Double Chin and Sagging Jowls After Pregnancy Weight Gain and Loss

In my 40s, gained anf lost alot of weight after...

In my 40's, gained and lost a lot of weight following multiple
pregnancies. I also noticed that double chins seem to run in my family,
even with the thinner relatives, and figured that was my eventual fate. I
initially visited a plastic surgeon who was a medical director of a local
large practice; he was a general plastic surgeon who said he started
focusing on doing mostly faces in last decade. Although he initially
thought he'd recommend noninvasive Ultherapy, he ended up recommending a
neck lift for me due to the laxity of my skin. When I asked if there was
anything else, he said my face overall looked great and youthful, but he
would like to address the sagging jowls, which would then require a lower
face lift under general anesthesia. I left his office, a little shocked.

Then, I visited 2 other facial plastic surgeons, both highly specialized
in just faces. Both recommended similar procedures: neck lift required in
order to remove my double chin due to skin laxity. Losing more weight would
actually make my double chin worse, not better. Lower face lift recommended
at same time to address sagging jowls, and while one quoted for just the
neck lift, both facial plastic surgeons said the combined procedure would
give the best result and I would "age" into my 50's better.

Initially, I had a somewhat difficult time choosing between the 2 facial
plastic surgeons. One was quite a bit more expensive, but had a more
responsive and efficient office staff. He had also written chapters on
facial procedures, presented at conferences, and does a "short incision
lift" and removal of fat pad under neck. The less costly surgeon, who I
also really liked because he seemed perfectionistic too, said he does a
deep layer lift but I couldn't get his office to answer whether he removes
the fat pad. Both facial plastic surgeons said general anesthesia was not
required, and that the procedures could be done under IV sedation and local
anesthesia (because they had higher skill level than the general
surgeon). In
the end, the difficulty communicating with that office turned me off, they
couldn't even get a question answered by the surgeon for me while I was
trying to make a decision to book with them.

Whereas, at Dr. Amir Karam's office, every step in the process was super
smooth, efficient, and easy. From scheduling the initial consultation, to
making the decision. The patient coordinator, Leanna, was super responsive
and helpful, and even scheduled me to come in for a follow-up consult with
Dr. Karam when I was still trying to make a well-informed decision. Dr.
Karam patiently and thoroughly answered all my questions, including
providing a history of how and why he began doing the type of face lift he
does. After much careful consideration and research, I ended up choosing
him and paid my deposit. I just had the procedure done and am in Day 2 of
post-op recovery. So far, recovery has been relatively easy and smooth.
Little pain and I even felt good enough to work on my laptop from home all
day. Will post pics once I get them and updates thereafter.

48 hrs post-op: Feeling Great...hard to believe just had facial surgery 2 days ago!

Yesterday (one day post-op), I went in to the doctor's and they removed my dressing, cleaned the incisions, and the doctor checked for any hematoma (none, thankfully). He explained that swelling would likely go up over the next few days and not to worry as it will decrease over the next week. The entire process was relatively quick, painless, and went smoothly. Before I knew it, I was back at home, resting in bed. Because of some initial mild nausea during first day home from surgery, and because there was surprising little pain, I decided to switch from prescription pain med to extra strength Tylenol (also helps reduce issue with any constipation onset). Nausea dissipated rather quickly and I felt good enough to get lots of work done via my laptop in bed. Husband has been great about doing all the housework and taking care of kids, as well as tending to my needs. Not seeing the kids has probably been the hardest, they'be been knocking on the door wanting to see me, but with my head in a bandage, we didn't think it was a good idea.

Got to see my chin for the first time yesterday and wow- I can't believe the double chin is gone! My face did look "elf-like" in that my cheeks looked prominent compared to my jawline and chin...but thanks to realself.com (yes- I hopped right on and did a search of lower face lift recovery stories!), I was reassured that it is totally normal to have "chipmunk cheeks" at this point in the recovery process. I also have a little bit of lumpiness on one side, but again, will not worry for now as I was well-informed of this recovery process by Dr, Karam (and realself.com reviews).

