Seeking Refinement Before 35.

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Today, I paid my deposit for a series of facial...

Today, I paid my deposit for a series of facial procedures set for April 18. I am turning 35 this summer, and if these procedures are anything like my breast augmentation, it will take at least 3 months to look and feel normal again. I hope to feel happier by the time I blow out the candles on my birthday cake. :)

I carry a disproportionate amount of weight in my face. While my breasts never truly bothered me (I could always wear a push-up bra), my cheeks have bothered me since I was 10 years-old. You can't hide your face. In college, I found out that multiple guys thought I was a "chubby chick" despite being 5'10" and only 125lbs! Unless I wear revealing clothes, which I don't, it is fair to assume that I am on the hefty side. Perhaps that shouldn't bother me, but it does.

Back in 2007, I went to a plastic surgeon requesting buccal fat removal, and she turned me away, saying that I was too young and would want the volume later in life. I prayed she was right and that I would lose that volume in my face. Almost a decade later, SHE WAS WRONG. That doctor failed to understand the effects of my ethnic heritage and/or look at the older members of my family--their cheeks don't go anywhere. My 60+ year-old parents still have their cheeks. My 85 lb. 87 year-old grandmother still has my same cheeks.

I refuse to go another decade without doing something, especially while my skin is still elastic.

As of right now, I am slated to undergo:
* Buccal Fat Pad Removal
* Submental Liposuction
* Sculptra filler for upper cheeks
* Botox for frown lines and brow lift

I am also waiting to hear back on the possibility of adding:
* Jowl Lipo
* Filler for a few marionette lines and lips
* Botox for the masseter (jaw muscle) and platysma (jowl muscle) and smile.

While I think that it would also improve my jaw contour, I am ridiculously excited about the possible botox for the jaw and jowl since I clench my teeth and get monthly migraine headaches.

This may seem like quite the list of procedures, but I was originally considering much, much more. Since I had such an easy recovery after my BA, I was tempted to go crazy with a full overhaul--face and body. I am glad that I waited because it gave me time to reflect. It would be tempting to use surgery as a route to appease my perfectionist tendencies. Are my nose and chin perfect? No. But will surgery make them perfect? No. :) Because there is no such thing! So, despite the appeal, I will be sticking to things that will simply make me happier regardless of how dramatic the results may be. "Perfect" can go take a hike. ;)

That all said, I know myself and I will still obsess like we all do on RealSelf. ;) It's my hope that by scheduling these procedures during a busy time at my work (I work from home), I'll be sufficiently distracted with my deadlines to keep from over analyzing every last lump and irregularity while I heal.

Obviously, fat transfer would be the more economic option in the long haul compared to fillers, but I am intimidated by the stories everywhere of fat transfer gone wrong. I am going to try fillers first to see if I like the results, and then, if satisfied, resort to fat transfer at a later date.

My pre-op appointment is set for April 6th. Please wish me luck! :)

Costs & Before Photos

$3,045.00 - Buccal fat pad removal
$525.00 - Submental (chin & jowl) liposuction
$840.00 - Sculptra filler for upper cheeks
$330.75 - Botox for frown lines and brow lift
$600.00 - Botox for the masseter (jaw muscle)
$60.00 - Botox for the platysma (jowl muscle)
$600.00 - Radiesse for marionette lines and lips
$150.00 - Sedation
$5905.75 - TOTAL

My out-of-pocket will be in the neighborhood of $5400 because there is a slight practice discount as well as a discount for paying cash.

Suddenly, looking at this list makes me feel like I am a bit crazy.

Do I really need almost $3k in injectables on top of my buccal fat pad extraction? Probably not. But do I think they will make me look and feel better? Yes.

And, if I am ever going to do them, it would be ideal to be under sedation. So, why not?

Happy early birthday to me. :)

Pre-Operative Appointment

My husband was able to attend the pre-op appointment with me today, and Dr. Bitner ran through and explained all the procedures again. This put me much more at ease. I know that buccal fat pad removal isn't for everyone, but there is every indication that it is the right surgery for me.

Then Dr. B's nurse, Jaime walked me through all the pre and post surgical instructions. After I paid the balance for the surgery, I received 2 goodie bags. One bag contained all the post -lipo recovery items (hydrogen peroxide, polysporin, Q-tips and ace bandages) and another bag contained a "Bitner Facial Plastic Surgery" branded blanket. (The blanket was promptly appropriated by my 4 year-old.)

