Question:

Thank you very much for answering my  question. I was surprised to read that you believe anesthtic would have assisted my dermatologist in this procedure. I asked if she planned to use local anesthetic when placing the threads, but she said she couldn'tc because the fluid would distort her visual field and that she needed to see the planes in which she was working. I have to say that it was excruciatingly painful, particularly as she pushed through the scar tissue. (To be honest, I wondered if she was deliberately torturing/punishing me for having had a facelift a decade ago. "This procedure is meant for people who have never had any surgery. You shouldn't be asking for this," she almost barked as she was placing the threads.)  Since she was so angry, I worked very hard to suppress my impulse to scream, though I didn't fully succeed; I didn't want to give her additional reason to complain or to abort the project. Based on your previous answer, I'll be sure to ask for lidocaine if I can find someone else to do this in the future. Thank you!

Answer:

I am sorry you had to go through all of that. I wish you the best

Question:

I had my dermatologist place Nova Threads--a significant improvement on the old barbed sutures-- in hte past month. I had a facelif t 9 years ago and don't need another right yet, but this made some significant, subtle improvements. She found it difficulty to place them due to the previous scar tissue and, though they were effective (though I know they are short-term), I would like to do it again when when these sutures resorb, since they address the peri-oral jowls. Unfoturntatly, the derm said she didn't feel ike doiing it again because it took her 15-20 minute to place the threads rather than the typical 5-10. She seemed to get angry with me and blamed this on on my "thick skin." Isn't thick skin the GOAL of all these rejuvniation treatments? Does her response (in reaction to the extra ten minutes it took her) seem unreasonable to you, particularly since this procedure achieved the results we were seeking? I felt is if  were somehow to "blame" for the difficulty she encountered, though she was ale to accomplish the result we wanted. Do you know others who successfully place these threse? (Note: This isn' the same things as the mch-tauted InstaLift, which is more extensive.) I am white of N. European/British descent, by the way.  Thank you.

Answer:

I think it is quite unprofessional what the doctor did. Guess they want faster turnover to make more money. Should take care of each patient with whatever time period they need. The thickness is likely under the skin rather that in the skin itself. If you adequately numb the area with local anesthetic, that usually separates the tissue enough to place the threads. I do not have any names of doctors that do the threads, though, sorry. I personally do not do them, did many years ago and I have not personally tried the new ones. I wish you the best

Question:

Hi Dr Garcia, I have a quick question to ask you. I know you will always give an honest answer and you're extremely knowledgeable and great at what you do. Have you heard of a two stitch Face-lift? Who would you say it is suitable for and does it have good longevity? I'm aware that different surgeons have different techniques this is why I ask? Essentially I would like a mid face /cheek lift to lift my nasolabial folds, would this be effective for me? What would you say is a good procedure to have? I would prefer something surgical as opposed to fillers and would last 10yrs or so. Thanking you very kindly! 

Answer:

Although the doctors that perform this claim longevity of up to 5 years, that means that not everyone gets 5 years of results. It is essentially a minimal facelift and will give you something fillers cannot, but also cannot do what fillers do. My question has always been that it must be for people that need very little done as with only 2 anchor points, the amount of tissue repositioned into a more youthful location is limited. It grew out of the one stitch facelift, that obviously was not enough so they increased it to two. I think it is safe but do not expect a long-term improvement.

Question:

Thank you for your prompt response. The reason I need to take out my implant is due to a dormant infection but I definitely want to replace once healed to a smaller implant. Can they be taken out, Face-lift to be carried out and then in a few months be replaced with a smaller pair. What would be the best order to do this in? Also, what is the recovery like for a short incision lift and when would I look good by? And do you recommend a short incision lift, how long do they last? The reason I ask is that I'm getting married early next year and want to my best for it! :-) I know that I need to wait several months to replace my implants. Worst case I get fillers whilst my cheeks heal. Muchisimas gracias por su ayuda!

Answer:

The new cheek implant can certainly be replaced at a later date. That might allow a better decision on what implant type may be required. I think removing the implant and the short scar procedure can be done together. Should be out in public with some makeup in about 10 days or so. The longevity of the short scare procedure depends on skin and tissue quality, weight fluctuations, and genetics.  Fillers can also be used after the short scar procedure if the time has not passed after the larger implant removal. If you fear an infection in the present implant you have now, waiting 3-6 months would be best, but then you would need to heal from the new implant that and that might take a month for the swelling from placing a new smaller implant. De nada!

