LAM FACIAL PLASTICS

Dr. Lam, I am a 61 year old woman who has been using perlane for the past three years to camouflage jowling in chin and sagging jawline. I have been 100% happy with the results. My dermatologist has been encouraging me to get a minilift. However, here is the problem. I have a VERY thin face--no hollowing--just narrow with very flat cheekbones. I never had any nasolabial lines because cheeks were never prominent. The lines are from mouth down sides of chin. And sagging on jawline is bad. I have the typical squaring of the lowe face which makes my shape a rectangle. When I smile, I have nice apple cheeks but otherwise flat. But when I raise the skin over my cheekbones like in a lift, I only have a tiny amount of skin that could be cut--maybe a fourth of an inch pinch at the ear. My dermatologist admits that I would still have to have fillers, fat, or sculptra. I am terrified of making the situation worse with a lift. Two surgeons have suggested a skin only lift with scar in front of ear. Would I be better off to continue the perlane treatments than to take a chance on a lift with very little excess skin and have to use fillers anyway? I have also lost fat in temple area. I had IPL series of six treatments when I was 55 but I also went through menopause then so not sure why face is so thin. It might also be hereditary since my father's face also was very thin. I am not underweight just no fat on upper body or face. I just don't see how a surgeon is going to be able to pull such a small amount of skin. Thank you so much. I realize you can't say much without a picture, but I just wondered if for some people fillers or fat is the best way--not a facelift. Thanks again.

you probably know my answer already. i truly think fat makes the face look wonderful especially in a face like yours. too often we get focused on one little tiny area like the jowl and beat it down to death when we miss the entire face. when the face looks gaunt, the eyes tired, then who really cares about the jawline? we need to think globally. fat may not "fix the jowl" perfectly like perlane but i can create a total composite of a wonderful face. remember people talk to your eyes not to your jawline. as far as a skin only facelift, ARE YOU KIDDING ME? that is the most useless and dangerous surgery there is. i did not think people still did that since the 1960s. pulling skin leads to no real results after a week except a widened scar. i truly truly am flabbergasted that a skin only facelift would still be performed after 1970. ok, those are my opinions.
best,
sml

Thank you so much--it scares me to think how close I was to getting the skin only lift. I truly believe my main problem with the sagging jaw is because I have lost that fat in the cheeks. I see other women with jawlines that are not "sharp", but look lovely because the fat camouflages them. I have nothing to camouglage jowling. Would you possibly suggest (after having seen my pictures) to do the fat grafting first and then deal with any chin jowling? My neck is pretty good--thin, of course, and some laxity, but I could live with it. What made me come here was I read on a forum from a very smart lady that a facelift can cause even more flattening of the sides of the face and in a thin person that is horrible. Also, I saw a picture of a very beautiful actress (63 years old that everybody raves about and says her surgery is wonderful. Well, she has that squeezed in flattened sides of the head from the front. That really scared me because she either needs fat injections or her facelift went really wrong. I am so glad I found your name. I live in Illinois so not so far away. If you thought I needed a facelift, is that small amount of skin enough to pull up and then cut and stitch? Thanks again and I am so glad i talked to you--when I asked one of the surgeons about my thin face, he just said we could "put some sculptra i there". I am very afraid of sculptra.

preaching to the choir. yes, fat alone can be a very reasonable first step. in many ways it can be enough. of course, i would have to see you. i too am not a big sculptra fan. it does not allow me to balance the face by filling many areas safely. it only works in the cheek and it is a bit unpredictable in my opinion. as far as lifting some skin, remember a facelift is not a skin lift or at least should not be. i look forward to review your case when you are ready.
best,
sml