Your Questions
Your Questions
Q: Dr. Eppley, I am two weeks after mini facelift. My tragus is all of a sudden swollen and slightly pulled forward and I can feel it is under some tension. It literally happened almost overnight. My surgeon told me today that the swelling will go down and that the pulled forward tragus will most likely correct itself. When I touch that forward tipped cartilage, I can’t imagine how it will correct itself. Is it really possible that it will?? I’m desperate for an honest answer. And yes, there is a incision inside the ear, and under the lobe and behind. Everything else is healing well except my tragus which is pulled forward and is swollen. Will I need revision surgery? 🙁
A: It is important to realize that healing is often not a linear event. Just because something pops up in the healing process that seems unusual, particularly in the first month, does not mean that something is wrong or will not turn out right. Facelifts of any type takes months to fully heal and six months or longer for all scars to mature and the tissue to feel completely normal.
Having said that a distorted or deformed tragus may settle down and return to normal with adequate healing time. At the least you will need six months to see how it heals. A deformed tragus, however, often is a reflection of too much skin removed in front of the ear or tension not adequately distributed around other areas of the ear. I have seen this to be most common today as many surgeons try to make a mini facelift work when a fuller facelift is really needed with long skin flaps and better tension distribution at the top and behind the ear. Neither the earlobe or the tragus will tolerate much tension at all without subsequent deformation.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what is a mini facelift with a simple subtuck treatment? Is a subtuck treatment to the neck area, and how is it performed?
A: When you use the term ‘subtuck’, you are referring to the submental area of the upper central neck. That is an area that will not be affected by a mini-facelift unlike a full or regular facelift. In a mini-facelift (aka Lifestyle Lift amongst many names) the jowls and the face behind them is effectively lifted and tucked. But the submental area is not changed by a mini-facelift because it is a more limited type of facelift that does not reach this far forward. This is why some type of submental treatment, such as liposuction or a submental tuckup, often needs to be done at the same time as the mini-facelift to get a more complete result. These submental procedures are done through a small incision underneath the chin.
Not every mini-facelift needs to have submental manipulation, it just depends on how much loose skin or extra fat is in this area. I would estimate that two-thirds of mini-facelift patients do need submental attention as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 37 years old and although I still have a fairly young looking face, I am beginning to develop a few bothersome issues. I am beginning to get some marionette lines and the very beginnings of jowling. I have tried some injectable fillers to improve these issues and all they did was make my face look bottom heavy. I have read about mini-facelifts and jowl lifts which sound like more of what I need given the problem. What are the advantages/disadvantages of having this type of facelift at my age? I prefer to take a preventative approach and address issues before they become too big. But will starting early make me look unnatural?
A: While the concept of a facelift historically seems inconceivable at your age, today’s facelifts are not your mother’s facelifts so to speak. Contemporary facial rejuvenation procedures, and facelifts in particular, are tailored to the magnitude of the problem rather than a standard cookie cutter approach. In essence, small early aging problems merit a more limited facelift, more advanced aging issues need a more complete and extensive facelift approach. Although you are young, appearance and need are more important criteria than a chronological number. There are numerous advantages to early intervention…everything is smaller from the scope of the surgery to recovery to cost. Early facelifts actually create a more natural look because the changes are less dramatic than when a facelift is done at an older age.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, While I think I am aging fairly well at 48 I am bothered by my jowls that I have developed. My neck is just a bit saggy as well but not too bad. I am not ready nor do I think I need a facelift but a little tuck might be good. I saw a doctor on TV advertising some type of quick facelift procedure. It sounds like it might be good for me but I am leery as it sounds too easy. Is this type of facial tuck-up procedure legitimate and is it really like what is advertised?
A: Facelift surgery is done in variety of operations based on how severe the facial aging is on each patient. Since the average age of a patient seeking a ‘facelift’ has gotten younger over the past two decades, many people now appear with early signs of aging such as jowling and a little neck sag. These signs of facial aging can be treated by a smaller type of facelift, generally known as a limited or mini-facelift. The improvement is a smoother jawline and neck.
There is nothing unique or novel about this type of facelift and it is an operation that has been around since facelift surgery began. What is new is that the ‘limited facelift’ has become packaged and marketed by different companies. These types of facelifts essentially are forms of franchises that are sold or licensed to doctors to sell this scaled down form of a facelift. There is absolutely nothing wrong with the operations that are advertised. What you have to be careful about is who is really performing them, are they a good choice for you based on your amount of facial aging, and is it done under safe and comfortable environments. While these companies advertise and stress the rapid recoveries after these small facelifts, which can be true, it is still surgery and has all the risks that go with it.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting rid of my sagging jowls and neck. Do you think Thermage or radiofrequency treatments would work? If not, would you recommend a lifestyle lift or a mini lift? What about laser tightening for face & neck vs these lifts?
A: While I have never seen what you look like, I can only speculate about your neck and jowl concerns. However, almost any patient that I have ever seen with a sagging jawline and neck rarely would benefit significantly by any non-surgical or non-invasive treatment method. By and large, the use of non-surgical methods of neck and jowl improvement produce very minimal benefits and most patients would consider them unsatisfactory. They are best used when the patient has a very minimal problem or when the patient is fairly young with just the very beginning of any sagging. Most certainly, what often is paid for the hope of some of these non-surgical methods would have been better invested in a surgical solution. In short, any non-surgical method of jowl and neck tightening does not compare to the results achieved by more conventional surgical techniques.
There is no difference between a Lifestyle Lift, minilift or any other branded and marketing name for an operation that has been around for decades…a reduced version of a facelift.
It is understandable why patients seek anything but surgery for their aging concerns of their lower face, but they often end up chasing a solution that does not exist…and waste money along the way.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am tired of looking older. My jowls are getting bigger and my neck is starting to really sag. I hate to consider the thought of a plastic surgery procedure like a necklift but I am going to have to do something in the near future. I don’t mind getting old per se, I just don’t want to look old! I have read that there are different types of facelifting procedures. How do I know which one will work for me?
A: A facelift is a plastic surgery operation that changes the lower third of the face, the neck and jowls only. So it is a good match for the jowl and neck issues which bother you. Like many plastic surgery procedures, there are different ways to do them and they come in different ‘varieties’. No one type of facelift is right for everyone. Your plastic surgeon must ‘match the solution to the problem.’
Fundamentally, a full facelift changes both the neck and jowls and is best for someone whose primary problem is their neck. The jowls get improved as well and get swept alone in the changes that occur far away in the neck. The mini-facelift, aka Lifestyle Lift as called by some, changes the jowls primarily and a little bit of the neck. Any limited improvement in the neck is the result of the changes that have occurred in the jowls. The mini- or limited facelift is best for someone whose primary concern is in their jowls. Since jowling proceeds any significant changes in the neck, one can appreciate why a limited facelift is for younger people who have less signs of facial aging.
Another way to think about it is by looking at the incisional pattern around the ears. Mini-facelifts have use an incision that runs into and around the front the ear. Pulling upward from there only impacts the jowls primarily. A full facelift uses incisions in front of and behind the ear. By moving tissue upward from behind the ear, excess neck skin can be worked out to be cut off behind the ear.
Dr. Barry Eppley
Indianapolis Indiana