Question:

Dear Dr. Garcia, I trust you're keeping well.

I have a few questions to ask you, please know, it is great to have you answer my questions as I really value your opinion for it means a lot to have you help me, I really appreciate it.

I would like to have a short incision facelift, I don't have much needed to be lifted but more so to refresh my look due to my skin having been stretched with cheek implants that were too large etc and a great deal of swelling due to issues etc.I have good skin quality as I've been told by various surgeons but would like to fix how my face as to how it should look or make a little better. Therfore, can  I, do  I need to take out implants to later be replaced once healed due to infection can I take out my implants and have a short incision facelift at the same time or should I wait first for my implants to be taken out, bearing in mind they will be replaced with a smaller pair? Basically I don't like the projection they have from my oblique view and tend to look unnatural on my very slim face given that I also have thin skin too. They are a medium combined Malar implant, would you believe that a smaller combined Malar would look more natural also? Thanking you in advance and Best wishes xx

Answer:

Your cheek implants can be removed at the time of a short scar facelift. If you desire a smaller implant to be placed at that same time, that is also possible. I think the smaller combined implant is a good option. In my practice, when I go to a smaller implant, I use a suture that goes through the implant and is then brought out through the skin and tied over a cotton ball. The reason I do that is to allow the pocket of the previous implant to shrink down and become smaller, so the smaller implant will stay in its desired position. Just placing the implant without a stabilizing method might allow the smaller implant to shift, something we want to avoid. Hope that helps.

Question:

About 15 years ago, I had a mid-face lift with incisions along my hairline, from my mid-temples to my ears. The surgeon who did it closed with invisible sutures, which ran underneath my skin. I left his office with absolutely no signs that I had had surgery, and the effects lasted until a few months ago. It was amazing. Unfortunately, he is now retired. I am now scheduling another procedure and would like to tell the new surgeon what kind of suture technique my former surgeon used. What was it? Thanks for your help!

Answer:

The invisible sutures were just invisible because they were placed below the skin, what we refer to as intra-dermal sutures. There is no way to know what they used, but likely an absorbable suture like Vicryl or PDS, would be my guess.

Question:

Sorry you couldn't see my question. I had a facelift last week and had the sutures removed from the scalp at day 12. The post-auricular incisions, which extend to the base of my hairline, are thin enough, but the (wide) area around them is incredibly red and inflamed, making it look like the scars will be 4-5 cm wide when they heal, though I know that the actual incisions themselves are relatively thin. Is this normal? My surgeon says that this is just a localized and temporary foreign obdy reaction to the sutures. Is he right? Is this how incisions usually look after the sutures are removed? Furthermore, one of the incisions is at a frank 45 degree angle, extending from the occipital bone to the base of the hairline, placed very low on the neck, in a completely visible fashion. I won't be able to get my hair to cover it. Once it is that low, I don't see how it can revised, since it has "set the bar" at a permanent low. Is that correct? Thank you for your help and advice, Dr. Garcia.

Answer:

The area around the scars can be red as the skin is reattaching to the underlying tissue. I would suggest you see your surgeon next week to keep an eye on the healing to make sure it is going right. As to the low placed incision, if the surrounding skin gets loose enough in time, it can be shifted up higher in the future.

Question:
Answer:

please re-submit your question as I do not see it

Question:

Hi Dr. Garcia, I had a MACS facelift done 6 weeks ago and still have moderate swelling and firmness in the cheeks bilaterally. Is there anything I can take or do to help this resolve quicker? Thank you and hope you are having a good Labor Day weekend.

Answer:

It can take time. I might suggest some light massage as well as some moist heat to the area.

Question:

Hi Dr. Garcia, I have a short scar facelift 3 weeks ago today. I'm still very swollen and was wondering if I should talk to the PS about using a Medrol Dospak for swelling. I need to be able to go back to work on Monday. Any advice would be appreciated. Thank you!

Answer:

I think at this point where you are 3 weeks after the surgery the Medrol pack wil not give you much. It might have had some effect immediately after the surgery but not too much this far out

Question:

I know you recommend Arnica for bruising following surgery (which I've tried but which hasn't worked for me, unfortunately). What supplements do you recommend to prevent swelling following a facelift? I'm taking vitamin C an anticipation of the surgery to expedite healing, though the peer reviewed evidence for the efficacy of that is scant. I appreciate your advice.

