Why Adding Volume And Improving Skin Quality & Texture are as Important as a Face Lifting

Disappointment After Facelift and Fat Transfer In October 2012 I underwent a Short Access Facial Elevation face-lift and fat transfer. Unfortunately after several months, I noticed skin laxity returning to my lower face region. In May, I had 2mls of Voluma injected into my cheeks and pre-jowl areas hoping for some improvement (different doctor). I would appreciate your advice about this problem prior to returning to see my original surgeon. Thank you. Thank you for your question! You underwent a face lifting procedure and you felt that for a certain time period that you had some laxity and you had something to help restore some volume. And so I very much understand what your perspective is. As a specialist in facial aging, I have actually written a book called "The Fine Art of Looking Younger". And one of the lessons that is a key in understanding facial aging is that facial aging is actually two things that manifest in the face. One is elasticity and stretching or sagging from the deeper tissues such as the SMAS or Superficial Muscular Aponeurotic System, thinning of the skin and so the tissue sags and volume loss. And volume loss occurs at multiple levels. It occurs on the bone, muscle and fat. So what I explain to my patients and it does take a 3-dimensional thing to understand but the facelift is the first part of a facial rejuvenation process where all the tissues that need to be placed in their proper position of their place. Otherwise, if you try to do volume replacement on skin and tissue that's sagging, it becomes weird looking. That's why a lot of people are walking in Long Island and Manhattan looking swollen and strange. What we do first is lift. Now at the time of the procedure, although a procedure like fat transfer is good strategy to improve the volume, it's very important to understand that fat transfer intrinsically has a certain rate of absorption. So that rate can be anywhere between 30%-70%. So I always tell my patients, if you're planning to do fat transfer, assume that you'll get a second procedure. This way, we're walking into having a second procedure with the understanding that one time, although we do the correction appropriately, it's about how your body heals. So when you have relatively thin skin and a small amount of volume in your face, it is part of your strategy is to restore the volume and improve the skin texture beyond the surgery. So understanding how much volume is something, again, a 3-dimensional thinking. What I'll often do is that I let you demonstrate for my patients, when you talk about 1cc or 1 syringe of a material, whether is Radiesse, Restylane or anything, we show the syringe and it looks a lot of material. But when I actually show them that 1cc of water is, it is clear that it's a relatively small volume. And so what we try to do is be strategic about applying whatever volume enhancement we want to do in a way that is compatible with the patient's expectations and of course their budget. So, strategically, it's going to be an important discussion with the surgeon. Very often, it is important to understand that in face lifting, even if the face is very tight in the beginning, as early as several months later, it's possible for skin elasticity to stretch a little bit. As you turn your head, move up and down, sometimes there's a little bit of regression. And although the patient can say, look, and move it more, it's fine if you do it in a mirror lift when use your hands to lift but from a certain perspective, to be able to do that and not allow that to regress, is often very difficult. So it is a strategy. When we say when we have a patient who had a similar situation, where I had an excellent result with the facelift I did to her and she just couldn't understand why the area right here was still a little indented. And I explain, that's the mandibular notch and there's an indentation there that's from bone loss and the volume loss cause the marionette lines. So what we did was, we did the fillers to restore the volume. I did a combination of Radiesse and Platelet-rich plasma and it enhanced the volume so much and dramatically, she quickly learned that it wasn't just about lifting. So this is clearly a point where you and your doctor can communicate and develop a strategy of moving forward to help you get to the results that you desire. So I hope that was helpful and thank you for question!