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!

Dr. Dean Kane Q&A – I am a 35 year old man that is having some issues with some loss of volume around the corner of the mouth area.

Question from Jersey City, NJ:  I am a 35 year old man that is having some issues with some loss of volume around the corner of the mouth area. I noticed this occurred about a year after using a antidepressant for some sleep issues. I have read online that using antidepressants causes people to look older because of the constant relaxation of the facial muscles. I just want to know which procedures would benefit me. I have attached some photos. Your opinions are highly appreciated.


 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:​
I do see mild laxity causing your cheeks to soften, creating a minimal wave across the corners of your mouth and marionette folds. 

I would like to review the options that go through a well experienced and Board Certified Plastic Surgeons mind AND THEN make some recommendations...

Various options for face enhancements including facelift, minimally and non-invasive facial options 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.

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!.

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

Scuptra is the latest of the injectibles stimulating 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.

Focusing on you, try:

1.    1. Voluma as it is a very projecting 2 year filler. Add Juvederm or Perlane to the corners of the mouth and marionette folds. 

2.    2. Sculptra will continuously stimulate firming of the skin for up to 2 years. 

3.    3. ZO (Zein Obagi) Skin Health programs with retinoids will exfoliate and stimulate the skin for added external rejuvenation.

Any of these 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.

All the best!