Answer:

The products will  not work on everyone, and the degree of improvement one gets varies due to many variables. Besides the Arnica I would suggest papaya enzyme, or pineapple juice and bromelain. Best of luck.

Question:
Answer:

As one gets older they lose elasticity and collagen in the skin. Removing extra skin, like in a face lift, does not change the quality of the skin, only the quantity. As people age their skin will not hold up as well as the first time they had surgery. The surgeon who performed it for you might be able to do a little touch up in the office under local to try getting it a little tighter. Also, there are times when the scar tissue from the prior surgery makes the separation of the skin from the underlying tissues, something that is required for an aggressive lift, cannot be done due to potential injury of the tissue encased in scar tissue form the original surgery and the procedure you recently had done may not have been as aggressive as the first.

Question:

I had a very bad facelift experience/result over a decade ago (in my late 30's).  I had early jowling and lower face looseness.  The doctor placed his fingers in front of my ears and gently pushed back, demonstrating how it would look, which was wonderful so I went for it.   In reality, he did a face,necklift and 'yanked' me very hard.  Face is still very distorted and unbalanced..flat and wide with no definition.  I'm 50 and look awful with aging on top of bad work.  I have no cheek HOLLOWS, which is something I did not realize the doctor would 'remove'..that gap (hollow)on the sides of my face that create contour and definition is gone, my face looked (and still does) way too big and full afterwards (the exact opposite what I wanted and what he described).  My questions are; why would a dr pull/remove/tighten that?  is it made up of smas , muscle or both?  

Also my skin was pulled too right and i have pixie ears and bad scarring (flat) around my ears.  My skin pulls in an odd direction when I purse my lips (vector?), also the nike swoosh on sides of my mouth.  I know I need a complete revision is there any way to rearrange the smas and redrape the skin to look better and perhaps like my old self or minor improvements is all I can expect after such aggressive work.

Answer:

What you are describing comes from pulling too tight as you said. In most cases it is not the SMAS that is over pulled but the skin.That tends to flatten things out and leave too much tension on the incisions. That tension is what led to the pixie ear issue. What can be done is hard to say without examining you. It might be some skin re-arrangement combined with aggressive fillers. Skin excision is likely not going to help and I cannot say whether repositioning the SMAS would accomplish much without seeing you in person. I am sorry to hear about the problems.

Question:

Just had a mini mini (that's what the doctor called it) to try and improve some lumpiness beside my mouth.  She pulled the lower face only at the bottom, incisions around the lower ears and back of the ear.  No improvement to the lumpiness at all.  jawline looks better, neck looks better but did not fix my problem.  Am I a candidate for a regular lower facelift?  If so, how long do I have to wait?  (she told me there were sutures under the skin)

Answer:

It is hard for me to say whether a facelift will help without seeing the lumps you are referring to. At times it is herniated fa that can be removed through an incision inside the mouth. If you send me some pictures to drgarcia@lvcosmeticsurgery.com I might be able to define some options for you.

Question:

I had a submentplasty/platsymapkasty done 9 months ago and it healed almost smoothly but  I notice a very slight divot in the center (hollow part between the muscle bands)... its really only noticeable if I tilt my head back. 

I have seen pics of cobra neck deformity and what I have looks like a much less severe version of the pics I've seen. Is having such a mild degree of contour irregularity par for the course for this procedure or should I been seeking a revision?

Answer:

Small areas like that can happen for a variety of different reasons. If it is something that bothers you, then I would speak with your surgeon. Likely, there is a filler or your own fat that can be injected into the divot to correct the depression. It is something that can be done in the office with minimal down time and discomfort.

Question:

I have the beginnings of that terrible softness-merging-into-crepiness at the base of the neck, just above the clavicle, that comes with age. I'm closing in on 60 -- female and white. Just how successful is a neck lift in redressing this? Until very recently, I had an extremely tight and smooth neck and want it back. I'm not interested in a surgery or a surgeon that will make me "look good for my age," leaving tracing of that pouch. I want a smooth and very tight neck again. Can that be achieved with an aggressive neck/lower facelift? Thank you?

Answer:

I am sorry to say that the lower on your neck the wrinkles the less effective a neck lift is is improving that, and any improvement in the neck follows that the lower in the neck the problem is, the less time the improvement will last

Question:

I have a hypertrophic scar (4 cm x 12. cm) behind my ear from a facelift last June. In the past few months, I have it needled, lasered, and injected 3 times with kenalog. Nothing has changed it. Any other suggestions? Thank you for your opinion, Dr. Garcia.

