How many facelifts can one person have?
There are no limits on the number of ‘good’ facelifts a patient can have. And by good, I mean they were performed with a technique that maintained respect for the tissue and its blood supply.
It is common for patients who undergo a facelift in their 40s-50s to undergo a revision facelift 15-20 years later. Remember, a facelift will turn back the clock a few years but it does not halt aging. Time, gravity, and Mother Nature are still there. You will continue to age, you will continue to lose collagen, and things will continue to sag with the pull of gravity. Moreover, the quality of the skin decreases as we age, giving less of a cushion to the structures underneath.
As a community of face experts however, we have generally found that patients undergoing facelifts at a younger age tend to look better overall, heal more favorably, and their results last longer.
Will my otoplasty last forever?
Unlike facelifts, otoplasties and rhinoplasties tend to last ‘forever.’ I put ‘forever’ in quotes because the surgery has to be done well to achieve long-lasting results.
The cartilaginous structure of the ear and nose are more rigid and don’t give way to the natural processes of aging and gravity like our cheeks and necks do.
An otoplasty surgery is one in which the outer ear is reshaped or resized in order to achieve a more natural look. While each otoplasty surgery is a bit different, a common goal is to make the ears sits closer to the head (or not stick out quite as much). The techniques used to set the ears back are intended to last forever with no anticipation of revision surgery later on.
Threadlifting: what is it?
Thread lifting involves placing a suture under the skin, within the soft issue, pulling in a desired direction, and suspending the tissues in a more “lifted” position.
The issues with thread lifting are numerous:
No tissue is dissected, or released. Most surgeons will agree that it’s the physical separation of superficial tissues from deep structures that is key to providing long-lasting rejuvenating results.
No tissue is removed. There’s often bunching at the distal lift point, just as you’d expect if you pulled one edge of a duvet taught over a bed. Over time, the “lifted area” tends to settle back into its original, pre-procedural position.
Effects are short lived. It’s rare to see long-term (e.g., >6 month) before and after photos demonstrating meaningful results. That’s often because the tissue has relaxed back into its original position.
Indwelling threads can lead to infection, bunching, and extrusion (where your body begins to reject the thread and push it out, towards the skin surface).
I do not perform threadlifts and caution patients from this procedure when with other providers.
I want a browlift and want to avoid surgery…what are my options?
Neurotoxins (Botox, Dysport, etc.) are a great option to achieve a bit of brow elevation without surgery. The key to understanding the answer to this question is understanding that there are different muscles around the eyebrows and eyelids that pull the brows in different directions.
The main forehead muscle, the frontalis, lifts the brows up. The main eyelid muscle, the orbicularis oculi, pulls the brows down. And in the middle of the brows, in a region we all the glabella, there are a group of muscles, the procerus and corrugators, that pulls the brows down and towards each other.
The key to a non-surgical, or chemical, brow lift is appropriate dosing and injection of neurotoxin into each of these areas. Think of it like a scale – if you want to raise the brows, you’ll need to dose one are a bit higher than the other.
The other important thing to note about neurotoxins is that they don’t last forever. While there are some differences in duration between the different brands, patients will generally start to notice the medication wearing off in 3-4 months. So just like getting your nails done or hair dyed, it requires regular maintenance to achieve an ongoing look.
Rhinoplasty - low long does the surgery take?
The answer is highly variable. It varies based on the patient’s anatomy, their aesthetic goals, and the experience and techniques used by their surgeon. At its shortest, a rhinoplasty may take an hour. At its longest, it may take up to 8 hours.
The length of the surgery is good to know as a patient, but isn’t everything. Let’s dive a bit deeper…a very straightforward, primary rhinoplasty in a patient who simply wants a small tweak in the hands of an experienced surgeon may only take an hour. While a more complex, revision rhinoplasty (meaning they’ve had one before) who is desiring a bigger change and requires multiple grafts may take multiple hours. Both patients will likely end up with great results.
Prior to undergoing any procedure, I encourage patients to ask their surgeon about the length of the procedure, the type of anesthesia that will be used, the person who will be administering the anesthesia, and the facility used during the procedure.
