Risks of Lip Fillers and how they can be avoided

What are the risks of lip fillers?
Fear of overinflated and unnatural looking lips can keep a lot of people from having
lip fillers.
As is the case with any cosmetic filler treatment, results are dependent on the doctor and patient’s
aesthetic goals.
Achieving this goal requires skill and experience as far as technique is concerned as well as
knowledge and experience with the specific filler being used.
I’ll discuss some risks associated with lip filler treatment, and how these risks
can be minimized so you can achieve the results you want safely.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic & Reconstructive
I’ve been in practice in Manhattan and Long Island for over 20 years.
I spend everyday in my practice helping people with their facial appearance.
I routinely perform surgical procedures such as cosmetic eyelid surgery and facelifts.
I also specialize in nonsurgical cosmetic procedures, which are enhanced by my knowledge
and experience as a surgeon.
With this perspective I help my patients with a range of fillers for volume deficiencies
related to factors such as genetics and aging.
The Biggest Concern
The biggest concern for people considering lip filler treatment is the risk of having
conspicuously bad results.
Patients often cite a certain person or celebrity who has as they describe “huge lips” caused
by fillers, applying the term “duck lips” as the descriptor.
They often say, “if this celebrity has so much money and they can afford the best, how
did they end up looking like that?”
The answer in my opinion is a combination of factors.
The first is the shared vision between the doctor and the celebrity.
It’s not unusual in this field for a particular type of doctor and patient who share a perception
of exaggerated features as being desirable.
At the same time, some people really feel that their lips should look in a way which
most people would perceive as being too large or disproportionate.
My Vision
These individuals are committed to find the practitioners who are willing to help them
achieve their ideal vision.
This overfilling, or overuse of fillers is not my aesthetic.
My vision, which I share with my patients, is to achieve harmony so the facial features
look natural and the patient doesn’t appear as if they had a procedure done.
This natural aesthetic is way of achieving enhancement while maintaining the character
of the person I’m helping.
With the growing popularity of fillers and a wide range of physicians and non-physicians
performing these procedures, an increasing number of avoidable complications are being
It’s important to understand that minimally invasive is still invasive.
Once you go through the skin the risks of complications are comparable to the risks
of surgery.
This raises the question about the level of expertise the person performing the treatment
has if a complication were to occur.
When a complication occurs, timing of intervention by an expert who is a physician can be critical.
That being said, the art of lip filler placement in my hands begins with taking photos and
reviewing with my patient the details I see on the photo so we both agree on the areas
for enhancement.
Lip Filler Placement
I then plan on minimizing the number of points of placement to maximize my patient’s comfort.
I use blunt cannulas and anesthetics in a way, which minimizes trauma and maximizes
My patients rarely have any bruising and have minimal swelling.
When it comes to lip volume, I’m conservative with the volume of filler I place so lips
look fuller and take on a shape consistent with the other facial features.
I see my patients after 2 weeks to see how the filler has settled, and we decide together
if additional filler is needed.
I feel that hyaluronic acid fillers are the safest, and ideal choice for lip fillers.
I routinely use Restylane-L, Restylane Silk, Juvederm Ultra XC, and Juvederm Volbella for
lip enhancement.
These are all softer, fillers which integrate well with the lips resulting in ease of movement
related to speech, expressions, and eating.
Softer hyaluronic acid fillers last about 6 months to a year and are gradually and safely
metabolized by the body.
Since hyaluronic acid occurs naturally in the body, these fillers are tolerated well
by the majority of patients.
An advantage with hyaluronic acid fillers is that should an undesirable outcome occurs,
I can dissolve the hyaluronic acid filler with an enzyme called hyaluronidase.
This characteristic is in line with my preference for any procedure where I strive for maximal
safety, predictability, reversibility and minimal discomfort and downtime.
This is in contrast with permanent or semi-permanent fillers, which can be associated with more
serious complications.
Complications such as nodules and infections can require surgical removal and can be disfiguring.
One of the most serious risks of lip filler injections is vascular occlusion, where the
filler is injected directly into a vessel, which then blocks a network of vessels which
are critical for blood supply to sections of the lip.
This can be disastrous as pain and loss of lip tissue can occur very quickly.
Again, the popularity of fillers creates a perception that these procedures are without
The question that should always be asked, like being on a plane, what happens if something
goes wrong.
Is this the most qualified practitioner when something doesn’t go as planned?
I often hear from my patients that they are hesitant to try having a lip filler placed
since they have a friend who experiences extensive bruising and swelling which prevented them
from seeing people and even going to work for several days.
Bruising occurs when a needle pierces a blood vessel.
Doctors or practitioners who enhance lips by performing multiple needle punctures often
create several bruises.
In addition, multiple entries of the needle through the lips may also cause bumps at the
entry points of the needle in addition to the bruises.
I routinely use blunt cannulas for placing lip fillers which significantly reduces trauma
to the tissue and vessels making bruising a rare event.
I also minimize the entry points so my patients experience minimal discomfort and minimal
Like any cosmetic medical procedure, there are potential risks as soon as the skin penetrated
by any instrument, including needles and cannulas.
However, risks for any procedure are reduced by the knowledge, experience and techniques
used by the doctor.
I apply the standards to my patients that I would apply to any physician who would care
for any member of my family or myself.
By minimizing risk with optimal techniques, you are more likely to have the results you
want and have a positive experience.
I hope you found this information helpful…thank you for your question