Answer:

I like to use 5FU with the kenalog into the hypertrophic scars. I have had better success with that and I can inject more often as the kenalog dose is so much smaller.

Question:

I have the same body and hair type as my mom. I am not sure if we have the same face shape, but we have the same nose. In aging, her skin has dropped/sagged below the chin. She has spent much more time in th sun. I'm not sure if sagging skin is caused more by the sun or genetics? I was wondering if I might end with saggy skin hanging under the chin as well? Is there anything I can do to prevent this? I'm not sure if I'd need multiple jowl lifts. I know woman today tend to get fillers instead of facelifts for a more natural look. However, it seems if one had filler injected under chin, it would result in a double chin look.

Answer:

Sagging skin is caused by both genetics and environmental exposure as well as lifestyle and weight fluctuations. The best thing to keep the neck area looking good is to not yo-yo diet where you gain and lose the same pounds and avoid the sun as much as you can. Fillers under the chin do not afford a lift so they are rarely used for neck issues.

Question:

About how long should a lower facelift take? I am getting ranges from 2-7 hours, with no additional procedures (e.g., a bleph, a rhinoplasty, etc.) added in -- all only neck and lower facelifts. I suppose some surgeons are slower than others, and some are more thorough than others; but that seems like quite a range! Can a truly thorough neck and lower facelift be accomplished in 2 hours, or is more like 4-5?  Or is it, in fact, 6-7 hours, which seems like a long time to me for dissection, tissue elevation, skin draping, and suturing? Thank you.

Answer:

the shorter times imply less things being done. I think a reasonable amount for a good facelift should be 3-5 hours. The second go round takes less because there is less to do417

Question:

I had a face lift (& revision) 6 years ago that has several vector errors, but the main thing I still struggle with is that the dr. apparently removed too much of the smas/muscle from my neck, which makes it too tight.  (The skin is not too tight.)  This extreme tightness under my jawline is constantly pulling DOWN HARD on my lower face and is pulling my mouth downward, which looks old, sad or almost grotesque.I have tried applying a hot washcloth, and pulling as hard as I can UPWARD on my neck & at the sides around my ears.  It may have helped some but not nearly enough.  Is there a substance that would help stretch this smas, or could a procedure be done to release this over-tight smas?  I will never have a chance to look like myself again unless this can stop pulling downward on my face.  Thank you.

Answer:

Short of cutting the SMAS to allow it to retract upwards I am not sure of what might help. That could lead to a deformity seen in the neck if there is not enough tissue below the skin to hide where the SMAS is cut through

Question:

I think I need a lower facelift and necklift to address the loose skin on my neck and the bands need to be tightened. Can this be done and cut behind my ears so not to bother any of the hair on my head being it is thin and I can't afford to lose any? Also is this a painful surgery, and do you have to wear any kind of band or anything to hold the muscles in place till they heal? Also how could you wash your hair if you can't bend over?

Answer:

It will usually require an incision in front of the ear as well. The incision can be made right at the hairline so no hair loss should occur. It is usually not a painful operation.I do not use any bands or straps to hold things in, that is accomplished with stitches at the time of surgery. I allow my patients to shower then next day and they need to avoid letting their heads go below the level of the heart for the first week or so is all

Question:

Hello from very dry Calilfornia! We feel like we're with you in the Nevada desert. I had a MACS lift with minimal platysmal plication on June 2. The surgery was 2 hours, in-office. I had mild swelling after the procedure but no bruising, and the swelling I saw in the first week was pretty much gone by day 5. I know that swelling persists for a few weeks, but I think in my case, the edema phase may be over. I'm writing to ask if you think that is an actual physical possibility--that is, that the swelling would be resolved so soon. In your experience, how long does it usually take for a facelift to settle down? I ask because, while I don't think I look swollen, I definitely do look distinctly --- well, odd. Is it likely that this is just micro-swelling that I'm not appreciating or do you think that at 11 days, this is pretty much how I'm going to look?  (Sleeping sitting up in a recliner by the way, no salt, plenty of water, Vitamin C, arnica, etc.) My surgeon, of course, thinks I look "absolutely great" and is very impressed with his work.  He claims he's never seen such speedy healing. But I don't know. I don't look "like myself just rested," as is usually the hope with mininal facelifts; I look like a police artist's sketch version of myself. Strangely and most notably, my lower face actually looks wider than it did before the surgery, and one of the reasons I elected to do this was to lift that lower heaviness and go for a more triangular shape. (Sorry to go on for so long. Maybe my brain is dehydrated from the draught!) Hope you have a great weekend, Dr. Garcia. Great service you offer here. THANK YOU! God bless.

