplift 3 years ago. Fillers under the the eyes , the last one 6 months ago. I 'd like to correct the neck, tear trough, the marionette line and the folds around the mouth. Do I need lipo filling? Do I need restoring the volume of the soft tissues? Thank you for answering.

Lucian Ion, FRCS · Answer

Hello,

Thank you for your question and for providing details about your concerns regarding a repeat neck lift and improving the contours for the marionette lines, folds around the mouth, and tear trough.

Consideration of Deep Plane Facelift:

Given that your lower facelift was approximately 6.5 years ago, it may be worth considering a deep plane facelift intervention. This procedure can provide significant improvement in the neck and jawline areas. If the deep plane facelift uses scars that extend in front of the temporal hairline, it allows for a more vertical skin tightening, which also improves submental skin laxity. This means you may not require any specific additional intervention for the neck.

Volume Enhancement with Sculptra:

Since you have a relatively small amount of fatty tissue in your face, achieving smoother contours can be challenging. For this reason, I recommend considering volume enhancement with Sculptra. Unlike fat transfer, which can be unreliable in people with a low BMI, Sculptra works by increasing collagen production in the tissues. This does not rely on fatty tissue but produces volume changes that appear similar to the restoration of fatty tissue.

Benefits of Sculptra:

•	Marionette Lines: Sculptra can help improve the appearance of marionette lines by adding volume and smoothing the skin.
	•	Folds Around the Mouth: The treatment can also address lines around the corners of the mouth when smiling.
	•	Tear Trough: Sculptra can enhance the tear trough area, reducing the appearance of hollowness and dark circles.

Treatment Process:

Sculptra treatment may require a series of treatments to achieve the desired results, as well as yearly maintenance to maintain the effects. However, it is not affected by BMI, making it a reliable option for volume enhancement in individuals with low body fat.

Conclusion:

In summary, combining a deep plane facelift with Sculptra volume enhancement can effectively address your concerns and provide a more youthful and refreshed appearance. I

J. Timothy Katzen, MD, FACS · Answer

Hello,
Thank you for reaching out with your question about facial and neck rejuvenation, especially considering your history of multiple surgical procedures. Based on your situation, it sounds like further surgery may not be necessary or the most beneficial approach for you at this time.
Instead, focusing on volume restoration in areas of your face that appear depleted could be a more suitable option. Volume loss is a common aspect of aging and can be effectively addressed with either fillers or fat transfer.
If you opt for fat transfer, fat would typically be harvested from areas such as around the belly button, lower abdomen, or love handles. Many people have a sufficient amount of fat in these areas that can be utilized for this purpose. Fat transfer offers a more natural and long-lasting solution, involving using your body's tissues.
On the other hand, using off-the-shelf dermal fillers is a non-surgical option that allows for immediate correction with a lower risk of complications. Fillers are versatile and can be tailored to your specific needs, with the added benefit of reversibility and adjustability. However, keep in mind that fillers are not permanent and typically last around a year before they need to be refreshed.
In summary, both fat transfer and dermal fillers are excellent choices for rejuvenating your face and neck without undergoing further surgical procedures. I would recommend consulting with a board-certified plastic surgeon or dermatologist to discuss these options in more detail and to determine the best approach for your specific goals and facial structure.
I hope this information helps guide your decision on how to rejuvenate your face and neck effectively.
Sincerely,

Gianfranco Frojo, MD · Answer

To address all of your concerns, it may be required to perform a deep plane facelift/necklift with facial fat grafting, lower blepharoplasty, and some type of skin resurfacing (deep peel or laser).  I would go see a board-certified plastic surgeon (with plastic surgery residency and aesthetic fellowship training) for a preoperative consultation.

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