Effects of prp on the eyelid skin and why it cant replace surgery

Can my eyes look better with PRP treatment? Platelet-rich plasma or PRP has received a lot
of attention in the past few years in the medical community I find this more than a little amusing
since I first started administering PRP to improve skin quality for my patients in the early 2000s
and the same dermatologists and plastic surgeons offering the services now
many were openly discrediting the value of PRP at that time in spite of its established
success in oral and orthopedic surgery as well as for aesthetics in other countries
of course the pendulum has now swung in the opposite direction the aggressive marketing
of PRP has created a perception for many in the general public that it’s a panacea for any problem
with the eyelids including hooded eyes under eye bags hollow eyes and dark under eye circles so
I’ll discuss what PRP can and cannot do for your eyes and what I do for my patients in my practice
I’m Dr Amiya Prasad and I’m a diplomate of the American Board of Cosmetic Surgery
and a Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice for
over 25 years in New York City and Long Island I specialize in cosmetic eyelid surgery as well as
non-surgical treatments for the eyelids and the eye area which includes administering PRP
for eyelid skin rejuvenation as I mentioned earlier I was one of the early adopters of PRP in
the cosmetic medical field for skin rejuvenation surgical healing and as a component for hair loss
treatment this means that I have a perspective based on many years of personal experience on what
PRP can and cannot do so what exactly is PRP PRP is a concentration of the wound healing and growth
factors present in the blood which are activated when there is an injury such as a simple cut
PRP preparation starts with a routine blood draw followed by spinning the blood in a centrifuge
to concentrate the platelets in the serum in the early years of using PRP in my practice
an opportunity to discover the benefits of PRP around the eyes had arisen when a patient who
of mine who was a middle-aged woman of middle eastern background expressed a concern about
having under eye dark circles recognizing that she wasn’t a good candidate for laser treatments
I offered her PRP to see if there would be any benefit up to this point there were essentially no
options for under eye dark circles related to skin quality for people with olive tone skin or darker
we saw her again in follow-up two weeks later and she was delighted with the improvement in
the skin quality under her eyes at this point I knew we were on to something and as they say the
rest is history the mechanism of this improvement is likely to be due to the induction of collagen
production and new blood vessel formation which occurs when there is an injury after platelets are
activated collagen is a protein that provides structure to the skin giving it strength
and elasticity you lose about one percent of the collagen in your skin every year as part of the
normal aging process starting around age 25. this percentage of loss is even greater when there are
stressors to the skin such as excessive sun exposure smoking and other toxin exposures
when you consider the mechanism of treatments like microneedling laser and radio frequency
application is to create a controlled injury in order to stimulate collagen production
it makes sense to combine these treatments with PRP to further enhance the intended benefits
of these technologies so for example I use PRP routinely after performing fractional co2 laser
under the eyes so the skin heals faster and looks healthier after healing is completed
people often ask if PRP can treat eye bags instead of surgery or if PRP can treat under eye
hollowness as an alternative to cosmetic fillers it’s important to first understand the basis for
these particular issues under eye bags that are present all the time are caused by prolapsed
orbital fat or fat that’s normally around the eye which has herniated forward herniated fat cannot
be reduced with PRP the options for improving the appearance of under eye bags include surgery such
as what we do transconjunctival blepharoplasty or camouflage with under eye filler depending on the
degree of the fat herniation as far as hollowness is concerned it’s common to see the coexistence
of lower eyelid fat prolapse with under eye hollowness so whether there is lower eyelid fat
prolapse or not under eye hollowness is caused by a relative deficiency in the bone structure
very often the focus is on an area called the tear trough the volume deficiency requires a
material that has substance and viscosity such as a hyaluronic acid filler this filler material
can provide volume and at the same time I can use PRP to improve the overlying skin quality
this is well established evidence in the medical literature of a synergistic effect when PRP
and hyaluronic acid is combined I’m also often asked if PRP can be used to help people
who have upper eyelid skin redundancy also known as dermatochalasis PRP can improve upper eyelid
skin quality to treat wrinkles sun damage and discoloration but it cannot provide a lifting or
tightening effect to significantly change the appearance of hooded eyes in order to
treat hooded upper eyelids I typically perform a procedure called upper eyelid blepharoplasty
I routinely use PRP to help people improve the appearance of their fine lines and wrinkles for
example I use PRP in combination with neurotoxin in the area of crow’s feet lines crow’s feet lines
result due to creasing from repeated contraction of muscles around the eyes a neurotoxin like Botox
Jeuveau or Dysport reduce muscle activity thereby reducing the depth of the creases while PRP can
be used to stimulate collagen and improve the appearance of these lines from within the skin
PRP is a very effective option to help improve eyelid skin quality texture particularly when
combined with other procedures such as fractional co2 laser if you have under eye bags or hollows
then other procedures such as blepharoplasty and hyaluronic acid fillers can be further enhanced
with the use of PRP I hope this information from my experience helped you
if you are interested in recommendations for your individual situation you may
contact us through our websites or call our offices to schedule a consultation thank you

Cheek filler results rely on technique more than the brand of filler and safety of filler materials

