Your Questions

Q: Dr. Eppley, Not sure what I really need. My forehead has deep wrinkles, I have sagging eyelids, bags under my eyes and jaw line and under chin drooping. Is this a full facelift or what?

A: What you are describing are numerous facial aging changes that are located around the two main areas that bother people the most, the eye area and the jawline/neck region. Unless there is some significant eyebrow sagging, the forehead wrinkles are treated with Botox injections and not surgery. Changing these two aging facial areas require a combination of blepharoplasties (eyelid lifts/tucks) and a neck-jowl lift. This is often interpreted as a ‘full’ facelift but this is not really an accurate description. A facelift is the purest sense of the word really just addresses the neck and jowl area and nothing above the lower 1/3 of the face. You may have interpreted eyelift surgery as part of a ‘facelift’ but they really are a separated procedure that is often done simultaneously for a more complete facial rejuvenation effect.

Please send me some pictures of your face for my assessment and a more individualized answer for your needs.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Hello, I am looking the best procedure for diminishing marionette lines, over lips, and most importantly, droopy skin on the neck. What do you recommend?

A: In reading your question, I am going to assume that you mean marionette lines that start at the corner of the mouth and hangs over the corners. (hence the phrase ‘over lips’) When you combine those aging facial features with droopy neck skin, you are talking about a combined neck-jowl problem. Heavy marionette lines that hang over the mouth corners indicates that there is likely some jowling and skin that is falling forward and down…the reason thaty most marionette lines exist. While I obviously have not seen any pictures of you nor have examined you, all of these aging facial issues point to one and only one effective treatment option…some version of a neck-jowl lift. The key issue is the droopy neck skin. Nothing short of this type of a tuck or lift can change a loose neck skin issue. This is often combined with a corner of the mouth lift to get rid of the overhang, a small little procedure done at the corner of the mouth. This will most effectively get rid of the loose neck skin, ‘over lips’ and decrease the depth of the marionette lines.

It would be helpful to see some facial photographs or come in for an evaluation to confirm this potential recommendation. These are common facial aging problems where patients are often searching for some ‘simple’ or non-surgical approach where such treatments do not really exist. You want to avoid wasting money on any non-surgical treatments that really have no hope of making a substantive difference…and there are lots out there that sound good but don’t work very well.

Dr. Barry Eppley

Indianapolis Indiana

Q: Hi Dr. Eppley, I am interested in nose and neck surgery. In the front view the tip of my nose is too fat. My nose profile shows that my bridge projects too much and the line from my top of forehead down through the bottom of my nose is too straight. I wish to have these things changed by a closed rhinoplasty. Also my neck and jowls is sagging and I would like liposuction to tighten them up, I am 49 years old. Additionly I don’t wear face makeup so I wish for no visible scars to show. Thank you for your time and I really enjoying reading all your info on the web and hoping you can improve my nose and neck. I have attached some pictures for you to review.

A: Thank you for sending your pictures. I have some computer imaging on them and those are attached. Here are my comments based on your stated desires and what is realistic.

Your rhinoplasty would be best done open. You have thick nasal bones and cartilages and to effect those changes you would get a better result through an open visual approach. (less chance of need for revision) You have thick nasal skin so there is no risk of having your nose ‘overdone’ or looking like it is too small or has an operated look. Thick nasal skin always make a rhinoplasty result less rather than more in appearance.

You have too much loose jowl and neck skin to just do liposuction  alone. That will just make the skin look loose and have more sag. You need a tuck-up neck-jowl lift with liposuction to get the result that you are after. Again, the thickness of your skin and it looseness work against a fat removal only procedure. Your skin quality and amount in the jowl and neck area makes it necessary for a more aggressive approach to get a good result.

One additional thought is that of your chin. It is horizontally short and that works against you getting an improved jaw line and neck appearance. A chin augmentation would really complement the neck-jowl lift.

Dr. Barry Eppley

Indianapolis Indiana