Answer:

Although unusual, it is possible that the majority of your swelling has gone down in that time. I do think there is likely swelling down deeper in the tissues that is contributing to your appearance that will take 3-6 weeks to get better though. Hang in there and drink your water!

Question:

I had a facelift last week. On one side, the surgeon ran the incision up behind the ear and turned it into the hairline above the occipital bone, as we had discussed. As a result, it will be well hidden. Unfortunatley, on the other side, he ran the incision from the base of the earlobe at a 45 degree angle into the nape of the neck, making it extremely visible. I don't know why he did this. My hair can't cover it because it is very curly and grows out, not down. I'm writing to ask if you think it can be repaired or, now that it is so low, I'm stuck with it in its current position. I imagine that this is the case. I'm extremely upset by this. I'm a rabbi, and my congregation will not look kindly on their clergy person having caved to vanity, which will now be visible to everyone. So much for my moral authority!

Answer:

It can be repaired if there is enough skin to excise the area between where the scar is now and your hairline. If it is only a week, I think it is likely pretty tight and not ready for a revision yet.
I
n 1964, a question was posed to several leading posekim regarding a woman who felt that benefiting from plastic surgery would enhance her prospects of finding a suitable husband.
Rabbi Jacob Breisch (author of responsa Chelkat Yaakov) maintained that the prohibition of wounding oneself does not apply in a situation where the pain is intended to alleviate another, more excruciating, pain. He brought proofs from various places in the Talmud that the psychological pain associated with having abnormal features overrides the pain associated with the surgery. He therefore permitted this surgery when done to alleviate psychological distress. A similar explanation was offered by Rabbi Moshe Feinstein, the most recognized posek of the past generation (1895–1986), who explained that the Torah only prohibits self-affliction when done with malice, or in a degrading manner.Rabbi Breisch also addressed the risks associated with surgery, and ruled that with the advancement of experience and expertise in this area of medicine, the risks involved have been greatly minimized, and therefore undergoing such a surgery cannot be reasonably considered a risk to life.
 Just some side thoughts

Question:

Thanks for the info about fillers before a facelift. I didn't know that they would degrade due to the surgery. Good to know. I guess I was more concerned about the surgeon being able to visualize what he needs to lift. The HA fillers -- but especially the Sculptra--have really given me a lifted appearance. It looks like I don't need a facelift, but I do. My dermatologist injects the Sculptra and HA's, not the surgeon, so he doesn't really have a vision of where this stuff is. I've given him photos of me many years ago, but it's been so long that I've been using Sculptra and HA's (10+ years) that those photos aren't really accurate any more.  As a surgeon, can you easily see intraoperatively where the fillers are and figure out how to lift around them? I should think that's harder with Sculptra, since as a bio-stimulant, it causes one's own collagen to grow -- so you can't really SEE "it" inside the skin, right? Sorry for the additional question. I just want to be sure I get my money's worth out of this very expensive facelift! Also, do you think large doses of vitamin C pre-operatively are useful? My surgeon is recommending it, but I can't find much clinical evidence that this is useful.

Answer:

They degrade because of the inflammatory response form the surgery. They will not obstruct  what needs to be lifted though. You really do not lift around the fillers. If the tissue where the filer is needs to be lifted, it is all lifted al as one piece.  Sculptra is injected beneath the skin and is commonly seen when lifting the skin off of the tissues. It causes the skin to stick a little more to the tissues than normal. I think Vitamin C is fine, nothing wrong with taking a little booster around surgery. It is an empirical use as it is known to assist in wound healing when people have low levels of Vit. C in their system. Best of luck.

Question:

Dear Dr. Garcia, I am scheduled for a full facelift soon. I've had HA  fillers for several years as well as Sculptra (2 vials every 6-8 months). The surgeon says that this won't affect the surgery at all. Is this your experience? None of it will not be dissolved at all by the time of the surgery. Thank you for your opinion.