what’s the best cheek filler?
When you think of a youthful face full and defined cheeks naturally
come to mind as you get older facial volume decreases
making the cheeks looking flatter and more aged
this is mostly caused by bone volume loss
as well as diminishing fat and soft tissue
cosmetic fillers are the most popular option to enhance
cheek volume stereotypically patients with conventionally placed cheek fillers
often appear overfilled doughy or pillowy
assuming that it’s the type of filler used that makes these people
look unnatural i’m often asked what’s the best
cheek filler in consultation i’m also asked
what is the best cheek filler by people who’ve had filler done prior
and felt the filler didn’t last that long
i’ll discuss different cheek filler options and what i do
to help my patients look defined and natural
and enjoy long-lasting results i’m Dr Amiya Prasad I’m a
Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in New York City
and Long Island for over 25 years i perform cosmetic filler treatments
every day in my practice using techniques to minimize bruising
which is particularly important in delicate areas
such as the lips or the upper and lower eyelids
i apply my knowledge as a surgeon to perform deep and precise placement of
Technique Depth
hyaluronic acid filler for procedures such as non-surgical
rhinoplasty technique is critical to successful
filler placement for example i routinely apply a unique
approach to bone level placement in order to enhance
areas such as the cheeks jawline and chin for a more defined natural looking
appearance this is in contrast to conventional
techniques where filler is placed at the skin level
resulting in a less defined and more swollen appearance
during consultation for people considering fillers
they are often very concerned about looking bloated
or doughy characteristics seen in some celebrities or
shown in stories about cosmetic procedures gone wrong
for some people who’ve had previous cheek filler treatment
there is also frequent concern about the longevity of their results
in addition people who’ve had cheek filler in the past express
frustration with the variability in their results
and frequently experiencing bruising and swelling
afterwards as we’re all aware there is heavy marketing of fillers
directly to the public so it’s not unusual for people to ask
for a filler by brand name the other side of
this marketing approach is that many people blame their dissatisfaction
with their results on the brand name of the filler used
and actually less on the practitioner performing their procedure
so when people look for the best cheek filler
they first want to avoid looking bloated and doughy so they ask
what filler can best help them avoid this
unnatural appearance as stated technique is critical for optimal results
most doctors place cheek fillers just below the skin
at the fat and soft tissue level below the dermis
in practical terms placing filler to enhance cheekbone structure
at the fat and soft tissue level is limited because the tissue structure is
unable to maintain a shape that is intended beyond a small
volume of filler so instead of the cheeks looking
full and defined characteristic of a younger person
you end up looking soft and bloated since the soft tissue levels of the face
can’t hold much filler the material migrates and spreads
beyond the cheekbone area making the face look rounded
so in order to avoid having a bloated looking face
it’s not specifically the brand of filler
but rather the depth and technique of filler placement
that matters i place filler at the bone structural level
the bone structure is more stable platform for the filler to be positioned
in addition the material is held in place
by the muscle layer over the bone which prevents migration of the filler
material through this approach at the structural
level your cheeks look full and defined
not soft or doughy i refer to this method of filler placement as Structural
Volumizing which when performed in several other
areas of the face such as the chin and jaw angle at the
same time is referred to as the Y Lift
although placement of filler at the bone level is a
non-surgical procedure i apply my knowledge and experience as a
facelift surgeon and facial implant surgeon
to optimally place the filler at the proper
level a large proportion of injectors lack this surgical experience and make
assumptions about where they’re placing fillers for
example they may feel that they’re placing filler at the bone level
when they take the syringe and contact the bone
with the needle unfortunately this is not delivering much material to where
they think it’s going i use blunt tipped cannulas
instead of needles and i’m able to glide through a space without
traumatizing blood vessels or other important anatomic structures this
reduces the chances of bruising and other
potential complications in order to understand how i select
fillers it’s important to know the difference
between fillers and their optimal areas of use
Filler Options
in my opinion hyaluronic acid fillers are the gold standard when it comes to
filler options hyaluronic acid is naturally present in
the body in areas like the skin and the joints what further makes the
use of hyaluronic acid fillers appealing for me is that they can be
dissolved with an enzyme called hyaluronidase
this makes any procedure with hyaluronic acid
more easily reversible the body produces hyaluronidase
as part of the normal metabolic processes
related to your own naturally produced hyaluronic acid
this makes hyaluronic acid very biocompatible
manufacturers produce hyaluronic acid fillers with different viscosities
generally speaking the thicker the hyaluronic acid filler
the longer it lasts however thicker hyaluronic acid fillers are not
ideal for areas such as the lips the eyelid to the
forehead for areas such as the cheekbones i have
found thicker hyaluronic acid fillers such as
Juvederm Ultra Plus and Juvederm Voluma to be very effective with longevity
ranging from one to two years of course there are competing products
which are semi-permanent or permanent fillers these fillers which are often
made of material that are actually resistant
to the body’s metabolic processes with these fillers there’s a greater
risk for farm body reactions requiring medications and steroid injections
as well as the potential need for surgical removal
should these permanent and semi-permanent fillers get infected
they cannot be dissolved like hyaluronic acid fillers can
i strongly advise against semi-permanent or permanent fillers
although complications can occur with hyaluronic acid fillers
the biocompatibility and reversibility makes them in my opinion
superior to any other filler option Structural Volumizing of the cheekbones
is performed routinely in my exam room taking very little time with little to
no bruising or any significant swelling many of our
patients come in during their lunch hour making this a true lunchtime procedure
i routinely see my patients again after two weeks to see
how the filler material has settled and if any enhancement should be considered
as for any elective procedure safety is paramount
to enhance the cheeks the use of natural hyaluronic acid fillers combined
with precision placement techniques has been a
very effective approach for my patients i hope you found this information
helpful thank you for your question

