Revision Facelift, Upper Lids Blepharoplasty, Fat Transfer to Face, Chemical Peel - Houston, TX

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56 year old white male, 5'10", 175 lbs. Surgery is...

56 year old white male, 5'10", 175 lbs. Surgery is tomorrow morning under IV sedation. I'm a bit nervous, but ready to do this. I've posted front view and profile view before photos. I'll post progress updates throughout the recovery process. My main area of concern is my droopy cheeks, which have resulted in very prominent nasolabial folds.

Day after surgery

All went well yesterday, the day of surgery. I had my bandages and drains removed this morning. I've had no pain or discomfort of any kind, although I look a little freakish. But hey, it's only 24 hours since I got out of surgery, so I guess that's to be expected.

7 days post-op

This is what one week out looks like. Still a lot of residual under eye and cheek swelling, which I assume will improve a good deal in the next week or two. A couple of things I don't want to change at all are the absence of jowls and heavy nasolabial folds. Let's hope they're gone for good.

I experienced only very minor, early discomfort and almost no bruising from all this. I think I'm healing well. The discoloration under my eyes is from the chemical peel, where there seems to be a lot of peeling left to do.

14 days post-op (f/l, upper bleph, fat transfer, chemical peel)

So far I've healed well overall, I think. The incisions look great already and I'm sure will fade to near invisible in no time. I'm still peeling a little, especially under my eyes. The frozen, mask-like look I had right after surgery is fading fast, and my face is becoming animated again. The only issue that concerns me at this point is the significant swelling below my eyes, particularly my right eye. From some research I've done on this site, I've learned that the type of mid-face lift that I had done often leads to a lot of under eye swelling, so I'm going be patient and keep thinking positive thoughts!

18 days post-op

I'm still looking a little alien because of the under eye swelling, but there is slow but steady improvement each day. The asymmetry is slowly improving as well.

18 days post-op

I already posted a picture I took this morning, but wanted to put this one up too. It seems the swelling below my eyes is worse in the morning and goes down quite a bit throughout the day. I'm sleeping in a recliner at about a 45 degree angle, but I still swell overnight. I'm wondering if I should just sleep in my bed again, as my sleep quality absolutely sucks in the recliner.

Swelling under my eyes down slightly, but bruising is more evident now

Apparently, as my under eye swelling improves it's revealing the previously hidden bruising that still remains there. As you can see, the bruising is more evident in my latest picture (26 days post-op) than in the 18-day post op picture. Also, my right under eye swelling isn't resolving as quickly as my left side. I was told to expect that because more was done on my right cheek during surgery. I'm expecting that the asymmetry in my eyes will correct itself as the remaining swelling goes away. I am concerned about this bruising, though. I've read that it could be hemosiderin (iron pigments in red blood cells) deposits and that it could take 6 months or more for it to go away. Like most men, I don't wear makeup, so this isn't something I can camouflage that way. I'm not panicking (yet), but I am concerned about this apparent setback.

The structure is good, but the walls need paint

At 28 days out, I'm very satisfied with my face lift and upper blepharoplasty. My eyes are still swollen and bruised, but I was prepared for that. From what I've read, it seems that the deep plane cheek lift is known to result in prolonged swelling. It's the price to pay if you want your cheeks done right. I do have a concern though, and it's what the chemical peel has done to my skin. I have some hyper-pigmentation on my cheeks and chin. The peel was only applied to my central face since it was combined with a face lift. Dr. Boutros explained that the skin that is directly undermined in the face lift can't be peeled, so the lateral cheeks and pre-auricular areas weren't treated. In the pictures I've posted, you can clearly see the difference in the treated and untreated skin. The untreated skin is clear and even, while the treated skin in darker and splotchy. Dr. Boutros is out of town, but I emailed him these same pictures. He called in a prescription for a topical cream containing hydroquinone, hydrocortisone, and a third ingredient (I think Retin-A. I'm going to pick up the Rx tomorrow morning. Does that seem like a reasonable course of action to you guys? Is this a common complication of chemical peels? Will I be like this forever?

Skin issues persist

At 7 weeks post-op, I'm thrilled by my new facial architecture. My surgeon did a masterful job, I think. Most of the swelling is gone. My jawline is near perfect. My neck is much improved as well. My nasolabial folds, which is an area where it's difficult to get a dramatic improvement, are noticeably smaller (by probably >50%) . A lot of youthful roundness has been restored to my cheeks. My undereye areas don't look hollow anymore. My upper lids, which were also looking hollow due to aggressive fat removal during an upper blepharoplasty 10 years ago, look so much better now. I am going to have a little filler injected to try to get even more improvement of my NL folds, but otherwise I can say I'm almost completely satisfied with my surgical outcome.

All that is great, but I'm worried about what the chemical peel I had done as an adjunct to my surgery has done to my skin. The TCA peel was only done to the central part of my face, not on the lateral parts of my cheek and jaw where the skin was directly undermined during the face/neck lift. The untreated areas of my skin look normal, exactly as it did before surgery, which was pretty good. Admittedly, the part that was treated didn't start out looking as good as the untreated part--my undereye skin was sorta creepy and the pores on my nose and my mesial cheeks were large. On the good side, my skin tone was very even, with very little hyper pigmentation anywhere. As of now, the skin on my cheeks is red, and the pores look larger than ever (maybe simply because of the redness). I also have a couple of hyperpigmented spots on my left cheek that weren't there before. The skin under my eyes is darkened, which is probably residual bruising, but now I'm wondering if this didn't result from the peel, too.

I'm going to see my PS on 11/01. He plans to do a Fraxel treatment (I think it's the Fraxel Dual), which he says will effectively treat the problems I just mentioned.

What do you guys think? Any suggestions? Would IPL be a better alternative? I've spoken to a nurse injector/cosmetic laser technician who thinks IPL would be more suited to treating my specific problems.
Houston Plastic Surgeon

Dr. Boutros has been very open and forthcoming during the consultation and pre-op process. Only time will tell for sure, but I have a great deal of confidence in him going into surgery.

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