What do you think? Facelift/neck lift? Fillers and Botox or fat transfer?

Dr. Dean Kane Q & A.

Q. I'm 43 but feel like I'm 23. The past few years I've noticed less volume, for the record I think I already have a thin face. The upper eyelids stand out along with the tear trough. My dermatologist told me no on the face/neck lift but I submitted my photos to a plastic surgeon. He also said I wasn't a candidate for the lifts. He suggested an upper eyelid surgery and fat transfer! I don't want to spend thousands on that if in a few years I will need a facelift. Please help with your opinions. Thank you!

​A. Thanks for sharing your photos! You will notice that your best appearing presentation are the photos in which your cheeks are the most prominent and your jawline is most angular. This is due to a "heart-shape", convex presentation where there are more highlights then shadows.
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​You, like many patients may achieve these features with facelifting options, injectibles, peels and laser. Each has its own advantages and disadvantages, onset and duration, recovery and cost. Your personal needs must be evaluated with a well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon that provides all options so they are not biased based on a lack of skill level.
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​I have many patients choose fillers, retinoids, peels / lasers when they won't consider surgery, have the funds or recovery time for surgery.  Others, recognize the advantages of surgery to reduce / lift the jowls, widen and fill the upper cheek and redrape the lax skin while maintaining a thinner facial appearance and obtaining a longer duration of results.
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​Both of these and other combinations are options you will determine with a trusting physician.
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​I hope this has helped! All the best!

What would your advice be if I walked to your office? Botox?

Dr. Dean Kane Q & A. 

Q. I have this horrible lines on my neck (deep ones) and I am so young I shouldn't have to be worrying about it... I think its genetics so... there is only so much I can do, but I definitely will proceed on something against them since I'm fairly slim and I just want them to get toned out and vanished as much as possible. Ive tried aloe vera, collagen pills... etc. you name it; I've tried it. I feel hopeless... Oh, and when I was 15-18 I was a bit chubby but not anymore. Thank you in advance.

A.  ​​​​Thank you for sharing your photos!
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​As advancements are made in surgical and non-surgical cosmetic improvements, concerns not previously addressed are now facing (no pun intended) the limelight.
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​Neck creases or necklace lines may now be more apparent as the computer-cam generation and "selfie" revolution highlights these and other personal concerns including the weak chin, the open nose and facial asymmetries not previously appreciated. The necklace creases may be created by the more repetitive flexion of the neck looking down toward these devices.
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​While there is a sheet of muscle called the platysma under the neck creases, it produces vertical folds more than horizontal creases. Botox will relax the muscles creating "dynamic" lines like those of the crows feet and not easily reduce the visibility of neck creases.
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A continuous evolution of heating technologies (laser, ultrasound and radio frequency) to produce collagen thickening and skin tightening by combining the body’s own natural healing process to tighten loose skin has been less than overwhelming.
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​I have experienced a greater improvement in "necklace" line reduction and thickening of dermal thinning with resistance to creasing with an off-label use and dilution of the injectible "filler" called Sculptra. This is very injector dependent and not for routine use but illustrates how technology and technique are helping enhance our personal lives and aging’s consequences.
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​Please consult with a Board Certified, well experienced injector specialist to examine you and review with you, your options.
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​I wish you well!

Three respected plastic surgeons had different opinions. Any suggestions?

Dr. Dean Kane Q & A. 

Q. Three respected plastic surgeons each had different opinions. 1. Facelift, neck lift, upper eye lift both eyes, fat grafts/transfers and dermabrasion around mouth. 2. Facelift, neck lift, upper eye lift on right eye only (said not enough extra skin on left eye), lower eye lift on both eyes and full face laser, 3. Facelift, neck lift (with very small incision under chin to liposuction), fat grafts and temple plasty for right eyelid. We did not discuss laser or dermabrasion. What should I do?

A.  ​​​​Various options for facelifting, minimally and non-invasive facial enhancements and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below and offered according to your anatomy, recovery time, budget, skills and availability of services offered by the surgeon.

​The 2 basic foundations to rejuvenation include:

1. ​Lifting  and suspension (with removal of skin excess if needed), and
2. ​Texture improvement (lines, pigment, laxity).

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

The most popular of the fillers, Restylane and Perlane, a jelly-like clear skin filler is used to fill lines, wrinkles and folds. Juvederm and its longer lasting "cousin "Juvederm Ultra Plus are similar skin fillers, used to soften and fill the nasolabial ("parentheses") and marionette folds, the brow ("number 11") lines and fill and lift the cheeks and lateral brow or chin.Voluma is the longest lasting, up to 2 year duration HA filler. Each one is used to expand or volumize the loss of tissue associated with expression, weathering or aging. All the fillers come with numbing anesthetic!. Fat grafting is a wonderful option but consistency in survival of the fat and need for multiple procedures to achieve your "filling" results may disappoint.

Non-surgical facial contouring is possible with fillers such as Radiesse, a bone mineral for the nose or cheeks, jaw and chin as well.

Sculptra is the latest of the injectibles stimulation collagen at different levels of the skin adding volume but primarily firming and adding resistance to the formation of wrinkles, folds and descent.

Botox and Dysport too have been found to rebalance excessive facial expression, provide a non-surgical brow lift and lip lift and reshape the nose, as well as reducing wrinkles!

Dr. Obagi's new, second generation ZO Skin Health programs may be added to personalized chemical peels, light and laser resurfacing and tightening and will, smoothen and even the color of your skin.

IPL and fractionated lasers such as CO2 and erbium and now RF (radiofrequency) are additions to smooth the texture of the skin, tighten and reduce red and brown uneven pigmentation. Dermabrasion is a older but tried and true technique to improve lines and tighten skin.

If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin.

You may consider: a traditional face and neck lift, short scar face and / or neck lift.

The recent resurgence of the S-Lift (created in the early 1900's), also called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck.
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​SMASplasty of the face and platysmaplasty of the neck will further enhance the suspension of deeper tissues.
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​The 3 opinions you have received are very close in recommendations. Asymmetry or anatomic variations between one side and the other are adjusted for by well experienced surgeons.

Face lift and / or neck lift or any of the other procedures and their combinations should be discussed following a proper examination by a Board Certified Plastic Surgeon who performs all of these options so you will not receive a biased approach because he or she is limited in their skills. Choose who you trust will deliver a level of care you wish to receive.
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​I hope this has been helpful. All the best!