Asian Eyelid Surgery Limits of Changing Eye Shape

Can I change the shape of my Asian eyes with eyelid surgery?
The desire for a double eyelid fold or eyelid crease drives the overwhelming popularity
of Asian eyelid surgery.
Asian eyelid surgery does not describe only one type of surgery.
The term Asian eyelid surgery can include procedures for any one of the following:
A young person who lacks a fold and wants a double eyelid fold
A middle aged or older person with sagging skin and fat pockets
An individual with drooping eyelid caused by a weak muscle usually referred to as “ptosis”
Someone who has a fold of skin covering the inner corner of the eyes called the epicanthal
fold who wants the eyes to appear larger and show more of the inner corner of the eyes
In the next few minutes, I will discuss how I evaluate and plan with my patients the shape
in double eyelid surgery.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I have been performing non-incisional and incisional double eyelid surgery throughout
my career, as well as epicanthoplasty and eyelid ptosis surgery for patients of Asian
I am known for my natural looking aesthetic style with eyelid surgery, as well as my methods
to achieve shorter healing time with less post-op swelling.
Eyelid Creases
People who come to see me for consultation are concerned about how their eyelids and
crease will look like after double eyelid surgery.
In particular, they express their interest in looking natural after surgery.
So,I show them how their body would naturally have had an eyelid crease.
I do this by using a Q-Tip or an instrument to lift the eyelid skin to create a fold to
revealing what the eyelid crease can look like after surgery.
The anatomy of the eyelid is important to understand.
The backbone of the eyelid is called the tarsus and this structure is used to determines where
the eyelid crease would naturally be and is important when surgery is performed.
In addition, the muscle which lifts the eyelid called the levator muscle is very important
in defining the eyelid crease.
When a natural crease is present, there are connections between the muscle and the skin.
In Asian double eyelid surgery, whether I use the non incisional or incisional method,
a connection is made with sutures to create a crease.
The simulated eyelid crease also helps me determine whether the crease would be naturally
tapered downward toward the inner corner eyelid fold or epicanthal fold resulting in a nasally
tapered crease.
If the eyelid skin at the crease runs parallel until the skin blends toward the nasal bridge,
this is called a parallel crease.
Some people come and see us with pictures of their favorite celebrities’ eyes, and
want that shape for their own eyes.
This provides an opportunity to help my patients understand the anatomical aspects that determine
eye and eyelid shape.
These include bone structure, the presence of fat, the amount of skin present, the soft
tissue, and the relative prominence of the eyes.
Of course, So it’s important recognize the limits the anatomy which if compromised can
impact the health of your eyes.
As with any eye cosmetic procedure, health and function of the eyes must never be compromised.
I do discuss how the procedure I perform can result in something comparable to the celebrity
but is unique to the patient.
There are two primary objectives of double eyelid surgery.
The first is to turn a single eyelid fold, also known as a monolid, to a double eyelid
fold, commonly referred to as double eyelid.
The second objective is to make the eyes look bigger and more open, which adds a look of
vibrancy and vitality to the whole face.
Having eyes that look bigger is not just a sign of beauty in Asian cultures, but among
all ethnicities and cultures.
When someone questions whether these procedures conflict with ethnic character, I respond
with an explanation where I explain that the procedure being performed makes the eyes look
bigger by revealing the true shape of the eyes.
Before the procedure, the fold effectively defines the shape of the eyes.
After the procedure, the eyes true shape is revealed which shows the beauty of Asian eyes.
After I show my patients where the eyelid crease would be naturally placed, measurements
are taken, and assessment of any extra fat or skin is done.
Measurements are important to determine where incisions are made and how extra skin can
be removed if necessary.
Excess fat above the eyelids is also assessed as the presence of fat can affect the formation
of the crease.
Generally speaking, little to no fat is removed.
For non incisional surgery, strategically placed marks are placed where small openings
will be made to engage the skin with the levator muscle.
During the actual surgery, patients are routinely give LITE IV or intravenous sedation followed
by some local anesthetic.
This approach allows for my patients to recover comfortably and walk out of our office without
I prefer this approach over putting patients under general anesthesia which often results
in more swelling, longer recovery and other issues such as postoperative nausea and vomiting.
In situations where there is no redundant (or extra) eyelid skin, and no excess fat
above the eyelids, which is common in younger patients, I usually choose to perform the
non-incisional method of double eyelid surgery.
This method involves making small openings in the eyelid skin to pass a suture through.
The sutures are placed to create a connection between the eyelid skin, and the muscle that
lifts the upper eyelid called the levator muscle, like word elevator without the letter
The connecting points between the eyelid skin and the levator muscle causes the skin to
fold, and this fold is where the eyelid crease forms.
If there is extra fat above the eyelid preventing the crease from forming, and excess eyelid
skin that partially covers the eyes, then I would perform incisional double eyelid surgery.
Excess skin is precisely measured to the millimeter before a thin strip of skin is excised.
Through this approach, some fat is removed when needed.
Sutures are then placed to close the incision and to engage the eyelid skin to the levator
muscle to establish the eyelid crease.
Post-surgical swelling occurs in varying degrees after the procedure.
To manage swelling, patients are advised to use cold compresses for the first 2 days.
After 2 days, patients are encouraged to be more active to help the circulation clear
the swelling.
War compresses may also be used to increase circulation, and to allow fluid causing the
swelling to clear.
Sutures for incisional surgery are removed after a week.
The early recovery period after double eyelid surgery is a time for many patients to be
concerned since temporary swelling can make the eyelid creases appear too deep, and too
It’s important not to panic about results during this time and to allow the healing
process to transpire.
Swelling resolves differently in patients, anywhere from several days, to a few months.
Total surgical healing can take up to year, but with advanced healing techniques, the
eyelids can be pretty close to the final results in just a few months, and even sooner in many
I follow my patients progress two weeks after surgery, then at one month, then at three
When can you go back to work: Patients normally return to work in about a week after surgery,
but active healing and resolution of swelling still continue past the one week point.
When can you look good for an event: I’ve had patients look pretty close to their final
results in as little as 10 days, but healing that quickly is too difficult to predict.
While swelling may still be present, most of it should resolve in the first 1-2 months.
Generally, I expect appearance to by close to the final appearance around 6 months.
If a patient has a history of allergies, sinus problems, smoking or other circulation issues,
swelling can persist longer than is typical.
In the first 2 days after the surgery, cold compresses help decrease the initial swelling
after surgery.
After the first 2 days, the clearing of swelling depends on the amount of swelling and circulation.
I encourage my patients to be up and about walking, talking and smiling and if they’re
planning to be more sedentary, warm compresses can helpful.
Double eyelid surgery is a highly effective and successful procedure for Asians who are
interested in having an eyelid crease with brighter looking eyes.
It is important to understand that your individual anatomy determines how I design and create
a naturally appearing eyelid crease that suits your unique facial character.
Look for a cosmetic surgeon with extensive experience with Asian eyelid surgery, and
make sure you have a proper evaluation with an understanding of the anticipated outcome
for your eyes prior to any surgical procedure.
I hope you found this information helpful…thank you for your question

The right age for a facelift

Am I ready for a facelift?
If are looking in the mirror and pulling up your face, you’re may be asking if this
is the right time to have a facelift.
I’ll try to help you understand how I approach this question in my practice every day.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
Reconstructive Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I have been performing every type of facelift from short scar quick recovery to deep plane
face and neck lifts in my practice throughout my career.
I would also add that although I’m a surgeon, I have integrated many minimally invasive
advances help my patients concerned about their facial aging changes.
This includes specific methods to treat volume loss, skin quality, the use of suture based
suspension, as well as non surgical skin tightening.
Men and women come to see me everyday with concerns about looking more aged and appearing
What’s particularly bothersome for these patients is that they feel their appearance
on the outside doesn’t match how they feel on the inside.
When a patient comes in for an evaluation for a facelift, I start by taking pictures
from different angles at rest and with expression.
I ask the patient to look at their photo and state what they feel is the most significant
areas which concern them.
Of course, many times, they look and say “Everything!”.
I then systematically review with them what I see in the upper, middle and lower third
of the face.
A perspective which is particularly helpful is a three quarters and side view.
I look for the presence of jowls and sagging neck skin.
If these areas are significant, I move the cheek and neck upward and back to see if there
is enough looseness to perform a facelift or face and necklift.
I also educate my patients about understanding that facial aging is not just about loose
skin which is sagging but facial aging is significantly affected by progressive bone
This means that volume correction has an important role in helping you look better with or without
facelift surgery.
In the past, it was often that a woman in her 50s would come in and I would recommend
a facelift procedure.
Often these were short scar facelifts sometimes referred to as mini lifts.
Currently, if there isn’t significant sagging of the skin, rather than recommend a short
scar facelift, I educate my patient about how bone loss and soft tissue loss is more
responsible for their facial aging changes.
I discuss considering volume correction with a method called structural volumizing using
long lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma.
It’s very common for patients to be afraid of looking pillowy or puffy after having fillers
citing friends and celebrities who they feel look unnatural.
I explain how traditional filler placement is performed at the skin level in a skin structure
called the “dermis” or just below the skin.
This means that the weight and shape of the filler can have a significant negative impact
on aging skin which tends to be thin and loose.
When I perform structural volumizing, I apply my surgical knowledge and experience, particularly
with facial implants to place the fillers at the bone level comfortably with little
risk for bruising.
This is ideal since the bone level is where the most significant volume loss has occurred.
In contrast with traditional methods which can make the skin look puffy, this technique
actually results in improvement of the definition of bone structure and restores shape in a
way which looks more youthful.
For many patients who were considering a facelift, this procedure works out very well, without
If there is significant skin sagging, a facelift can be performed and structural volumizing
can be performed after surgery.
The main goal of facelift or face and neck lift surgery is to restore the anatomy of
the sagging tissue to improve cheek position, jawline definition and improve the neck angle.
My facelift patients are mostly women in their 60s and older.
Prior to surgery.
I always review the medical history and the results of the most recent physical exam with
their medical doctor including diagnostic testing such as EKG and blood work.
In terms of medical history, most people who have well controlled conditions such as high
blood pressure or diabetes can undergo surgery.
I am particularly concerned about patients who smoke as the effect of smoking on the
blood supply to the skin can be a problem for optimal healing.
In my practice, I routinely perform all types if facelift surgery from short scar mini lifts
to deep plane face and necklift surgery under local anesthesia with LITE intravenous sedation.
This is in contrast to traditional surgery which is performed under general anesthesia.
My patients appreciate how good they feel immediately after surgery and how quickly
they’re able to recover.
After surgery, a dressing is placed which is removed the next day.
I generally suggest taking 1 to 2 weeks off work depending on the extent of surgery to
be performed.
Closing: The facelift has been the gold standard for helping people address the anatomic changes
of aging, particularly sagging and jowling.
In my practice, my approach to recommending a facelift is now part of a range of options
which I customize to meet the needs of each patient.
No two faces are the same so every face has to be looked at individually.
I hope you found this information helpful…thank you for your question

