Bulletin Board for Patient's Questions and Answers
Cheek lift, Malar Lift, Facelift / Neck Lift (Rhytidectomy - Rhytidoplasty) 3

Explore what others have to say about cosmetic face and neck surgery with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Facelift 3

Subj: Re: face lift

I would like to know where the scars are situated in this procedure, before or behind the ears?

I scar badly and would not like to have scars on my face'

Thank you

Sincerely

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are different facelift incisions depending on what needs to be done. In the most common case, the incisions start in the hair above the ear (temporal region), continue down in front of the ear, dip just behind the tragus (bump in front of the ear canal(, down around the earlobe, back up behind the ear, cross to the hair behind the ear, and continue back into the hair. Other incisions may be necessary. When the brow drooping is involved, the incisions continue from the temporal region up over the top of the scalp. Other forms of facelift may use other incisions, but this pattern manages the extra skin of the face and neck. Some bad scarring patients are not candidates for facelifts. It depends on the anatomy of the problem and the risks of the scars showing.

The best way to learn the risks, benefits, and alternate methods of care is during an in office consultation.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Face lift

I am an attractive 56 year old African American of medium to light brown complexion. Recently I have noticed my chin line is beginning to jowl! I hate this. I used to be beautiful and think I could be again with this taken care of! I think this is probably all I need, but how do I go about finding a board certified plastic surgeon with extensive experience with black skin? I've heard there is often a problem with scarring with black skin. But maybe the stitches could be under my chin? I live in New Mexico, but would be willing to travel to the closest large city. Can you offer advice on how to proceed. Thanks

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

I have extensive experience with black skin and minimizing scars, but I do not hold myself up to be a particular "expert". Not all patients are candidates for elective cosmetic surgery. Those with major problems with severe scars take additional risks for how such elective incisions will do. With appropriate patient selection, good surgical techniques, and compulsive patient participation in aftercare my patients seem to do well (this is unfortunately not a guarantee).

I know the skill and care that we deliver to our patients here in Richmond. I would not be able to offer with confidence someone in your region that practices with our commitment or philosophy. We see patients from all over. My office staff and I must use our time to help our own patients and cannot provide a general referral service.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: midface lift

Dear Dr. Bermant:

I am 38 year old female who lives in Europe. I am considering blepharoplasty and skin resurfacing. I have been advised by a surgeon in Spain (Dr. H) to do vertical midface lift. I am concerned that this is too early, even though the doctor suggests that such procedures can be performed starting the age of 35. I do not have any skin or facial defects. Just age appropriate aging. I would like to know your opinion on the above procedure. Is preperiosteal rhytidectomy of the upper two thirds of the face the same?

Sincerely,

O

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The age is less important than the skin and tissues of the face. A person with excessive skin aging at 38 may benefit from surgery, it depends just how bad is the problem. Time continues to age our bodies even after surgery. The younger facelift patient has many more years to age and may require further surgery to maintain results. Secondary facelift surgery can be more difficult than primary surgery. Exploring the risk benefit ratio is part of the education experience for the patient in our office.

Deep planar surgery is one of many possible methods. Swelling after surgery tends to be greater and last longer than some other methods. The best surgical choice depends on the condition being treated.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: facelift & bleph

Hi, my question is this. Two and a half weeks ago, I had a mid face lift, Blepharoplasty, and a brow lift. I am recovering fairly well. I have a concern about my right eye though. I have some Ectropion in my lower lid. I sags some, and I'm worried. My doctor says that It is normal. I'm wondering if it will correct it's self. I'm 42, and have a hyper-thyroid condition that I take medication for. Could that contribute to the problem? What if any thing can be done if the problem persists. Is it my financial responsibility to correct it? Please give me some advice.
Thank you, K

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Eyelid tone problems after surgery can happen depending on what was done.

Swelling can overcome the normal lid functions pulling the lid away from the eye. As swelling goes down, better function returns. The muscle tone can be worse after surgery if that structure was worked on. If the injury to the muscle was temporary, tone returns and the sagging lessens. Some patients have poor lid tone before surgery that barely compensates for the eyelid function. Without additional surgical movements such as canthopexy or canthoplasty (tightening of the lower lid) the eyelid with poor tone decompensates and droops. Such uncompensated anatomy may not correct.

Major mid face lifts can be done in the deep layer. In this operation the drooping cheek pads are restored to a more youthful position on the face. This major movement usually needs some type of eyelid tightening operation with it or major ectropion can occur. Fine adjustment of deep plane facelift can also be difficult. Surgery at this level can result in the cheek pulling the eyelid down if not properly anchored.

