Female: Should I have a face lift, neck lift, or just blepharoplasty? I'm considering surgery. I have had plastic surgery in the past, but I've been afraid to consider anything around my face. Now my eyelids are getting in my way. So, since I have to be able to see in the future, I'm going to take care of this now. While I'm taking care of this area, my daughter has suggested I do something about my gobbler. So now I'm thinking about the whole shebang. What is your opinion? I know the pictures are not the greatest.

Dr. Amiya Prasad: Thank you for your question. You have submitted some very good photos. You're asking should you get a face lift, a neck lift, your eyes, what would be the recommendation of any of the doctors who are reviewing your question. The photos you submitted certainly demonstrate that the presence of some particular issues, such as with the upper eyelids and lower eyelids. We refer to that as dermatochalasis, which means extra skin, as well as fat prolapse of the upper lids and the lower eyelids. With the side view as well as the view from below, we see that there is clearly extra skin under the neck. There are these two bands under in the neck area. We refer to those as platysmal bands.

So the question of are you a candidate for blepharoplasty, face and neck lift surgery, if you were to come to our practice and you said, "Doc, what should I do?" I would say that you are a candidate for all of those procedures. Now the question then becomes, "Are you ready to have all those procedures?" What I do is I spend a lot of time talking to my patients. I feel that communication is very important. Many people go to a plastic surgeon, or a cosmetic surgeon, and their consultation is very short. They get pushed into doing something that they would have done otherwise, but they feel like they were just pushed without getting proper information.

These surgeries all have risks and benefits. A detailed discussion of what's involved and how the procedure is done, where the incisions are placed, why the incisions are placed where they're placed, and what to expect. Very often, it is the combination of a good discussion, physical examination, and a review of the doctor's previous patients to get an idea of what the personal style is is very important, so that you can make an informed decision.

When you ask a question like should you have a face lift vs. a neck lift, you can find many doctors who will have overlapping concepts in their minds of what a face lift and neck lift are, but in our practice, what we do is we define a face lift from the cheek to the jawline and a neck lift from the jawline to below into the neck, so that most of our facial rejuvenation surgeries for people at your stage would be a face-and-neck lift. That can certainly be explained through where the location of the incisions are, and the vectors in how things are lifted, but that's getting more into the technical details.

The most important thing is, although it's your daughter that mentioned the little excess skin under the neck, is how important is it to you. In our practice, there are patients who come who are focused very much on their eyes. I always say that if someone's gonna do anything on their face, in their entire lifetime, related to facial aging, it'll be their eyes. The eyes make a very big impact on the facial appearance. Now that being said, when you do the eyes and the face-and-neck lift together, I always say the whole is greater than the sum of the parts. Everything is in place. You literally bring back ten years, if not more, and you look really great, but it's a very subjective thing. You should always think to yourself in your heart, what do you wanna see changed, how motivated are you, and, of course, are you ready to make the investment in money, time, and the whole process.

Learn about the style, the methods, as well as an important factor, the anesthesia. In our practice, we have made it a mission to avoid general anesthesia. We feel that people do much better with local anesthesia, with light I.V. sedation, which is just an intravenous, and our patients recover much faster. I feel like I do my surgery much better. Again this is my opinion. This is my experience as a doctor. I'm not interested in disparaging anyone else's approach. That's been something that our patients have found tremendous appreciation and value in.

Learn details, and organize those details, get to know the doctors you have consultations with, and then move forward with whatever your priorities are. So I wish you the best of luck. I hope that was helpful. Thank you for your question.

Prioritizing Cosmetic Procedures

Dr. Amiya Prasad explains that if you are considering multiple procedures or have a number of areas on your body that you would like treated, the eyes have the most visual impact.