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Beating the Clock: How to Know When It’s Time for Surgery

March 13, 2017

No one is in a hurry to go to the operating room. Who wouldn’t choose a noninvasive-less costly-no downtime-scarless-relatively painless procedure over surgery? Injectables, lunchtime “lifts” and skin tightening devices are certainly popular, but there comes a point of diminishing returns when surgery is truly the best option.

According to Dr. Michael Lee, once certain characteristics are present, non-surgical methods cannot be expected to substitute for surgical intervention. Ironically, trying to correct these problems with non-surgical methods often leads to what patients fear most about surgery–an unnatural, distorted appearance that makes them look “done.” So, how do you know when it is time to “graduate?”

Here Dr. Lee explains the telltale symptoms for proper self-assessment when it comes to facial rejuvenation. Technically speaking, a facelift addresses the mid and lower face; a necklift will treat the neck and jaw line, an upper eyelid lift corrects redundant eyelid skin and a lower eyelid lift treats bags and hollows under the eye. While it is common to treat the face, neck, and eye areas holistically as part of facial rejuvenation, Dr. Lee will discuss each below as an isolated procedure.


Patients are usually very interested in how I assess their face. I begin a facial rejuvenation consultation explaining that as we age, changes begin to surface in two distinct areas of the face. This happens because of gravity, loss of tissue support, and often loss of volume.

Loss of midface volume.
The long-term impact of gravity can be seen when the tissue volume of the cheek area begins to descend lower on the face. This often leads to the development of prominent nasolabial lines (the lines that begin at the corner of your nose and extend to the corner of your mouth). Filler is a great option to treat the nasolabial fold. Early on, fillers can also be used to camouflage the descent of the cheek volume. However, it is important to understand that the cheek tissue did not disappear– it simply dropped lower on your face. This leads to a square shaped face. Using filler to try and correct this square shape can lead to overfilling and an abnormal look. When you find that you are constantly having to receive more and more filler, it is time to see a facelift specialist. The High SMAS facelift actually repositions the droopy cheek volume back where it should be addressing both the cause and effect of the problem.

Loss of lower face definition.
A poorly defined jawline is the result of the fullness that was once part of the midface–shifting downwards. When it becomes more prominent at the bottom of the face, at the jawline, jowls become noticeable. Filler is often placed in front of the jowls to camouflage the area. This is an option early in the formation of jowls but surgical consultation should be sought when moderate to severe jowls are present. A facelift repositions the jowl tissue, restoring a more youthful jawline.

High SMAS Facelift Before & After Photos


potential-facelift-patientFacial aging can be quite noticeable with the changes that occur in the eye area. Excess skin and fat in the upper lids create “hooding” making people appear tired and fatigued. While most patients are focused on the upper eyelid skin, many are unaware that the brow may also be low. There are three circumstances I see during consultation that affect the upper lid and require surgery.

One situation is simply excess skin on the eyelid. Sometimes the skin can fold over on itself, or completely cover the lash line or hang over the side of the eye. If the brow is in the proper position, an eyelid lift is a simple procedure that can have dramatic results.

Another condition is brow ptosis where the brow has descended due to aging. Patients often come in for an eyelid lift, unaware that the brow is the reason for excess skin gathering on their lid. The upper eyelid and the brow are intimately related and function as a unit. Once the brow is repositioned surgically, the skin will lift off the lid.

In the third scenario, both conditions are present–the brow has dropped and the eyelid has skin laxity. Both must be treated for the best result, so I would recommend a combination upper eyelid lift and brow lift.

What can be done non-surgically? Early in the aging process, Botox® can be used to gain a subtle lift in the brow by relaxing the muscles that are bringing the brow down. While Botox® may provide some improvement in the brow, surgery is the only real answer for excess skin or excessively low brow.


eyelid-lift-questionsEarly signs of aging can often be seen in the lower eyelid area. Patients are concerned about excess skin, dark circles, hollow areas, or bags under their eyes. Filler is an option for this area though there are associated risks given the proximity to the eye. Some of the minimally invasive treatments for excess skin on the lower lid include lasers or chemical peels to tighten the skin. Surgery remains the gold standard as it can correct the three anatomic structures mostly responsible for these changes. Surgery allows excess skin to be removed, fat to be removed or repositioned to fill in hollows, and the muscle to be suspended to alleviate shadowing of the area.

Eyelid Surgery Before & After Photos


neck-lift-resultsThe neck is comprised of skin, fat, and muscle, but I tell my patients, it all starts with the skin. Some non-surgical devices may help slightly tighten the skin but none come close to the result that surgery can deliver. If the skin is relatively tight but there is isolated fat in the neck, there is better news. That fat can be treated with noninvasive and minimally invasive means such as CoolSculpting® which freezes fat or Kybella®–a new injectable that destroys fat associated with a double chin. These modalities can mimic surgical results. Some patients are thrilled to eliminate the fat on and around their neck, but then realize the platysma bands formerly disguised by the fat, are now prominent.

If the problem is platysma banding (the bands that protrude when you grimace), those are only sufficiently treated surgically. In very mild cases, you can see some correction using Botox® to soften the bands, but if they are severe and hanging down, surgery is the better option. With surgery prominent muscles can be contoured and smoothed, supporting the neck and providing a more youthful look from chin to clavicle.

Neck Lift Surgery Before & After Photos

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