Today (48 hrs post-op), I am feeling even better, alert, little pain, actually productively getting lots of work done via laptop at home. There is a little more swelling today, but that is expected and I assume more swelling over next few days or more. I'm keeping up with the doctor-ordered regimen: Arnica, Bromlein, morning and evening vitamins ("clinical support" vitamins in aid in healing process), antibiotics, and Tylenol. I keep a log on my cellular phone as it can get confusing as to when I've taken what.

Today, as approved my doctor, I got to take a shower, making sure to keep shampoo off the incisions. Cleaned the incisions (hydrogen peroxide then aquaphor), covered with gauze, then rewrapped with Ace bandage. Told to repeat 2-3 times per day.

So far, recovery has been smooth, easy, and relatively pain free. And you know what? Being "forced" to relax, not lift anything heavy or do housework, and rest...seems like a luxury day! Sleepwise, was told to sleep with head elevated (2-3 pillows) at night. Hasn't been difficult to do so.

So far, so good. Keep fingers crossed that it will continue as smoothly! (Knock on wood.) Again, really hard to believe that just a mere 48 hours ago, I had a facial lower lift and neck lift surgery...

P.S. Dr. Karam's office sent flowers and chocolates today with a sweet note-- such a thoughtful gesture! Not to mention...I was craving a piece of chocolate, so it hit the spot!

Before and After Pictures - Lower Face Lift & Neck Lift (3 days post-op)

3rd day after post-op. Recovery still going smoothly, easily. Taking Tylenol every 6 hours as preventative measure. Also taking antibiotics, Bromolein, Arnica, surgeon-recommended vitamins, and Colace stool softener (again, as preventative measure). Swelling still there but nothing unanticipated. Seems typical as compared to other realself postings. I've been taking it easy, hanging out in bed with my laptop and getting loads of work done via laptop.

Today, I am making sure to keep my sodium intake low. Drinking protein chocolate milk for breakfast, eating rice soup (mouth doesn't open wide so need a small spoon, ha!) for lunch, and drinking water for hydration. Keeping my head elevated by sitting up on pillows in bed, and avoiding looking down by having a laptop table.

Very little pain (if any), some feeling of swelling but it's not bad. Keeping my head bandaged so still keeping kids away from seeing me. 3x per day, I am removing the bandages to clean incisions and replace gauzes.

A little bit of lumpiness on one side of the face, but again, looks like that is normal and I'm hopeful that it will go away. Other side looks good. Overall, I am sooo happy with results and cannot wait to see final result!! Dr. Karam is amazin. I was worried about the lumpiness so emailed the picture to his office, and got his response by that morning. Very reassuring and so responsive.

Before and After Photo (3 day Post-Op)

Accidentally deleted my after "frontal" photo in the prior post. Posting here in case anyone finds it helpful. As today (day 3 post-op) has progressed, I got really swollen around early afternoon, so much that even my eyelids were swollen. Thankfully, in past 2 hours, it's continued to go down. Can't wait to see my final results! Crossing my fingers that the lumpiness on left side will go away before 2 weeks is up...

Day 4 Post-Op: Swelling "fun"

So, I learned a lesson from last night. When the surgeon tells you to sleep with your head elevated, flatly...well, do it! I've been really good about sleeping with my head elevated via 3-4 pillows. But last night, I shifted just a few degrees to the right, not even much, but it was enough to cause my right side to swell up, and particularly my right eyelid. So now it's a little hard to see out of that eye because it's so swollen. Underneath both eyes are yellowish and swollen. I'm doubling-down today and making sure I take in very low sodium, high protein, and hoping that the swelling will go down soon. On a brighter note, the area under the compress is looking better. And the incisions look like they're healing rather well. It's just this swelling in my eye area...grrrr...but I know, patience...

Day 5 Post-Op Photos

Swelling seems to have gone down...only ever so slightly. Having AC & fan on seems to help keep cool. Drinking high-protein chocolate milk, cottage cheese, oatmeal...trying to stay low sodium. Under eyes are yellowish and swollen. Lumpiness on the one side seems to have gone a little too. Starting to get cabin fever. Can't wait for this swelling to go down. I read somewhere else on realself.com that it's called "swell hell."