Answer:

It will not affect what is done at the time of surgery. I do think that material like Sculptra or other fillers will be seen and likely have an accelerated loss or dissolving. I think in most cases at least some of the fillers need to be re-done. Having said that, many time in most areas the facelift will alleviate the need for fillers.

Question:

How far down the neck does this procedure typically go? The edges of the platysma have separated just above my clavicle. Will the muscle be sewn together from that far down all the way up through the cervico-mental angle and then finished submentally? I don't want this repair just at the TOP of my neck, leaving it looking half-done. Is that robust a procedure usually undertaken or avoided by surgeons who do this operation? Thank you.

Answer:

The procedure is customized to the patient. In your case it very well may require suturing the muscle back all the way down to the clavicle. Most surgeons are willing to do, it in my experience, if required.

Question:

I had Sculptra to my temples and forehead (2 vials) and Voluma (2 syringes) to my cheeks in February. I'm scheduled for a facelift in early June. The doctor who's doing the surgery says that the filler won't interfere with his work, but that seems counterintuitive to me. Wouldn't he be able to manipulate the tissue more without filler? What's your own experience with this issue? I can't reschedule the surgery until all the filler dissolves due to my schedule. I also don't want to walk around looking deflated before the surgery. I appreciate your taking the time to answer me. Have a great day.

Answer:

The issue is one of how much to lift the tissues in order to give you a pleasing hill and valley contour. If there is appreciable filler in the cheek, the degree of lift performed may not be as aggressive as it could have been. Once the Voluma dissolves it might then leave the cheek pad less lifted than desired. The only way to avoid that is to not dissect that area and work just around it, but that has similar issues of inadequate lifting of what has fallen. I think you will likely have lost half of your Voluma by then, so the differences should not be large. I  know the makers of Voluma claim their product lasts two years, but what is actually said is it can last up to 2 years, not that it always  does. I do not think the Sculptra will have much effect as it is in an area that will not be touched at the level of the filler. I do not think waiting longer would make a huge difference so I think it is OK to proceed, if anything the surgeon can just over lift a bit to compensate for the filler placed. That might leave yo a bit over-corrected for a bit but would be fine in the longer run. Best of luck.

Question:

Thanks for your answer. I didn't ask my question clearly. If a dissolvable suture material is used, how long does it typically take for that to dissolve? And if a permanent suture material is used, how long does it typically take for that to dissolve? Thanks. Sorry for posting twice!

Answer:

it depends on what suture they used, some dissolve in 6 weeks, some in 12 weeks and some are meant not to dissolve at all, ever. Surgeons chose a suture based on what the are trying to achieve, so there is a wide variety of what suture is used for a procedure, there is no universal choice. A permanent suture will likely last years if not more, but the suture can be permanent but the result it achieved initially may not last due to the tissue tearing, fat loss, the knot unraveling, lots of reasons. Just because you use a permanent suture that does not dissolve does not mean the result you see initially is permanent.

Question:

Are the sutures used in a MACS lift dissolvable or permanent? If dissolvable, how long before they disintegrate completely? Thank you.

Answer:

it varies from surgeon to surgeon, but even a permanent suture will not guarantee permanent results as knots can break and tissue can tear or pull through the suture. Ultimately it is scar tissue that holds it in place

Question:

Had a SMAS lift last year but it didn't really address the mid-face or sagging tissues beside the mouth. No jowls but softening and droopy tissue above the jawline. I saw my surgeon this week and he recommends trying a MACS lift to catch and suspend that remaining tissue. Do you think that's a reasonable plan? Thanks for your advice. Be glad you're in Nevada. Everyone north of you is buried in snow or drowning in rain! Enjoy your warmth!

Answer:

Well, it should help but not sure why the SMAS did not help as they are both procedures that use the SMAS to elevate things. It sounds like you need a bit more done and I guess doing the same thing more aggressively is not the best so something new might work. Thanks for the weather wishes, yes, wonderful day here, stay warm and safe.