I am somewhat worried about the scars from the lipo since I scar poorly. At least the scars should be small and discrete at the base of my chin and on both sides of my jaw. I don't wear make-up, so I probably need to start looking into scar steroid injections soon.

The following is a list of the final, agreed-upon procedures:
$3,045.00 - Buccal fat pad removal
$525.00 - Submental liposuction
$840.00 - Sculptra for upper cheeks
$330.75 - Botox for glabella and eyebrow lift
$600.00 - Restylane for marionette lines and lip border
$150.00 - Sedation
($80.00) - Allergan Coupon
($245.00) - Practice Loyalty Discount
($225.75) - Cash Discount
$4940.00 - TOTAL

I am hopeful and excited. :) Only 12 days away!

Day of Surgery

I am still in a haze but wanted to post an update on this morning's surgery. The surgery seemed to go off without a hitch. I was awake for most of it but I barely remember what was going on. I'll post more details on pre-op tomorrow. I just threw up due to the nausea, so I started on some Zofran I had on hand. Vomiting was very painful due to using my cheeks. I am icing every 15 minutes. I am extremely swollen. That said, I am already in love with the change in my profile--double chin gone! And I think I look less jowly from the front too but I know it is too soon to tell. Fingers crossed!

Pre & Post Surgical Details

The Friday before my procedure I received a call from Dr. Bitner's office setting my operation time (9:45 AM), confirming that I was to go NPO at midnight the night before, and requesting that I come in an hour before surgery (8:45 AM) because they had forgotten to give me prescriptions to fill beforehand. The prescriptions were a 10 day course of an oral antibiotic, some hydrocodone for pain, and a single valium for pre-surgery. When I was taken back at around 9:20 AM, the nurse took my before pictures and helped me gown up. Dr. Bitner then came in to confirm the procedures. Lastly, the anesthesiologist came in to take my surgical history. The CRNA administered the valium and then a few minutes later I was taken back to the OR. I wasn't nervous at all before the surgery but I suspect that the valium made me a little chatty. It took two tries to get an IV in. I remember quite a bit more about the surgery than I anticipated, such as the music, the tugging of the buccal fat pad, and how surprised I was that the lip injections hurt. After the surgery, Dr. Bitner and his nurse both spoke with me about what happened and aftercare. I don't remember much, if any of that, but fortunately my companion did. After vomiting multiple times yesterday, I stopped taking the hydrocodone and switched to tylenol. I also started taking zofran, which I fortunately had on hand. In addition to the tylenol and the oral antibiotic, I have been taking arnica (for bruising) and dulcolax (stool softener) as preventative measures. I iced every 15 minutes for the first 24 hours, and have continued to ice intermittently since then. I have been cleaning the incision sites 5x/day with hydrogen peroxide and polysporin. (My right ear is still bleeding.) To be on the safe side, I began doing a gentle saline rinse in my mouth for the oral incisions 4x/day today. And, as per Dr. Bitner's instruction, I will begin massaging the sculptra sites tomorrow (5x/day, 5min, 5days). As soon as I can keep it down, I will begin taking whey protein shakes to help with healing (whey is a natural anti-inflammatory and it helps rebuild damaged tissue). Eating and swallowing is difficult. I hope to manage a bit more than just applesauce tonight and hopefully brave a shower to get the blood out of my hair. While the recovery isn't particularly difficult, it is more unpleasant than I had anticipated. That said, I am already very happy with the results I am seeing (neck, chin, lips), and hope they will continue to improve. :) Best wishes and happy healing to all!


It's day 4 post-op and I am still extremely swollen. However, today is the first day that the swelling appears a little less than the day before. My right side is significantly puffier and less mobile than my left. I worry that despite the antibiotics, I may have an infection. It's either that or the right cheek was trickier to extract? My cheeks, chin, neck, ears and lips feel and look bruised. (My neck looks like I barely survived someone strangling me.) I am still having difficulty eating and speaking. I work from home but even telecoms are difficult. Anyone considering this surgery should plan on taking off the full week. I've gotten less done during this recovery than during my BA recovery. It's been unexpectedly difficult. I hope that yesterday was the low point and it will all be uphill from here. Fingers crossed!