How long will a neck lift last?
The contents of the neck are numerous – you have skin, superficial fat, deep fat, muscles, and submandibular glands within the neck. During a neck lift, one or more of these layers is addressed.
I heard a mentor once describe the neck similar to a grassy hill. If you’re excavating the hill and the dirt beneath is completely leveled, it won’t ever ‘grow back.’ The overlying grass will weather as time progresses, but the hill will remain flat.
The same is true for a neck lift. If the surgeon appropriately addresses (or ‘levels’) each layer of the neck during a neck lift, results will last with age. The overlying skin ages and loses elasticity, which is inevitable, but the underlying structures with remain contoured.
What is ‘mentoplasty’ surgery?
Mentoplasty refers to cosmetic surgery of the chin and surrounding area. Commonly, chin augmentation is performed to give patients a stronger chin. Less commonly, an overly large chin can be made smaller.
There are different approaches to augmenting the chin, both surgical and nonsurgical. If a patient elects for surgical chin augmentation, a permanent implant is placed just over the bone. This can be achieved through a small incision beneath the chin, or less commonly, through a small incision in the mouth. The main benefit of a chin implant is its permanence. Whereas if a patient elects for non-surgical chin augmentation with filler, repeat treatments are required over time.
Tell me more about lower blepharoplasty…
The term blepharoplasty refers to cosmetic surgery of the eyelid. A lower blepharoplasty is commonly performed to address the ‘bags’ of the lower eyelids.
Think of a youthful face. The lower eyelid-to-cheek junction is smooth. There’s no obvious demarcation between the two regions. As we age, the skin thins, we lose collagen, tissue begins to sag, and the lid-cheek junction becomes more obvious. The ‘bags’ are composed of protruding fat. This fat can be either removed or repositioned during lower eyelid surgery to smooth that lid-cheek junction.
Incision placement for lower blepharoplasty is either on the skin, just beneath the lower lash line or on the inside of the lower eyelid. The decision on where to place the incision is a point of discussion preoperatively, based on the patient’s anatomy, their goals, and the surgeon’s preference.
Acute recovery time is about 1 week, where it’s advised to reduce your activity level, swelling and bruising occur, and we ask for no makeup and/or contact use. More long-term healing is appreciated over 3-4 months, where the last little bit of swelling abates and you’re better able to appreciate your final results.
How long after an otoplasty can I exercise?
The body heals all wounds. Whether it’s a surgical wound or a non-surgical wound. But to heal most optimally, a relaxed and non-stressed environment is ideal.
What does that mean after a cosmetic surgery? It means performing diligent wound care – keeping things clean and appropriately moistened to allow the body to heal the incision site. It means eating well and providing the body appropriate nutrition. And it also means laying low and not vigorously exercising for the first 2-3 weeks. Exercise, while great for our overall health, can stress healing wounds by increasing our bodies’ blood pressure and temperature beyond that ‘relaxed state’ that’s required for optimal healing.
Does buccal fat removal help with jowls?
A facelift, neck lift, and/or buccal fat removal can all help address jowls. The term “jowling” refers to a sagging area of skin, fat, and other facial tissues that descends with age and is most noticeable along the jawline, on either side of the chin. Some individuals are more predisposed to developing jowls based on genetics and lifestyle factors.
To treat the jowls, some will advocate for filler in adjacent regions to help camouflage the area of concern. The gold standard, or best treatment, for jowling, however is surgery. The exact procedure and extent of that surgery is dictated by the patient’s anatomy, age, goals, and tolerance for downtime.
How long does a facelift last?
This is one of the most common questions I receive. And the answer is a bit more nuanced that you may expect. A few points:
A facelift, or any facial rejuvenation procedure, sets the clock back but it does not stop time. After a facelift, you will continue to age.
Every patient ages differently. And this is often related to your overall health, genetics, hormonal status, sun exposure, stress level, etc. It’s impossible for a surgeon to predict how you personally will age.