Question:

Dear Dr. Garcia. I had a facelift last year but it didn't take care of the sagging tissue beside my mouth, which age me greatly. They're not jowls; they're higher up, next to the lateral corners of my lips. Some years ago, I had a plastic surgeon place filler under and beside them, but that just ended up making me look swollen, so we had to dissolve it. The surgeon who did my facelift said that my problem is a classic one in plastic surgery and notoriously difficult to treat. He suggested that another surgeon he knows who does subperiostal midfacelifts might be able to help, since he dissects down to the mouth and lifts all the tissue from that point up, resuspending it. My own surgeon doesn't do the procedure because he thinks that it is generally 1) not all that helpful and 2) sometimes unsafe due to the potential of nerve damage. (He is famously conservative, so I'm not sure if he's overstating the risk of this procedure.  What is your opinion, Dr. Garcia? Do you think midfacelifts are useful for this problem? Not effective? Too dangerous? Do you yourself do them? Any other suggestions for handling this particular problem effectively? Thank you so much for your help and time.

Answer:

Midfacelifts due have their limitations and risks are higher than traditional facelift. I personally do not think the midfacelift is what will help you as your issue is between the skin and the tissue below and although the midfacelift will lift the tissue up, it does not separate the layer between skin and tissue so you could end up with the looseness just higher up. I think that a cheek lift, which is the upper part of the facelift with a vertical imbrication of the medial tissues, medial to the line drawn straight down from your pupil of your eye should correct it. Many surgeons do not like to be that aggressive when they do a facelift, and it is not required in all facelifts, but it appears that it is in your case. I wish you the best.

Question:

I had ThermiTight to my neck back in May. My skin texture definitely improved, but only by about 15-20%. My surgeon and I agree it's time for a necklift. Will the surgery reverse the effects on the skin quality of the ThermiTight, since the skin that was tightened will be undermined in the surgery? 

Answer:

the effects of the ThermiTight on you skin quality will not be lost if you have the neck lift performed.

Question:

 I have seen a plastic surgeon about my jowls and neck and he suggested a lower facelift where he places the incisions behind the ear and not in the hairline so there won't be any hairloss. I asked him if it would be painful, and he said facelifts usually aren't painful, but when I read of others experiences of a facelift, they say it is very painful and you can't wash or blow dry your hair for quite a long time. They also said it was months and months before the swelling went down, and that isn't at all what was explained to me. I would like to know what you have to say on this matter.

Answer:

I think the negative issues you have read about are the exceptions. Understand that when people go to sites on the web to discuss their surgeries, it is very uncommon for people that did well and are happy to comment, it is mostly the ones that had an issue. That gives an inaccurate representation of what happens unfortunately. I think in general they are quite comfortable, my patients take pain pills the first day and then only at night to sleep for the first week. We allow them to wash their hair the next day and color their hair in one month. I wish you the best.

Question:

I am a 65 yr old african american woman who is considering a full face lift.  What procedures do you use to minimize scaring and discouraging the formation of keloids when performing a facelift?  Do you have any photos of facelifts you have done on black skin? Many years ago I had a keloid which formed after ear piercing removed with good results.   Terri

Answer:

Keloids are mainly due to excessive tension and/ or small infections. They are quite common with ear piercings as the metals used for the post can be irritating and can cause that problem. The key to avoid the keloid in darker complexion skin is to avoid tension, so more work needs to be concentrated  on the repositioning of the tissues below the skin rather than just pulling the skin tight. I do not at present have any pictures of African-Americans facelifts that have given me permission to show them, but it can happen in caucasians also.

Question:

Why would a lump appear 3 months on side of face after facelift? Size of a grape, tender to touch? What could this be? Thank you

Answer:

maybe where the stitches were to support or lift the tissues and now that the suture dissolved or broke it is leaving a little pouch, or it could be a cyst around a suture, hard to tell without seeing you in person.

Question:

May I ask another question, please, about the sutures in the neck? Since my FL surgeries did not involve incision under the chin (no platysmal tightening), would there still have been a suture there? Thank you so much.

Answer:

They might have run sutures from behind the ear to the other side when the skin has been seperated. It would be sutures still but not in the center. Those could be cut from the area where the knots are, could be behind the ears.

Question:

Regarding releasing sutures in tight neck that is pulling lower face & mouth downward, are these sutures in the FRONT of the neck, for example, under the mouth area? I do have access to surgeon`s notes. Are operative reports from the surgery center different? If so, I could probably get those, also. Thank you so much.

Answer:

Operative notes are different. The sutures aer in front, under the chin and downward.

Question:

You said that sutures in the neck might need to be removed to loosen the neck smas/muscle. Is that a difficult thing for a surgeon to do or pretty straightforward? And would it be loosened behind the ears? (It would have to be done by a different surgeon than the one who did the FL.) Thank you.

Answer:

the autures that need to be cut are in the middle of the neck. Having access to the original operative report would really help.

