Question: I have been looking at the different options for plastic surgery of the face. It amazes me what can be done now. I think that I would like fat transferred to my neck to fill out the lose skin. Is this a viable option?

Answer: I do not think that fat grafting to your neck would be a wise decision to fill out any sort of laxity or lines due to the fact you would simply look like you had a fat neck after that type of procedure.  Most of the time what we would like to create is a very elegant neck line in most individuals which would require he elevation of the neck structures and the removal of any excess skin if needed.  Ultimately, a consultation with a board-certified facial plastic surgeon would allow you to have a customized treatment option that would best fulfill your desires regarding your specific anatomic concerns. 

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No, there really is not any significant possibility of cartilage shifting after the repair of a broken nose but there are certainly circumstances where the cartilage and bone have been altered such that there will be persistent asymmetry after the repair of a broken nose.  Classically, a broken nose involves the fracture and displacement of the nasal bones, one typically being depressed and one being pushed out from its normal location.  During repair of a broken nose, the depressed nasal bone is elevated and the displaced nasal bone is then pushed towards the midline so that they essentially lock back together again, and they create a midline appearance and symmetry to the nose that was present prior to the injury.  In certain circumstances, however, the cartilage just below the bone can be avulsed or separated from the nasal bone itself, and this may not be recognized during the initial evaluation.  The nasal bones can thus be reduced and placed back into their proper anatomic location but, due to the fact that the cartilage has been separated from the bone, there may still be a depression on one side or the other due to this dislocation of the cartilage from the nasal bones themselves.  This can be extremely difficult to analyze immediately after the injury due to the fact that there is typically some minor residual swelling but also due to the fact that the nasal bone itself is depressed and displaced and it is, therefore, very difficult to appreciate whether the cartilage is displaced relative to the bone or if the cartilage is just displaced due to the fact that the bone is malpositioned.  There really is no good way to try to correct the displaced nasal cartilage anyway and, for the most part, I tend to treat the nasal bony fracture and, should there be a resulting cartilaginous displacement, this can be addressed at a later date and, unfortunately, a second surgery.  I feel that an evaluation by a very experienced rhinoplasty surgeon would be very beneficial for anyone who has undergone treatment of a broken nose and yet still has unexpected consequences.

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A weekend facelift is simply a miniature facelift that can be performed in an office setting under local anesthesia.  Various names can be applied to this type of lift such as a lifestyle lift, a Quick Lift, an S lift, mini lift, and even many surgeons have made up their own names for this procedure but, all in all, they are very similar and have been well known for 30-plus years.  The procedure involves the application of some local anesthetic under the skin in and around the ear area.  Incisions are then made in and around the ear to hide them and then the skin is elevated, and portions of the deeper tissue are then lifted and secured to a more aesthetic position using sutures.   The excess skin is then reflected back, removed, and closed with more sutures that are removed typically in about one week.  This type of lift can be very nice for patients with early laxity that really do not require an extensive full facelift or for those that can either not afford the more sophisticated facelifting approach or are not healthy enough to undergo any sort of a more advanced surgical procedure.  Ultimately, I always recommend that patients seek out a well experienced facial plastic surgeon who can give various options regarding their facial rejuvenation.  I am always concerned if the surgeon only is capable of performing one surgical technique of facelifting because all of that surgeon’s patients would therefore qualify for that single technique, and obviously not all patients are ideal candidates for a specific surgical procedure.  I personally highly customize all of my facial rejuvenation procedures for each individual patient’s facial anatomic features.  That way, the patient’s rejuvenation is maximized, and even the overall natural appearance of the outcome is also maximized by this significant customization process.

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The far majority of my patients can go into public without looking like they have had any sort of surgical procedure approximately one week after a facelift.  For patients with very early signs of aging who elect to undergo an in-office mini lift, that may be as little as a few days if they wear their hair in front of the areas where the incisions are made around the ear.  For patients who elect to undergo the more sophisticated and more rejuvenating and longer lasting extended SMAS deep plane facelift, they too can look quite good in less than a week depending on the amount of bruising that they end up with.  Certainly, by day 6 to 7 when sutures are removed, the majority of bruising is already resolved, and a little cover makeup can be applied, and patients can go back out into public looking quite normal and quite rejuvenated.

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