Improving facelift results for the long term

How can I improve the results of a facelift?
A facelift is one of the biggest investments you can make to enhance your
appearance typically performed by specialty trained doctors facelifts are
performed in operating rooms with the team of people in addition to the surgeon over the course
of several hours with so much time resources and money spent on a facelift
why are there people who are disappointed with how they look after
facelift surgery I’ll discuss what kind of results should be expected from a
facelift as well as the facial aging issues that a facelift alone does not
address I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in
practice in New York City and Long Island for over 25 years I routinely
perform all types of facelifts from short scar mini lifts to more extensive
deep plane or subs mass facelifts I often perform a combination of face and
neck lifts for people who are more advanced facial aging since facial aging
also affects the appearance of your eyes I often perform eye rejuvenation such as
upper and lower eyelid surgery at the same time in many of my face lift
surgeries I make it a point to address the volume loss of aging seen in the
lips and facial support structures through strategic placement of selected
hyaluronic acid fillers to enhance the lips and vertical lines in addition to
the cheekbones chin and jaw angles one of the core principles in my
practice is to first define the problem before determining the optimal strategy
to reach a solution it’s therefore important to first identify what
specific problems can be addressed by a facelift a facelift involves a surgical
restoration of the cheeks and jawline soft tissue which has become loose and
descended downward due to facial aging these anatomic features are not just
skin but they exist in layers which include the skin soft tissue and the
connections to the deeper facial muscles the connection to the deeper facial
muscles is often referred to as the muscle and is referred to in our
profession as thus mass which stands for the superficial muscular aponeurotic
system thus mass serves as a critically important foundation for the skin to be
supported by skin only lifts and procedures such as thread lifts do not
have the level of support of a properly performed facelift and consequently
don’t work very well as I mentioned earlier aging changes are not limited to
the cheeks and jawline but also affects the eyes for example aging can cause the
upper eyelids to appear hooded or sagging as the skin above the eyes
stretch and become redundant with age the lower eyelids can also have a puffy
appearance which is often referred to as eye bags puffy eye bags are due to fat
that is normally around the eyes prolapsing forward combining eyelid
surgery with face of surgery is something I recommend to help you look
your best as a combination when appropriate the recovery time overlaps
the face of surgery and you get the most value
out of the cost of the operating room facility and staff in our office there
are two important factors in facial aging one is the descent of the skin and
soft-tissue which is addressed by facelift surgery the other is volume
loss at the bone and soft tissue level youthful facial volume can be
appreciated by the fullness and projection of the cheeks the jaw line
definition and the overall facial harmony seen in a younger person many
facelift patients often report that they really liked their results during the
first few months after surgery and then they feel that their facelift doesn’t
look as good after one year this is a misconception since during the early
recovery period the swelling which is temporary can create an appearance of
having more youthful volume as the healing process progresses this
temporary fullness caused by swelling disappears so how do I address your
facial volume deficiency if I’m performing your facelift as a surgeon I
have used two strategies in the past to help my patients one was to place facial
implants made of silicone such as cheek and chin implants at the bone level the
other was to harvest fat and perform fat grafting patients often resisted having
facial implants and fear of looking overdone they were generally willing to
have a small chin implant but often objected to having cheek implants I
found myself concerned about two things with the placement of cheek implants one
was whether the patient would be satisfied with the outcome or would they
feel that the shape wasn’t what they wanted or if the implant was either too
small or too large the other concern for me was whether the patient
then skin would eventually or at the same time reveal an outline of part of
the implant particularly as aging continued and bone loss and skin
thinning could make the implant appear more visible further if the patient
wanted the implant to be removed it means they have to undergo another
surgery I also try to enhance the facial soft tissue loss with fat grafting this
involved my performing liposuction and taking the fatty tissue and placing the
fatty tissue into the areas of facial volume deficiency unfortunately the fat
survival rate was too unpredictable and patients needed more surgery in order to
try and restore the lost volume from the first surgery in addition aged skin is
intrinsically thinner and weaker than younger skin this means that whether
it’s fat or filler the skin has a limited weight bearing capacity I made a
significant paradigm shift in my approach to facial volume deficiency
several years ago this was the result of a synergy from combining the principles
of facial implant surgery with the technological advances of recently
introduced thicker and longer lasting hyaluronic acid fillers such as Juvederm
Ultra Plus and Juvederm Voluma I place these fillers without surgery using
blunt cannulas at the bone level of the cheeks jawline and chin I cannot
overstate the importance of technique many doctors and so-called injectors
believe that if their needle contacts the bone that there at the bone level
the needle may be touching the bone but the filler is generally not going where
they intend the material to be placed while facial fillers have a reputation
for appearing doughy and unnatural I use my knowledge and experience as a
facelift and facial implants urgent to precisely place filler at the bone level
below the facial muscle layer which results in a more defined and sculpted
appearance I call this technique Structural Volumizing because it adds
structure and definition to the face as I mentioned earlier about technique I
use very few entry points to place the hyaluronic acid filler so bruising is
rarely an issue many of the so-called master injectors do demonstrations on
social media platforms with needles piercing the skin multiple times in just
one small area only to be repeated several times more for the other areas
to be addressed that’s a lot of poking which means more swelling and more
bruising by performing Structural Volumizing I’m able to be much more
precise with volume and shape allowing me to make micro adjustments for
asymmetric features unlike a facial implant which would require additional
surgery should there be a need to reverse the filler all I have to do is
use an enzyme called hyaluronidase in my exam room and the filler is completely
dissolved I routinely use structural volumizing for people who’ve had
facelift surgery performed by other surgeons who want to look better these
patients are often delighted to learn that they don’t need another facelift
and are very impressed by how good they look in less than 30 minutes in my exam
room if you’re considering a facelift you
clearly care about your appearance and you expect to look significantly better
afterwards while faceless surgery is effective for lifting sagging
cheeks and jowls I counsel my patients about facial volume loss and the
appearance of their eyes and lips when planning a comprehensive treatment
strategy for them my patients appreciate this integrated approach by me as they
are a beauty doctor rather than having to go to multiple people for different
services whether I address volume at the same time as a facelift or afterwards
restoring structure improves the balance and definition of your face in a way
that completes the intended outcome of a beautifully performed facelift I hope
you found this information helpful thank you for your question

