When To Have Plastic Surgery

I am often asked by my Beverly Hills patients if it is the “right time” to have a certain procedure, or if they have “time to wait”. Certainly, this is a very personal issue and depends on many factors. Having a facial feature that you have never liked, as with a large nose or a receding chin, will never improve with time. So it amounts to deciding on the cost/benfit ratio and if you have the time available to recover. These patients also tend to worry that they may wind up looking worse than before. Consequently, they are torn between their desire for change and the fear of the unknown and tend to procrastinate. To these patients I say that plastic surgery, if done properly by a competent surgeon who understands your goals, will make you look better and will blend harmoniously with your other facial features. Surprisingly, though the result may be quite dramatic to the patient, it is rarely that evident to friends, colleagues and even family, especially if the patient changes their hairstyle, shaves off a moustache or does something else to alter their appearance in another way.
When we consider rejuvenative procedures such as face and neck lifts or eyelid surgery, there are some who think earlier is better and some who think just the opposite. Those who favor the earlier approach argue that the change tends to be less dramatic and, therefore, less obvious. On the other hand, those who favor waiting till it’s unbearable to look in the mirror or uncomfortable to wear tight collars think you get  more “bang for your buck” by waiting. My personal opinion is that you should try to look as good as you can for as long as you can. Since youthful skin has more elastic fibers and better collagen, it tends to re-drape and conform better producing a more rested and healthier appearance. And having a procedure earlier rather than later, allows you to enjoy the benefits for a longer period.

For patients who aren’t ready for a facelift or who may never want facial surgery, the Beverly Hills Necklift can give dramatic, rejuvenating results. As the skin loses its elasticity and starts to sag, the neck can suffer the most. Add an accumulation of fat underneath the jawline and laxity of the muscles in the floor of the mouth supporting the salivary glands and a full, sagging neck is the result.
The procedure is generally performed under intravenous sedation or general anesthesia. A small incision is made underneath the chin and incisions are made behind the ears. However, there are some patients with such extreme skin laxity that facelift incisions are also necessary. This is so because the skin has to be pulled superiorly on to the face as well as posteriorly behind the ears to accomplish the desired result. A small drain is usually placed over night and full recovery generally takes one week.

There are many young patients who have never had a right angle under their jawline and would benefit from the Beverly Hills Necklift. Their full neck is primarily related to the orientation of the muscles that form the floor of the mouth and, to a lesser degree, fatty deposits and/or prominent salivary glands or hypertrophied muscle.

To correct this deformity, a combination of several techniques are used. Liposuction, creation of muscle flaps, excision of muscle, transection of muscular attachments, suspension sutures or partial salivary gland resection are  the primary approaches. The procedure need not be performed with any additional facial surgery and can have a dramatic effect on the overall appearance.

There are two different classes of patients seeking necklift surgery.

The first group consists of younger patients who have always had a fullness under their jawline. Their problem is more of an anatomical nature where the muscles that form the floor of the mouth are oriented obliquely downward rather than parallel to the jawline. This, in turn, is related to the position of the hyoid bone to which they attach.. Instead of being high and posterior under the angle of the jawbone, it is forward and low. Also, in some instances, fat may be present to further exaggerate the deformity.

The second class of patients are older and usually in their 40’s, 50’s or 60’s. With these patients we see excessive skin laxity coupled with fatty deposits. Lifestyle coupled with aging and genetics play the prominent roles here.

In both instances, a necklift can have a positive impact on the overall appearance of the face.