Other possibilities are just too many. There are so many possible types of surgery that can fit the description you write, that you really need to be discussing this with your doctor. No we normally never expect an after surgery ectropion, but some anatomy problems / surgical solutions have a higher chance of this happening.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Double Chin

Hello, I am a 49 y.o. white female and have been searching the net about procedures to eliminate the "double chin" problem I have which I feel adds years to my appearance. I also think it causes pressure to the neck which gives me the sensation of choking. I am very interested in learning more about how this problem can be resolved through Liposuction or surgery, but have limited funds. What is your fee for a consultation, and will Key Advantage pay any portion? I live in the Petersburg area. A response to my inquiry will be greatly appreciated.

A

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

A double chin can be from the fold of extra skin that droops from the face with age, an extra collection of fat, position of the muscles, a growth, or just the way that person is shaped. Correction may include liposuction, neck lift, weight loss, as well as other options. Without an examination I would not be able to advise which alternate methods of care would be appropriate. Insurance does not pay for cosmetic conditions nor evaluations.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: Double Chin

Thanks for such a speedy reply. I will give your office a call within the week and schedule an appointment.

Have a pleasant weekend.


Subj: Re: Neck Lift

Dear Doctor,

I am 47-years old and have always had an attractive long neck. In the last several years, drooping skin has been a problem. This seems the major area that I show my age. I am not unhappy with my face. I have seriously considered plastic surgery and went to a surgeon in my area for a $75 consultation. He told me that he couldn't do just a neck lift, I would have to have a total face lift. I wasn't ready for such radical surgery, so I have not done anything. I am still unhappy with my neck. When I pull the skin back, I look much younger.

I would like to know if there is any such thing as just a neck lift and an estimate on the cost and recovery time. I would sincerely appreciate any information that you may have on this subject.

Thank you, M

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Aging skin drifts down. Most neck lifts require the facelift incisions and dissections to move the extra tissues back up where they came from. In some unusual cases only a neck incision is possible. Extended neck skin incisions can be unsightly and pulls the skin down. Most neck lifts require incisions as seen on my web site hiding the incisions in the line about the ear, and in the hairline. The neck muscles are often additionally approached through an incision just under the chin. Some patients do not recognize the other aging features. Some surgeons do not take the time to explain their recommendations. Since I have not examined you, I can not say what your anatomy problem is nor what type surgery I would recommend

During our office consultations, this aspect of facelift / necklift exploration is very important part of our patient's educational experiences. You would need an in office consultation and evaluation to see just what needs to be done, but a typical neck and facelift is $5000 (surgeon's fee). Anesthesia is around $600 and the hospital operating room is $900. There are wide variations possible depending on the problem to be treated, surgery necessary, and other factors. Recovery time depends on what is done.

My web site is only the introduction to our office educational experience.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: facelift wt loss

I have learned a lot from your website.
I am 49 years old and have lost 80 pounds over the past year. I believe that I should lose another 50 pounds in order to achieve a weight that is healthy for me.

My question centers around losing this last 50 pounds. I am planning to undergo a facelift and chemical peel within the next year and I was wondering if I should wait to do this until AFTER I have lost another 50 pounds? I know that all surgeries are safer when you are normal weight, but I am getting impatient and have considered moving my planned surgery date up from 7 months from now to 2 months. I cannot lose 50 pounds in 2 months. Could having these procedures before the last 50 pounds have been lost affect the final results?
K

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Weight loss after facelift surgery may loosen skin enough for it to sag again (and then again it might not). The facelift is a fine tuning sculpture of the body. Weight loss is a less refined remodeling tool. I prefer surgically sculpting the features after weight loss when possible. For some, the wait is too much and earlier surgery is important. If sagging results a second operation could readjust the loose tissues. Patience can save the cost of a possible readjustment.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: facelift wt loss

Thank you for your prompt response. I appreciate the information and will admit that I suspected I should wait. You are providing a very valuable
service. I hope your patients appreciate you.
K


Subj: Re: facelift question

I just turned 60 and 20 years ago I had jaw surgery (underbite) There was always slight puffy area around my mouth and over the last 20 years and because of age this area and just under the corner of my mouth could be improved.

I went to a doctor who said you cannot just correct this with pulling area of jaw bone to ears to pull skin tighter (just about l/2" total) that I would have to have what is considered a complete face life from temple area to sides and back of ears.

My question: can't just an area be corrected without all the cutting? Also any recommendations for doctors in RI or Boston area you might suggest if just area can be done

Thank you and I look forward to hearing from you

E

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Facelift surgery requires a patient surgeon to you help understand your options and reasons surgery needs to be done in a certain fashion. In my practice there is an introduction on our website and the main work is done during the in office consultation and evaluation. Without seeing the problem it is hard to understand what needs to be done. Moving aged skin back to more youthful proportions usually needs surgery that undermines and relocates this tissue. In facelift surgery, incisions are commonly placed about the ears to help hide the scars.

