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

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.

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?

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.