facelift factors for older people

Can you be too old for a facelift?
Throughout my training and much of my
career I considered the facelift in conjunction with eyelid surgery to be
the ultimate solution for facial rejuvenation in my practice I developed
my own techniques and systems to achieve optimal results with local anesthesia
and LITE IV sedation with quicker recovery than traditional surgery my
facelift patients have ranged from age 37 to age 87 when I’m asked the question
can you be too old for a facelift makes me think first about whether a facelift
is the best option for what the patient wants and would the results be worth the
investment in time money and recovery I’ll discuss how I consider the option
of facelift for my patients in my practice and how age is factored into
this discussion I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years I perform all types of phases of procedures in my practice from
short scar mini lifts to deep plane facelift if we look into the past of the
options to address facial aging where the skin and soft-tissue sagged
resulting in gels and loose neck skin it makes sense to operate in order to lift
and reposition the sagging tissue it should also be recognized that there has
been a wide range of proposed best facelift surgery options from minimally
aggressive to highly aggressive in our field attending medical conferences has
been unintentionally amusing for me as colleagues passionately advocate
procedures at one time and then years later they abandoned the same procedures
they advocated for so passionately so what happened what happened was that
regardless of technique there have always been challenges with face lifting
in terms of complications and long-term benefit the ideal procedure is one that
is safe and predictable with minimal complications interestingly I’ve
observed several of my senior colleagues evolved their surgical approaches such
that they look very similar to what I advocated for years ago I think it’s
reasonable to conclude that they came to the same conclusion I did about safety
and predictability in my opinion one of the core limitations of any face of
procedure is the bone volume loss associated with facial aging the pillars
of the face which define the facial structure include the cheekbones the
chin, jawline, and jaw angle in a facelift operation the more defined these
structures are preoperatively the better the facelift results are this means that
for people whose facial structure are not as strong preoperatively within a
relatively short period of time they often look like they still need a
facelift being aware of this variable I often advocated for the placement of
cheek and chin implants at the same time I performed face of surgery but many
patients were not comfortable with having facial implants many were okay
with getting a chin implant another variable is the quality of the
skin the fatty layer under the skin and the SMAS or the superficial musculoaponeurotic system which is often referred to as the muscle and needs to
be addressed to do a proper facelift the SMAS is actually a layer of tissue
connecting the underlying facial muscles to the skin if these tissues are thin or
fragile the face of procedure may not come out as well as the patient would
like I make a point to communicate with my patients about these issues so they
can make an informed decision when considering a facelift patients often
come in for a facelift surgery because they feel that their face is drooping
when they look at the mirror and when they pushed their face upwards with
their hands they conclude that they look better others come in to have a facelift
because they don’t want to have fillers and just want to get that one procedure
that’ll keep them looking good forever I look at my patient during consultation
to determine what aspect of facial aging is dominating in their situation is
their facial aging issues caused more by bone volume loss or by facial soft
tissue sagging or is it a combination of both I look at facial aging from the
inside outward which means I look at the bone structure as the foundation if
there is no significant sagging I recommend volumizing the bone structure
but instead of facial implants I recommend long lasting hyaluronic acid
fillers such as Juvederm Ultra Plus or Juvederm Voluma instead of performing
surgery I use blunt cannulas to place volume at the bone structure level in my
exam room within a few minutes they appear to look as if they had a facelift
this is not the overused and inaccurate term liquid facelift I’m using the
principles I know from performing facial implant surgery for the placement of
thicker hyaluronic acid fillers at the bone level typically with no bruising
and minimal swelling if the soft tissue sagging is so advanced that the filler
placement would not have a significant impact I
recommend facelift surgery but I explained to the patient that they will
still need structural volumizing to address their bone loss after they’ve
healed to get the best results I do in some situations perform a combination of
facelift with structural volumizing at the same time a facelift is part of an
overall facial rejuvenation plan and is not the definitive final step this
awareness of the challenges of lifting sagging tissue over diminished bone
structure makes me particularly disheartened by the claims made by
advocates of threads and thermal energy devices I make more of an impact with
Structural Volumizing in a matter of minutes than any thermal energy device
or thread lifting procedure where patients are told to wait four months to
see the benefit of their treatment which still don’t come close to being
comparable to what I do in evaluating a candidate for face of surgery I look at
age as a variable from a perspective of physical health bone structure and
tissue quality I mentioned earlier my oldest facelift patient being 87 years
old when I did her surgery she was physically strong had no medical issues
no medications and she was healthier than people decades younger than her her
bone structure and tissue quality was great as I do for any patient I look at
the face as a whole and provide my patient with a detailed understanding of
all the aspects of the face contributing to them looking not as good as they can
this includes their eyebrows upper eyelids lower eyelids cheekbones chin
jawline and jaw angle as well as the lips in the area around the mouth of
course I look for the presence of jowls and sagging
neck skin can I suggest a strategy based on what I feel will be the most impactful
for their situation I find that it’s often the case that people focus on
something they don’t like such as their neck skin sagging and then they lose
perspective of the areas of the face that are more significant during social
interaction I call this area of social interaction the beauty triangle which
includes the brows eyes cheekbones lips and chin it’s by no accident that the
cosmetic industry creates countless products to enhance these areas in
summary age is a factor for a facelift in the context of health bone structure
and tissue quality most important is to determine what is the best approach to
help you look your best with the lowest risk minimal downtime and the most
benefit I hope you found this information helpful thank you for your

Options for neck lifting and platysmaplasty plus temporary tightness after surgery

