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Is it better to address skin rejuvenation before or after facelift surgery?

Dr. Dean Kane Q & A.shutterstock_70658092

Q.  Is it better to address skin rejuvenation before or after facelift surgery? A.  ​​Great question! This is a continuous source of confusion for ALL patients. ​First, you must know all the options under the categories for face, neck, eyelid and forehead enhancements. These include: surgical, injectible, non-invasive laser / peel and skin health. ​ Second, you must compare photos of yourself years ago identifying skin laxity, pigmentation, volume changes and expression lines you wish to rejuvenate. ​ ​Third, obtain well seasoned, Board Certified Plastic Surgeon or Facial ENT evaluations with a diagnosis of your aging features…. NOT a single therapeutic recommendation but a management plan. ​ ​4th, develop a budget and a timing of what features you wish to improve recognizing you will need 3 weeks to 3 months or longer for recovery. ​ ​The following will be helpful: ​ ​Various options for facelifting, minimally and non-invasive facial enhancements 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. Sculptra is the latest of the injectibles stimulation 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. If you can pinch more than an inch of skin along the jawline in front of your earlobe, you should consider a surgical option to redrape and remove extra skin. You may consider: a traditional face and neck lift, short scar face and / or neck lift. The recent resurgence of the S-Lift (created in the early 1900’s), also called by other names as the Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. The shorter scar, limited undermining and second layer lift achieve the “quicker” procedure but not necessarily the quicker recovery or the improvement you desire. ​ ​YOU’RE CORRECT, IT IS CONFUSING!  I advise my patients: 1. that ZO skin health and Sculptra begin and continue to rejuvenate the texture of the skin before and after and surgical and injectible procedures. ​2. If you have a particular social event for which you wish particular enhancements, consider the recovery period and any potential side-effects or complications. 3. Find a trusting well experienced, Board Certified Plastic Surgeon or Facial ENT Surgeon who offers ALL the skills and options you are considering so he or she may offer you a trusting unbiased recommendation. I know this has been long winded but I hope it has been helpful. All the best!  
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