Patients undergo facelifts at different ages and different stages of their life. One on end of the spectrum, a patient may have a facelift in their 40s, wanting to ‘stay ahead’ of the aging process and pursing surgery at the first small sign of jowl formation and neck sagging. On the other end of the spectrum, a patient may wait until their late 60s. The amount of collagen and elasticity in the younger patient is higher, thus their results are likely to hold up better over the following 15-20 years.
If you are considering a facelift, it is important to understand that your facelift will never be “undone” or “fall.” You simply continue to age. And aging changes tend to accelerate the older we get.
How long does a browlift last?
A browlift raises the skin and soft tissues of the forehead and brow. Like any cosmetic procedure, it will turn back the clock but it won’t stop the clock. You will continue to age.
And age-related changes of the face occur differently for different individuals. So, there’s no defined answer to this question. It really depends upon how the patient continues to age. Patients who age more rapidly may have a handful of years before they begin to notice brow dropping while patients that age more slowly may never notice recurrent drooping of their brows long-term.
The best way to maintain your surgical browlift results is to continue to get neurotoxin (Botox, Dysport) injections in the crows feet and glabella areas after a surgical browlift. The key here is recognizing that the while a surgical browlift is good at surgically placing the brow at an elevated position, the long term, repetitive, and continual down pull is happening as a result of the nearby muscles. The strength of this pull-down action can be softened with Botox, Dysport, etc., yielding a better long term result for an elevated brow position.
Dressing after surgery: how long should I wear compression after my neck lift?
While every surgeon is different in their surgical technique, they also vary in their postoperative care protocols. I personally do not advocate for routine use of compression dressings after a neck lift.
Compression dressings apply firm and constant pressure to the skin and its underlying blood supply. This blood supply has already been disrupted by the surgery itself. For tissues to heal well after surgery, adequate blood supply is critical. For this reason, I do not have patients apply compression dressings routinely after surgery.
Prior to the routine use of drains after surgery, it was very common for surgeons to tightly wrap patients with compression dressings after facelifts and neck lifts. This was to help prevent fluid accumulation under the skin. With the placement of drains, however, the need for compressive wrappings is simply not there. Drains help evacuate the postoperative fluid that accumulates after surgery and the lack of compressive dressing allows for the best blood flow to skin during those first few days (arguably the most important) after surgery.
The good, the bad, the realistic - can Botox give me a brow lift?
Neurotoxins (Botox, Dysport, etc.) are a great option to achieve a bit of brow elevation without surgery. The key to understanding the answer to this question is understanding that there are different muscles around the eyebrows and eyelids that pull the brows in different directions.
The main forehead muscle, the frontalis, lifts the brows up. The main eyelid muscle, the orbicularis oculi, pulls the brows down. And in the middle of the brows, in a region we all the glabella, there are a group of muscles, the procerus and corrugators, that pulls the brows down and towards each other.
The key to a non-surgical, or chemical, brow lift, is appropriate dosing and injection of neurotoxin into each of these areas. Think of it like a scale – if you want to raise the brows, you’ll need to dose one are a bit higher than the other.
The other important thing to note about neurotoxins is that they don’t last forever. While there are some differences in duration between the different brands, patients will generally start to notice the medication wearing off in 3-4 months. So just like getting your nails done or hair dyed, it requires regular maintenance to achieve an ongoing look.
Can I massage after a facelift to help speed my recovery?
It is generally recommended against massaging or manipulating your own face after a facelift. The reason is that you don’t want to disrupt or pull too hard on the areas as they are trying to heal and knit back together. Excess manipulation in the early phases of healing could result in incision separation, hematoma (blood collection under the skin), or seroma (fluid collection under the skin).
Some surgeons will allow for lymphatic massages postoperatively, performed by a professional that is under the direction of the surgeon. These early, gentle lymphatic massages can assist with healing by promoting blood flood to the area and helping move some of the fluid responsible for swelling out of the area.
How long do blepharoplasty results last?