Corset plastysmaplasty and choking phobia.
Surgeon recommends corset platysmaplasty. Have a choking phobia. Does post-op tightness of corset plastysmaplasty feel like choking? Is this procedure typically done under general or local anesthesia? Doctor uses a certified registered nurse anesthetist and not a medical doctor anesthesiologist. Is this okay?
Thank you for your question.
You submitted your question with a single photo focused on your neck from the front
view. And you’re stating in your question that your surgeon recommends a corset platysmaplasty
and you’re concerned about a choking phobia or the perception of tightness and a choking
feeling after platysmaplasty. You’re also asking whether or not this procedure is done
typically under general or local anesthesia as well as a question about whether it’s
safe to have this done with a nurse anesthetist as opposed to a medical doctor or an anesthesiologist.
Well, certainly I can share with you my personal approach in helping my patients understand
the pros and cons of both the surgical approach as well as the type of sedation that’s optimal.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. Helping people with aging neck and improve the appearance of their neck
and face has been a significant part of my practice over the duration of 20 years with
continuous evolution of this very challenging area which is reflective of the many different
elements that it takes to try to get the best result possible for an individual patient.
So to begin with, let’s understand a little bit about what the purpose is of a corset
platysmaplasty. Now in my practice, generally speaking, rarely do a corset platysmaplasty
as an isolated procedure. And the reason is that the goal is to certainly improve neck
contour by defining the area between the chin and the neck angle as well as the overall
sharpness of the side view of the neck. However, generally speaking, at the same time, there’s
laxity and sagging of the facial tissue which is often done in conjunction with a facelift.
And if there is a significant amount of extra skin, then it’s also done with a combination
of a face and neck lifting procedure. So in terms of using those particular words and
terminology, there are many ways to do all those procedures.
Now specifically, one of the challenges of helping people with the platysmal bands which
is generally one of the indications of corset platysmaplasty is that whether you’re using
different types of suture material and the techniques in which you close the platysma
that is divided and various types of maneuvers to maximize the result, there is the possibility
of a tight feeling. I would say that it’s very rare for someone to feel like they’re
choking but it is certainly possible to feel a tightness. You can certainly discuss this
with your doctor. They can share with you their experience in what they generally find.
I think that one of the things to at least understand is that even though things are
done very tightly during surgery, the tissue has a natural relaxation. And what that means
of course is that the muscles stretch a little bit, the skin stretches a little bit. And
so with time, there is an equilibrium that ultimately settles out. So things that are
maybe tight in the beginning tend to stretch a little bit with just facial movement and
tissue elasticity.
And of the things to also discuss is of course whether or not it’s indicated to have another
procedure in addition to just the corset platysmaplasty whether it’s facelift or face and neck lift.
Just as a side note, if you look at the plastic surgery literature, to this day, almost every
year, there are significant numbers of journal articles about the best way to do face lifting,
neck lifting and platysmaplasty. I shouldn’t say best ways but new approaches which again,
as I said earlier, reflective of the certain limitation of working with the human body
and what you do in surgery ultimately settles out over the course of time.
Now as far as something is done under general anesthesia versus local versus local with
sedation, in my practice, we do something called LITE™ anesthesia which is basically
local anesthetic which means making the area numb with local anesthetic like you would
like a dentist. And you also get LITE™ intravenous sedation. We generally avoid general anesthesia.
This is something that has worked out very well for me in my practice in the way we do
things. I avoid essentially the many risks and challenges of general anesthesia. My patients
are very comfortable and get up and walk away without having any of the usual or often side-effects
after using general anesthesia. So it’s really the surgeon’s preference. Many surgeons
prefer general anesthesia versus local and sedation and they have their reasons and this
is something that you should discuss with your doctor.
Now as far as a nurse anesthetist versus an anesthesiologist, I think again it’s important
for you to discuss this with your surgeon. I think that every surgeon who has like what
we have in our practice, we have our own facility, we’re certified by the Joint Commission,
the staff that I work with is very comfortable with me and the way I do my surgeries. I think
it works both ways. A surgeon can work very comfortably with an anesthesia provider whether
it’s a nurse anesthetist or anesthesiologist. And so if your surgeon feels comfortable then
I think it’s reasonable for you to feel comfortable and I think that there shouldn’t
be any particular bias based on this particular qualification. I think experience is critically
important and depending on the relative risk of complications related to anesthesia, that’s
also an important factor to understand. So if I feel someone is not a patient that I
would feel comfortable with doing it in my office facility then I’ll either bring them
to a surgery center or hospital or I’ll just not do the surgery. So discuss this with
your doctor since your medical history is not part of your question.
So I hope that was helpful, I wish you the best of luck and thank you for your question.

Options to treat neck skin from surgical tightening fillers or correcting posture

