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Facial reconstruction with a multi layer face-lifting, fat grafting with fat injections and contouring, liposculpture with removal of fat, and endoscopic neck lift with contouring of the neck without a chin incision.

Patient Concerns:

This is a 54-year-old woman who is concerned about the appearance of her neck, jowls, the droopiness around the mouth, and the deep folds and facial wrinkles. She was very concerned about facelift scars and wanted to have as few incisions as possible. She requested scarless surgery and to have the incisions be as invisible as possible. She had previous liposuction done by another surgeon, but the patient was unhappy because it gave her two areas of drooping fat where the fat was not adequately removed with liposuction. There was also an indented area in between where she was over-liposuctioned.


We tried to avoid any incision in the chin or facial region other than the incisions placed in front of the ear, behind the ear, and in the scalp. An endoscope was used to assist in contouring down the excessive fatty deposits that remained after her previous liposuction. The endoscope gave such good visualization that we did not have to make an incision underneath the chin. On the right and left side, the neck is smooth and no longer has the fatty deposits. The indentations also have been smoothed out.

The jowls were a problem for her, as was the indentation in the jawline demonstrating the facial deflation that is so common in the aging process. Thus, the jowls were removed and the soft tissue was lifted with a multi-layer face and neck lift. Fat grafting with injections were also placed along the jawline to augment the jaw and fill in the deformities.

The jowls were treated in a similar fashion but the asymmetries are noted and the two sides needed to be treated differently. The wrinkles and the depression around the mouth also has been improved, as have the deposits of fat in the neck. The deposits are significantly different bilaterally.The result continues to be maintained well over a year after surgery.

The incisions are in the front of the ear, behind the tragus, and in the natural creases around the ear. They are also hidden in the hair-bearing tissue. Thus, the patient has no scars of the face that are visible to her.


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