For simplicity, let’s talk upper blepharoplasty that is being performed to address age-related changes of the upper eyelid. During an “upper bleph,” a surgeon will remove excess skin and/or fat of the upper eyelid to give a cleaner, brighter, more open appearance to the upper eyelid. The skin redundancy is secondary to loss of collagen and elasticity, sagging due to gravity, and overall volume loss. Further, the fat beneath the skin begins to bulge as we age as a result of a weakening orbital septum.
The key to this question is understanding that any surgery that’s performed to address aging, whether it’s eyelid surgery (e.g., blepharoplasty), facelift surgery, etc., will turn the clock back X number of years. But nothing can stop the clock. You will continue to age.
And age-related changes of the face occur differently for different individuals. So there’s no defined answer to this question. It really depends upon how the patient continues to age. Patients who age more rapidly may have a handful of years before they begin to notice excess upper eyelid skin while patients that age more slowly may never notice recurrent excess of their upper eyelids long-term.
Can I work out after getting lip filler?
You can, yes. It’s generally advised to avoid vigorous exercise, extreme heat, and direct sunlight for the first 48 hours following injection of lip fillers. This precaution aids in reducing the risk of bruising, swelling, and other unwanted complications. Light exercise, such as walking, is generally fine after receiving lip fillers.
In comparison to other areas of the face, the lips are especially prone to swelling and bruising, given their tissue composition. The last thing you want to do after spending the time an resources getting your lips augmented is to overdo it at the gym and experience prolonged (and very annoying) swelling. Give your body a couple days after the procedure in order to aid in a relatively stress-free healing phase.
I want to apply some coverup. How long after blepharoplasty can I wear makeup?
Incisions like healing in a clean, stress-free environment. And happy, healthy incisions yield inconspicuous scars.
Proper wound care, adequate blood flow, healthful nutrition, and lack of foreign material/debris are all part of that stress-free healing zone. This is most critical in the first 1-2 weeks.
Makeup can contain irritating ingredients, bacteria, and foreign material. All of these should be avoided, as much as possible, during the acute healing phase.
I advise patient to wait at least 2 weeks after a blepharoplasty to apply any eye makeup. In rare circumstances, you may be advised to wait even longer.
How long should you wait to work out after Botox?
Botox, or any other name brand neuromodulator (Dysport, Xeomin, etc.), works by softening the muscle contraction of the area it’s injected into. Aesthetically, it is common for Botox to be injected into the forehead to help with horizontal lines, around the eyes to help with crow’s feet, in between the eyebrows to help with 11 lines, etc.
The issue with exercise after injection of a neuromodulator is that exercise increases blood flow and body temperature. Both of these factors can lead to the medication spreading to surrounding areas…which is what we don’t want. We want the medication to stay right where it is injected. Why? Because if it migrates to nearby areas of the face (e.g., eyelid or mouth), it can cause weakened muscle contractions in areas we don’t want weakened.
For example, let’s say a patient has Botox injected into their forehead and in between the eyebrows to give them a softer appearance and less visible lines in those areas. If that Botox migrates into the upper eyelid, they may have difficulty fully opening the eyelid for the following 3 months.
Generally, I tell patients to wait until the following day to perform any vigorous exercise.
Can a neck lift help with sleep apnea?
Generally, no.
Obstructive sleep apnea is just that – obstruction, or blocking of the airway, while a patient is sleeping to the point they become apneic, or no longer breathing. There are many contributors to sleep apnea, including obesity, unfavorable anatomy, medications, etc. And the big issue with sleep apnea is that it predicts poorer health outcomes in nearly all arenas. Patients with untreated or undertreated sleep apnea are statistically at greater risk for heart attack, stroke, high blood pressure, heart arrhythmias, diabetes, and obesity.
The gold standard treatment for sleep apnea is nighttime use of CPAP (or continuous positive airway pressure, where a machine physically forces the airway open and allows for continued breathing).
A neck lift is a cosmetic surgery in which various layers of the neck are surgically addressed to give a leaner, more contoured appearance. To date, there have been no large studies demonstrating that a neck lift has helped with sleep apnea.