1 Week Post-Op (Worth It!)

Today was my 1 week follow-up appointment. Everyone at the doctor's office (Dr. B, nurses, receptionist) complimented me on how healed I looked. I still have some light yellowing on my neck and right cheek, but even without make-up it is not very visible. (Arnica, protein & sleep are magic.) Most of my stiches had already come out from my ears and there was only a small one to clip from my chin. The stiches inside my mouth are still dissolving. I no longer have to wear the chin strap during the day but I do have to wear it at night for 2 more weeks. This is fine by me because my submental area is still kind of tingly/numb. Dr. Bitner is so sweet. He was practically apologetic that the results aren't "dramatic". Compared to a face lift they aren't but to me they are! I feel like a ballerina with a long graceful neck! A 20 something ballerina. ;) I *adore* how my lips turned out! Coupled with the Submental lipo, the lips make my chin and profile look soooo much better. (I had been considering a chin implant once upon a time--no longer!) And, I LOVE that Dr. B graciously complied with my last minute request to take the fat from my Submental lipo and transfer it to my nasal folds. I hope the fat takes! He said that it will still take several weeks to see the sculptra develop in my upper cheeks and for the swelling to go down in my lower cheeks for the buccal area results. It gets better?!?! I am blown away by how great everything looks already--now that I am not as puffy and bruised. I need to stop smiling so much because I want that fat to graft. ;) I am sold on Restalayne and Botox. I wish I was brave enough to post full face photos, but you'll just have to trust me that I look like I got close to a decade back on my age. I asked about steroid injections for scar tissue, massage and maintenance. Dr. B answered what he could and said we could address these things again at the 6 week follow-up if there were still any concerns. Hehe. I am so psyched to see how things will develop over the next few weeks as the swelling subsides and the sculptra/collagen builds. Worth it! :) xo

2 Weeks Post-Op (Itching)

Today marks the completion of my second week post-op. I am still ridiculously in love with my results despite the lingering swelling. That said, the incision itching is driving me insane! I shot an email off to Dr. B this morning in hopes of some advice. I don't believe it's an infection, just healing. I started putting some 1% hydrocortisone cream on the sites to no avail. I will buy some Benadryl cream tomorrow. I want to scratch so badly but can't/won't. :( I also asked Dr. B about massaging the liposuction end areas. We'll see what he says. Fingers crossed that the itching lets up soon! Wishing happy (itch-free) healing to everyone!

3 Weeks Post-Op

It's been 3 weeks since my surgery consisting of buccal fat pad removal, submental liposuction, sculptra, dermal fillers and Botox. While I am happy with the surgical results, I am unhappy that I have gotten zero response from Dr. Bitner or his office on my concerns from last week. That said, the incision itching seems to be slowly resolving and responding to a Benadryl cream, and truth be told the incisions look great. Without feedback, I've decided to massage the submental area lightly based on what I've seen from other doctors here on RealSelf. I've also been applying Mederma cream (both SPF and advanced) on the scars. I want to inject the chin scar with kenalog because it feels very raised to me. I can tell there is still quite a bit of swelling in my face/cheeks depending on the time of day and my salt consumption, but overall I look much better than before surgery. I hope that the sculptra continues to increase the volume in my upper cheeks. I miss some of the post-injection swelling in my lips so I may consider adding some juvederm at my follow-up. I have lost volume in my marionette lines so I imagine that none of the fat transferred survived. Oh well! It was worth a shot. The Botox finally kicked in for my brow lift last week, so that was a nice surprise. I can stop wearing my compression garment tonight but I'll probably wear it for a few more days. Most of the numbness is gone from the Submental region and my mouth is 100% normal (can yawn, eat, chew without discomfort). All bruising is gone. Fingers crossed that the sculptra keeps working! Happy healing to all. :)

6 Weeks Post-Op

It's been 6 weeks since my surgery. I heard back from Dr. Bitner on my questions about 2 weeks after I originally sent them and followed up. His answers on itching and whatnot were consistent with what I had learned and implemented from RealSelf. I have been getting a lot of random "you look great"s and compliments from a wide range of people, none of which know I had surgery. I feel great but occasionally notice that my submental area still feels a bit odd. I feel that my scars under my chin and behind my ears feel very raised especially when compared to my scars from BA. I am hoping that kenalog injections may be an option and will help reduce them a little bit. I look forward to getting a little more in terms of lip injections and I will be using glabella Botox for a long time to come. I wish the sculptra had done a bit more. I think I need to maybe add a bit more volume to my upper cheeks still. The buccal fat removal is increasingly beautiful. The Submental lipo is the best money I ever spent. I hope this little update helps someone. xo

6 Week Follow-Up

I had my 6 week follow-up appointment with Dr. Bitner today. Attached are some of the before and after photos taken by his wonderful nurse, Jaime. The effect of the buccal fat pad removal is very subtle but elegant. I am very happy with my results.
Salt Lake City Facial Plastic Surgeon

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