A woman in her early 70’s who is bothered by an aged appearance and laxity of her neck skin. She has significant sun damage and was a smoker in the past, but has not smoked for more than 6 years. Examination shows significant volume loss around the eyes and cheeks from the aging process, and her left cheek is much deeper than her right. She also has a weak chin.
She is shown before and again, 6 months after a facelift, including a chin implant and fat grafing to her midface and upper eyelid sulcus to treat the aging related hollowing of her eyes. She also has had some Restylane Lyft to her cheeks after surgery.
Discussion: The poor quality of her skin from years of smoking and the sun damage will limit the result that we can obtain from a facelift. Her skin elasticity is quite poor. It is not just the tailor but also the fabric that we are working with that influences the result. But the fat grafting can improve the volume loss and may bring in stem cells that improve the quality of the skin. When a chin is weak, a chin implant can also dramatically improve the results. Fat grafting is unpredictable- even though significantly more fat was placed to her hollower left cheek at the time of surgery, it still remains hollower. It is common to “build the foundation” with the fat grafting and then return at 6-12 months and add a some of the non animal stabilized hyaluronic acid (NASHA) fillers such as those in the Restylane/Juvederm families to further improve the results. A patient with prominent creases of the skin from poor elasticity is prone to “jokers lines”-and upward sweep of the skin lines at the corners of the mouth. This has been limited in her case by the fat grafting at the time of her surgery to replace volume loss in these areas.
Cosmetic & Plastic Surgery Specialist
"I treat my patients like I would treat
- Jonathan D. Hall, MD, FACSmembers of my own family."
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