Question:

Dr. Garcia, I am afraid my surgeon removed too much muscle in my neck in a FL. After 3 years, there has been some loosening of skin in face, but the neck is so tight it is still PULLING DOWNWARD on my lower face/mouth area, and looks BAD. I`ve been holding my face upward to stretch the neck, and massaging some, but I`m not seeing much loosening there. Does the neck SMAS ever LOOSEN to normal? Would professional massage help? Thank you.

Answer:

At this point massage will likely not help much. It might require the sutures that were placed into the muscles of the neck to be released I am afraid. Sorry to hear about the problems.

Question:

I`m 45 and have noticed in the past year a chronic vertical line that runs from the outer corner of my eye straight over the outer aspect of my cheekbone down to just above my jaw. It`s worse on the right than the left but present bilaterally. Is this the lateral descent of the cheek pad which others show up on as nasolabial folds when they are closer the middle of the face between the nose and the mouth? Time to start thinking about a cheek lift?

Answer:

Unusual direction. If you send me a picture to drgarcia@lvcosmeticsurgery.com I might be able to give you a better guess.

Question:

Hi, Dr. Garcia. 10 years ago I had a wonderful corset platysmaplasty with which I was thrilled. Of course, it`s time for it to be tweaked a bit after all these years. I went back to the surgeon who did it originally but he tells me he never revises his own work, which disappointed me greatly. So I went to another surgeon who did a standard, minimal SMAS lift but didn`t do much with the neck. I was left with three parallel strands of skin (not platysmal bands) at the cervicomental angle. It looks terrible and not at all sharply defined as it had been. I really wanted the surgeon who did it in the first place to handle this, since he specializes in necks. Can you recommend any colleagues in the Northeast who would be willing and able to tighten this up for me? Is this something you do too? Thank you.

Answer:

I do perform that type of work. Please email me the city you live in and I will see if I can suggest someone that is close to you. I have heard this story from a number of other patients regarding this surgeon. I must say that it is quite unusual, but it is his choice. Email is drgarcia@lvcosmeticsurgery.com]

Question:

hi Dr. Garcia , i know that normal aging contributes to the sagging and formation of sagging eyebags because of lack of tissue support underneath ...but what hastens the lack of tissue support ? .. does smiling and other facial expressions contribute to it because correct me if i am wrong .. my understanding is that when you smile and form facial expressions the muscles tissues ligaments on the face and underneath the eyes lose their integrity over time because of repeated tear caused by facial expressions , thank you

Answer:

use of the muscles can cause small fine lines from the repeated folding in the same area but not sagging, that is from a structural loss of support from loss of elastin and collagen fibers within the skin and not the muscles. The muscles and ligaments do not tear with use, that is a misconception. It is actual oxidative damage to the skin and loss of the fat in the compartments of the face that allow the sagging. It is for that reason that facial exercises do nothing good for the face. When a surgeon says he is tightening up the muscles of the face they are merely rearranging the fat that lies over the muscle, but fat cannot hold stitches so they stitch to the muscle in order to elevate the fat. 

Question:

I am almost 6 weeks post mini facelift and neck lipo. The Mini facelift actually addressed the sagging under my chin and jowls. The PS did not believe that I needed any fat or filler in my cheeks since they are full. I am 62 years old. I saw the PS a few days ago, and he stressed that his patients should not sleep with the side of face pressing against the pillow for 4 months. He said it takes that long to heal the internal stitches in front of my ear. This seems like a very long time to me. I have not read any other doctors instructions that are that extensive. Is he being overly cautious ? I am still swollen and numb in front of my ears and under my chin slightly.

Answer:

We allow our patients to sleep on their side after 10-14 days.

Question:

Hi, Dr. Garcia, I had 2 bad facelifts 4 years ago in which my face was pulled DOWNWARD by a surgeon who had violent mood swings. My face is finally starting to soften in its downward pulling & I am looking less surgical. But still, he pulled my neck so hard horizontally that everything under my jawline is still PULLING DOWN ON MY LOWER FACE. I`ve been stretching my face upward and I think my neck is not pulling downward so hard on my lower face. Do you think the SMAS on my neck will relax with time and not pull downward so hard, esp. if I continue stretching it?

Answer:

I think the SMAS will relax and loosen in time, yes. I also think stretching will help it along. Sorry to hear about the problems and just continue to hang in there.