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Question :
I know the facelift improves loose and sagging skin but will it help with wrinkles too?

Answer :
When I see patients in consultation for facial rejuvenation surgery I discuss with them the components of the face which contribute to the appearance of aging.  Excess skin is something that can be treated with a facelift, and this is one of the most frequent issues patients see me for.  The quality of skin, however, is another issue.  If the skin quality is poor then treatments such as chemical peels, Fraxel laser, or full face laser resurfacing would also need to be performed if there is significant skin quality issues to include deep wrinkles.  Facelift surgery is really designed to reposition excess skin and facial soft tissue that has suffered from the effects of gravity over time.  Sagging and excess skin can be corrected with facelift surgery, however, deep wrinkles generally are not.

Posted by Dr. Philip Schoenfeld

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Question:
If a facelift lifts and tightens the skin, what do you then do about wrinkles in the skin?

Answer:
When I discuss facial rejuvenation with a prospective patient I focus on a couple of different issues. The first issue is the amount of excess skin of the face or skin QUANTITY. As you have stated, a facelift is a good way to deal with excessive skin of the face. The second issue is the fullness of the face. Like a balloon, the face will deflate over time and simply pulling the facial skin tightly will not bring back the youthful fullness of the face. In many facelift patients, I also perform fat injections to the face to help add volume to the aging face. Finally, I spend a great deal of time with my patients discussing skin QUALITY and how this impacts the appearance of the face. In order to address skin quality issues procedures such as, chemical peels, fraxel laser, and ablative laser skin resurfacing need to be considered. The exact treatment that we choose to perform will depend upon the status of the skin, the depth of wrinkles, and the tolerance for down time that the patient may have as the more invasive the procedure the more dramatic the results may be, but the longer the recovery time will also be.

Posted by Dr. Philip Schoenfeld

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Question:
If I stand in front of the mirror and push the skin on my cheekbones, back, it improves the look of my cheeks and what must be my jowls. This seems to be the oldest looking part of my face and I would like a mid-face lift to repair it. Would this surgery prevent me from getting a facelift later on if I need it? I am 48 years old.

Answer:
Your question has many different parts and a great deal of information. The area that you are pushing back to make you appear younger is your mid face area. The mid face is the area of your face that mostly involves your cheeks. As we age our cheeks begin to descend and this thins out our faces and makes us look older. Elevating the mid face can help refresh your appearance. I am also a big fan of facial fillers and fat injections for cheek augmentation. In more extreme cases, mid face implants can also be helpful. The idea of each of these approaches is to give your mid face a look of fullness and definition. Elevating your mid face will not address the issues that you have with jowling and a face lift would be necessary to adequately correct for aging in this area. At 48 years old, you may be a good candidate for a mini face lift to help with your jowls.

Posted by Dr. Philip Schoenfeld

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Question:
I am a 46-year-old woman with deep frown lines. I have read that dermabrasion can be used to reduce the appearance of frown lines. How effective is this procedure?

Answer:
A deep plane face lift is a type of face lift that is a bit more aggressive than a traditional face lift, but, addresses areas of the face that a traditional face lift does not do as well.  There are several layers of skin and tissue in the face that are dissected during the face lift.  The deep plane face lift goes beneath the SMAS layer of tissue and goes right up to and beneath the nasolabial folds.  By freeing up the tissue in this area, the purpose is to decrease the appearance of the nasolabial folds.   Surgeons who prefer the deep plane face lift claim that this particular face lift has better results and that the results last longer than a sub-SMAS plication face lift.  So far, the studies that have been performed comparing the two face lifts have not shown any increased patient satisfaction or longevity of the results when both face lifts are performed correctly.  Opponents of the deep plane face lift claim that the swelling associated with the procedure lasts too long.  Your question is a good one but a tough one, too.

Posted by Dr. Philip Schoenfeld

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Question:
I am a 44-year-old male and I’m concerned about the wrinkles around my eyes. I am white and I would like to know if I had laser skin resurfacing just around my eyes, would that change the color of my skin in that area somewhat? Do you suggest getting the entire face treated because of pigment changes?

Answer:
Laser skin resurfacing is an excellent way to address the wrinkles around your eyes. You do not have to treat your entire face. Some of the potential complications of laser skin resurfacing are hypo (too little) or hyper (too much) skin pigmentation of the lasered skin. Light skinned individuals tend to have fewer side effects from laser skin resurfacing as there are fewer skin pigment issues to be concerned with in the healing process. Your laser surgeon will feather in the laser so there is not such a dramatic change in skin texture and appearance between the treated peri orbital skin and the untreated facial skin.

Posted by Dr. Philip Schoenfeld

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Question:
I have smoker’s wrinkles around my mouth. I would like to remove them without surgery. What is the best injectable filler to use in this area?

Answer:
Smoker’s wrinkles, lipstick bleed lines, and other wrinkles around the mouth are extremely challenging issues for both the physician and patient. Although dermal fillers such as Restylane and Juvederm will certainly help with filling the wrinkles and plumping the lips, which also decreases the wrinkles on the lipstick line, for really deep wrinkles, a laser treatment or medium to deep chemical peel may likely be required to effectively reduce the appearance of these lines. In cases where the lines are worse with excessive motion of the mouth, a small amount of Botox or Dysport will help with this as well. Your physician will be able to help you decide which procedures would be right for you.

Posted by Dr. Philip Schoenfeld

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