Day 7: Stitches out and no more wrapping

Truly amazing how the swelling seemed so bad and endless on Days 4 and 5, and then how quickly it went down on Days 6 and 7. I feel great, can actually return to my desk job. Seeing kids again, hair covers the bruising so I didn't even need to cover it up with concealer. Bought "breathable" make-up from doc's office for later this week when I go back to work to cover the scars by ears. I really can't believe that in just one week time, I am already recovered and feel great. This was all truly worth it. I'm so grateful to the doctor and for a totally smooth recovery. So happy with my "refreshed" new look!

Just passed 2 week mark! Day 17 and feeling fab.

Have been fully back at work and socializing, including going out to dinners and parties, starting last Friday (Day 12 post-op). Feeling great. Still sleeping in elevated position and that makes a big difference with reducing swelling morning after. Saw a small resurgence in swelling this week after eating some high-sodium meals, so am now going to make extra effort to keep diet low-sodium for next week or so. Attaching some photos here from Day 12. I continue to be so amazed at the quick recovery process, and what a big difference in how I look and feel. No more (ineffectively) hiding my double chin with my hair. And while I feel like I look so different, everyone keeps attributing my "refreshed" look to my new haircut!

I still have some lumpiness on left cheek, some swelling on lower left jawline and neck, but the bruising is almost entirely gone to the point of not even needing makeup to cover up. I can't wait to see final results in the weeks and months to come. The incision under the neck does need cover-up, but it's not noticeable. I did do 2 lymphatic drainage massages (great referral from PS office when I inquired for one...she's terrific) which noticeably helped the swelling go down, even before I left the massage room. Exercise is still limited and I'm being patient but looking forward to getting back to working out as soon as I get the go ahead. It's important to take it easy to avoid blood pressure going up and causing swelling or internal bleeding.

One month post-op and in total clear!

Saw PS yesterday and given go-ahead for going back to gym, all activities, no more restrictions. Incisions healing nicely, barely noticeable. Swelling gone down a lot from even just previous week. There is a small lump under my neck, but it's actually noticeable to the eye so I don't mind it. PS says it'll go away over time. So happy I did this, so worthwhile. So glad I chose the right surgeon with the right skills and background. I look at the pictures and cannot believe the difference.

Skin care

Shazbat, here is a pic of the bottle.

2 months post-open side profile photos

2 months postop. Have follow up appointment soon but Dr. Karam's office still called to do a telephone check-in to see how I'm doing and if I had any questions- such excellent patient care.
San Diego Facial Plastic Surgeon

Excellent, top-notch doctor with great credentials. Graduated top of his class, specializes and has thriving practice in facial surgery, which means he does many, many repeated procedures (highly important when choosing a surgeon). His office staff is a well-oiled machine, highly efficient, thorough, responsive (quick replies to emails, calls), and discreet. The office location itself is very nice, upscale, and convenient. Most importantly, Dr. Karam himself, despite being a very busy surgeon, is highly accessible. The office gives his cell number directly to patients, and I even had a chance to "test" it out pre-surgery when I developed a UTI in the days preceding the surgery date and had questions about the antibiotics. I decided to text him and lo and behold, he responded immediately! He responded multiple times on 2 different days preop, and was so friendly and helpful! I immediately knew that I would be in good hands post-op. Surgery was 2 days ago. Went super smooth, painless (!), and before I knew it, 2 hrs surgery had passed and I was already being picked up by husband to go home. I misplaced my post-op instructions, and the office responded immediately. Then, I couldn't find my vitamins instructions, and they again responded immediately. Went in for my 1-day post-op appointment and there was no wait- super smooth visit and Dr. Karam, again, had fantastic bedside manner and impeccable doctor skills. My husband, who is not an effusive person, commented afterward that he was impressed with surgeon. I highly recommend Dr. Karam. He does cost slightly more than maybe some surgeons, but definitely worth it! (And he was actually about the same cost as the general plastic surgeon who wasn't even a facial plastic surgeon and required general anesthesia- so do your homework!). Dr. Karam teaches other doctors on his techniques; he has written book chapters on facial plastic surgery, presented a national conferences to other surgeons, and even provides consult calls advising other surgeons on techniques. If you want the best in the area, then this is the doctor. I did a ton of research and always check on educational/training backgrounds, stats, reviews, etc...and am so happy to have selected Dr. Amir Karam.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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