I am sorry the http://www.plasticsurgery4u.com website is an example of my commitment to patient education. We see patients from all over. My office staff and I must use our time to help our own patients and cannot provide a general referral service.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: rhytidectomy

In a message you wrote:

Hi , My name is D... .I am planning to come to America in March . I would like to have a face lift , and mayby a nose job . I do Elvis shows here in Australia , so i am trying to improve my looks . I had a price on my nose job , and by memory i am pretty sure it was about A$4500 .This was quoted last year , and i thought it cost way too much . Can you please send me an estimate cost of what the two jobs would be . I understand it cannot be a fixed price , but i need some price to work by . I hope you can help me .Love to hear from you soon
.
Regards D...

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

The problem with trying to quote prices over the Internet is that it REALLY depends on what needs to be done.

Rhinoplasty is the name for a large number of operations. The cost depends on the particular type of surgery, where the surgery is done, and the type of anesthesia. A simple hump reduction in my office under local anesthesia can be as low $1500. Other factors (a more extensive rhinoplasty, hospital based surgery, and general anesthesia) can raise the price to about $6000.

Facelift surgery can also represent a WIDE range of operations. Cost increases for the more complex procedures. My surgeon's fee for an average bilateral (both sides) facelift and neck lift is $4,200. Such surgery is for the cheeks, jowls, and neck. Eyelid surgery (blepharoplasty), or forehead lift (brow lift) would be additional.

There are combined discounts for multiple surgeries performed during the same operation. Call Jane in our office for a more complete discussion about prices.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: neck lift

Hi, I just wanted to know:

I have a bow shaped neck; it has no angle basically. I just wanted to know if there is anything I can do, like excersizes, to help get a more developed jaw and chin. And if only solutio is surgery, what type could help me??? Please reply.

Thankyou,
B
P.S.: (i'm 5'11/162lbs)

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

There are many types of necks. Some have no angles due to fat, others due to loose skin. Yet other necks have the swallowing muscles and neck muscles in such a position that there is no neck angle. Without an examination and evaluation, I cannot evaluate your problem to propose possible solutions. Some problems have surgical solutions, others do not.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: facelift

I had an upper and lower face lift and upper and lower eyes lifted also..at that time he made a large incision under my chin..about 3 inches..I am 47..My lower face was melting..it looked really bad..Now the neck looked fine after surgery, and then the Corners of my mouth came back dropping full force within 2 weeks..Now it has been 4 months..And under my right jaw bone I have this puffy spot the size of a quarter and under my neck where it bends I have a thin strip of something that looks like muscle, that broke loose and it is now bruised on both sides of this strip. I do not think this is normal to start bruising after 4 months..I think something broke loose and is bleeding in there.. .. This doctor here says you can not get rid of the Creases on the sides of your mouth!! It looks like I am mad! and I hate it..The bruising underneath my neck make me worried, this just started, when this strip of Muscle broke loose..This doctor..Will not help me..I am afraid the whole neck is going to break loose..Do you think I should see someone like you, or do you know anyone in my area that can help me.. I am in Sarasota Florida..I NEED HELP!!!
K

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

It really depends on what problem you started with, and what was done surgically. While lifting the nasolabial folds (lines between the nose and corners of the mouth) is one of the major components of an extended SMAS and other special facelift operations, other lines about the mouth are not managed by facelift surgery alone. Sometimes additional treatments like laser, peels, or dermabrasion can help with some of these lines about the lips. There are other possible causes for "creases on the sides of your mouth" and without an examination no surgeon can reasonable tell from an e-mail if anything can be done.

We often use a non absorbable suture during facelift operations. In certain techniques a sling suture can pull the neck angle higher (but this type stitch may break with time). If one of these support methods is under too much stress, they can fail with time. I can imagine someone having some bruising with a support breaking. For my cases I generally divide my support sutures over many such stitches and rarely see one of them breaking.

Of course working with your own doctor is the best, since that doctor knows what was done, the problems that were originally addressed, and what can be done. If that is not possible then you would need to be examined and evaluated in person by a doctor. Advice over the Internet is just not the same.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD


Subj: Re: mid face

Hello,
I am interested in info. re: the middle third face lift procedure. Are you familiar with this? Do you practice it? Do you have any info about it? Could you ex- plain it?

Thanks in advance for any input.

Sincerely,

J

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Yes, we do "middle third of the face lifts" which may be part of facelift surgery or blepharoplasty. There are many types of middle third lifts for the different problems seen in the middle face. It may involve lifting the nasolabial folds (lines from the nose to lips), the malar (cheek) tissues, and tissues about the lower eyelids. Some patients are candidates for an endoscopic approach for the midface from the brow as part of a forehead lift or by itself. The educational package beyond our extensive web resource is IN our office and part of the consultation. We prefer to design the experience for each patient around THEIR OWN problems. If interested in learning what plastic surgery may have to offer, please call our office.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

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