Do i need a neck lift, neck lipo, a chin implant? Something else?
Thank you for your question.
You submitted your question with 2 photos of the lower part of your face.
One with you appearing to look straight ahead and one with your chin downward.
And you stated in your question that from the side, you look pretty good when your face
is looking straight.
And then when your chin goes down, there’s all this appearance of extra skin so you want
to know do you need neck liposuction, chin implant or what essentially is the solution
for your appearance of your neck when your chin is moved downward.
Well, I can certainly share with you how I have this discussion with my patients who
frequently have comparable and similar concerns.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And helping people improve the appearance of their neck has been a big part of my practice,
doing everything from face lifting, face and neck lifting, liposuction, chin implants as
well as injectable fillers to help improve the appearance of this area.
So I can tell you that in my career over the course of these past 20 plus years, there
is certainly greater understanding of what are some of the anatomic issues that are responsible
for this change which is typically associated with facial aging.
So to begin with, it’s important to understand that there is a certain element of this that
is or significant part of this issue which has to do with the skin’s elasticity.
And what I mean by that is that as we get older and the soft tissue under the skin gets
thinner, the skin’s elasticity, the relative proportions of different types of collagen
and other proteins in the skin changes.
So very often, people, as they are getting into their 40s and older, will come to me
and pull their skin and watch that the skin doesn’t retract as well and go, “What am
I supposed to do with this?”
And they think, “Why can’t you just tuck it or pull it all the way from the back of
the neck?”
And so certainly, in the earlier part of my career, the approach would typically be to
do some kind of face lifting procedure.
Basically, what you’re doing with the facelift procedure is you are taking care of any redundant
skin and you are increasing the tone of that area.
That doesn’t mean you eliminate everything when your chin goes downward, it improves
I’m not saying that’s necessarily the right thing for you because there are other
areas that also have to be evaluated before making that decision.
One of the things that I have also noticed as time has gone on having been around for
the pre-internet era and seeing what has transpired as everyone is looking at their smartphones
is that generally, I’m finding that posture has incredible impact on this area in what
people see when they look in the mirror.
I feel that people’s postures in terms of their back and shoulders are getting more
They’re rounding forward, holding their phones closer, their necks are extended forward,
and they’re hunched over.
You can look around and notice how many people have changed their posture, and that contributes
a lot to this appearance of excess.
I have taken a patient with a similar concern, and I just adjusted their posture, not anything
chiropractic, but just have them bring their shoulders back, and their chin up, and aligned
their ear to the shoulder, then a considerable amount of neck skin has miraculously improved.
Now that being said, the other element of facial aging that I think is really relevant
here is also having to do with relative bone loss.
And a lot of times and again, judging is based on a limited photo, but assuming that the
photo is representative of someone who has a relatively thin face and is in their 40s
or older, there is an approach where you are actually adding volume to the diminishing
What I’m saying is essentially, as we get older, this is documented in the plastic surgery
literature, there’s bone loss and with that bone loss, comes this relative deflation of
the foundation of the face and the skin appears to be excess.
So what we do is we do something called Structural Volumizing which means we are using fillers
that are on the thicker side such as Juvederm Ultra Plus and Juvederm Voluma and placing
it strategically such as in the cheekbone area, the jawline, the jaw angle, the chin.
You are actually restoring a lot of the structure and it has the effect that can be comparable
in many ways to a facelift.
So a strategy essentially is, you’re looking at is something to tighten the skin relative
to the underlying structure versus adding volume to the structure and restoring some
of that support.
Now of course, there are many ways to improve skin elasticity up to a certain limit.
And the challenge I find in my practice is of course helping patients get the best value
for their investment in resources and time.
A lot of times, people look to try to get tightening of their skin and even if you get
the skin a little bit tighter through a non-surgical approach whether it’s a radiofrequency or
laser device, if it doesn’t tighten that significantly and the before and after is not that dramatic,
well it’s hard to justify that.
So I find myself gravitating towards restoring volume more than trying to tighten the skin.
And again, it’s always customized on an individual basis.
Everyone comes with different anatomy, skin types, history such as cigarette smoking,
sun exposure, etc.
There really is a customization necessary for every individual case.
And then we have to figure out what is the most practical.
So learn about these options such as Structural Volumizing.
I think that a full facial evaluation is necessary.
A physical examination is necessary but I think there is certainly an opportunity.
And also, don’t forget about looking at your own posture and seeing if there is any potential
benefit there and I suspect, you might find some use in that little pearl.
So I hope that was helpful, I wish you the best of luck and thank you for your question.

Clarifying different facelift techniques plus how to choose a surgeon

What is the best (and longest-lasting) facelift technique to lift heavy jowls?
Thank you for the question.
You are asking what is the best and longest lasting way to treat heavy jowls and you ask
on your question about the various techniques from high SMAS, SMASectomy, MACS lift, deep
plane basically a provider of a list of all the different techniques.
And you state that you see in this medium that people, after full SMAS facelifts have
recovered jowls.
Well the type of question you are asking is the kind of question that people who do this
type of surgery have been asking for decades and the best technique doesn’t really exist
because the human body is going to have a lot of variability.
And the reason, I will explain this further, as a background I’m a board certified cosmetic
surgeon and fellowship trained oculofacial plastic and reconstructive surgeon.
I specialize in helping people look better specifically in the area of facial aging and
I do all those procedures.
And I’ve been in practice for over 20 years in Manhattan and Long Island and I treat patients
who come for these procedures who come from all over the world.
I can say that the marketing elements of face lifting surgery which further confuses matters
and there are doctors who claim that they only do deep plane facelifts implying that
the other doctors that don’t do those procedures or that they are doing something that is complicated
than other people are not as brilliant as they are that’s just not the case.
Every surgeon who performs face lifting surgery who is properly trained and has experience
can do all those procedures that you just listed.
And more, and when it comes to it, at a certain level and experience, you really are customizing
even further because you are using your knowledge and experience to get the best result for
that patient.
And so, that essentially means that there is something missing in the equation as to
why you noticed that people do get recurrent jowls and there are a few things.
So the limitations of face lifting have to do with the realities of what the factors
are related to facial aging.
And facial aging is basically two things: it’s volumetric loss which means loss of
bones, muscle, fat and soft tissues and it’s also sagging, descent and weakening of soft
So that means you’re lifting against a structure that has less volume and you are lifting with
tissue that is more elastic.
A colleague of ours once said that the skin is like taffy and it is very stretchable so
whether you go very deep or whether you go superficial, in the end, you are still lifting
the foundation of the face called the SMAS.
But the weakest link in the chain is the tissue quality.
And so there is invariably a certain amount of regression which the skin in the neck can
stretch a little bit.
You turn your head up and down, it’s going to stretch a little bit.
The face will stretch a little bit just normal movement expression.
So I explain to my patients that if you are a candidate for a facelift, my job first is
to reposition and put everything back as to where it should be but it doesn’t mean volume
correction is not going to be appropriate.
Now volume correction can be the use of chin implants, cheek implants to restore volume.
Or volume correction can be the application of fillers, structural volumizing, placement
of thicker hyaluronic acid filler at the deeper levels so that after the facelift is done,
you can also get this volume restored.
And in fact, I would do a limited facelift and combine it with injectable fillers to
restore volume concurrently.
There is a lot of art to this type of practice and there is a lot of finesse and there is
a lot of variation and the personal style of different doctors.
Imagine if there was just one way to do the best job possible then everybody would do
it exactly the same way and that is just not a reality of there is one way to do a facelift
and that the best way you can be sure is someone who trains in this field would do exactly
I think what you are dealing with is just the elasticity of the human body and the variabilities
in the ways we can lift the face and neck area.
So I think that if you are interested in doing anything, meet with different doctors, explore
different options and learn about the different anesthesia scenarios.
Every doctor comes to this in a way with the perspective of doing the best job they can
with knowledge and experience they have and there are problems when doctors engage in
turf battles and disparaging other doctors stating they are capable or better qualified.
It just serves to confuse people unnecessarily because I think majority of the time, people
who often do these procedures do have appropriate experience and it is just a matter of finding
the right fit in terms of this style of the procedure, in terms of the anesthesia, in
terms of the overall vision the you and the doctor share about the outcome.
So I hope that was helpful, I wish you the best of luck and thank you for your question!