Uplifting answers: Understanding facelifts

Q: I am a 55 year old woman who is a little overweight. At 5’4” and 190 lbs, I wouldn’t call myself fat – just above my ideal body weight. The reality is that my weight is very stable and has been relatively the same for almost 20 years. I exercise and eat reasonably, and this is just the way it is. I am fine with that as I am otherwise healthy. My face has always been al little plump, but otherwise firm, until the past few years. I have noticed that there is some jowling appearing along the jawline, but the real problem is my neck. It has gone to hell in the proverbial hand basket. It has gotten so droopy and saggy that I know it is time for some type of necklift. My question is; am I too fat to get a facelift?

A: Your question is a good one and would be a lot more relevant if you were younger. But as you have gotten older, regardless of your weight, the skin in the neck has begun sag. This sagging is the result of the skin stretching and loosening and no longer being able to support the weight of the fat it contains. Many men and women with similar situations and face shapes actually get great benefit from neck reduction/tightening. Until proven otherwise, it may be that you may get a greater benefit from a necklift than someone who is thinner with less loose skin. Delaying a necklift may make sense if you are planning to lose more than few pounds of weight, but that clearly is not the case.

Q: I would like a facelift to remove jowls and improve droopy neck. I also would like my nose done, as the tip seems to keep getting lower as I age. Is it really growing at my age of 63 years old? The main question I have is the timing of the nose surgery and the facelift. Should they be done separately or together? If separate, should the nose be done before or after the facelift? My thought would be after, because it might give my surgeon a better idea of how to do the nose based on the new way my face looks.

A: You are correct in your impression that the nose is getting longer and ‘growing.’ It does not actually grow, per se, but the tip of the nose does fall as the ligaments weaken. As the tip falls downward, the nasal length increases and the nasolabial angle decreases. This means that a very simple tip rhinoplasty to elevate the tip and open up the nasolabial angle can make an older nose look younger.

There are arguments to be made on both sides of that discussion, either combining or separating a facelift and rhinoplasty. In reality, it is not necessary to look at the ‘new’ face afterward to figure out how to change the nose. I have found it best to combine the procedures for the benefits of one single surgery and recovery and lower costs. In addition, a rhinoplasty is a central facial surgery while a facelift is a lateral or side facial surgery. One does not really impact the other when it comes to facial appearance changes or swelling and bruising. Put together, however, the combined facelift and rhinoplasty procedure can have quite a rejuvenating impact on the aging face.

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