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extreme sagging facial skin, what can I do?
I had a SMAS facelift in March 2005. It was a bit uneven, but the Dr. said I have very loose, non elastic skin (which is true) and it would even out in time. 5 years later, I have lost 20 lbs, my skin is sagging terribly, and I am embarrassed at how bad my skin is. Left side is worse than right. I spent so much on this procedure in CT, I need help/revision but am afraid I will get a loan for the repair, and I won't look any better. I am attaching pics so you can see the disaster of my facial skin. I am 56 years old!! I am not a smoker, tanned when I was younger, but genetically... bad skin.
There are two issues which are separate of each other. The first issue is the re-draping of the ski. This can be addressed by a mini face lift. I have looked at your pictures, and I don't think you need a full revision face lift. The terms I use are not interchangeable because every doctor uses the terms mini-lift and full face lift differently. I see a mini face lift as tightening the skin and underlying muscle structure. I do not know how much tightening of the SMAS occurred on your previous surgery, nor do I know if your recent weight loss may have contributed to the overall looseness. The second thing I would suggest is full face resurfacing with CO2 laser to grow new collagen and enhance the appearance of the skin. CO2 is one of the few entities that really addresses the skin itself and actually grows new collagen. Take a look at the attached picture of a woman with a face lift and CO2 laser.
Your soft tissue envelope really does not look 'saggy' to me. It just looks like you have a lot of sun damage to the skin layer; the look of the collagen fibers cross linking which gives all those surface wrinkles.
I would suggest a skin program that includes: retin A, hydroquinone, alpha hydroxies, Vitamin C serum. First 2 are by script from doc. So first a skin protocol from a derm for about 6 months to a year. That would 'prep' you for a later down the line more aggressive skin resurfacing treatment as in a very deep chemical peel such as a phenol peel which is basically a 'controlled burn' that burns the wrinkles off the face and new collagen is formed afterwards. CO2 laser ablation is also something for what you have. But if you can find a doc who does a phenol peel, it's likely he's been doing those kinds of peels for a long time as they have been around longer than lasers where as lasers being 'new' each year or maybe even a doctor being new to lasers, I'd look for a doc conversant in phenol peels who has been doing them for a long time.
By the way, your skin problem is not limited to PSs. So, you could expand your search also for derms.
This is easy because there is only one solution. See a surgeon who specializeses in redo face work , has lots of experience in it, and can show you pictures of many great improvements. Unfortunately, most surgeons avoid this type of work and can be hard to find. If you do not do this you can find yourself on an endless teadmill where you never get what you need or want accomplished. Take the time to find the right surgeon, redo your facelift, get a great result and put it all behind you. If you call our office we will do the best to suggest a good reputable surgeon in your area who may be able to do this work for you. 305-935-4655 Dr. Richard Galitz M.D., F.A.C.S.
Addendum to previous answer, Because of the surface skin problems in the pictures after the redo facelift for the sagging I would consider the new CO2 fraxel which gets excellent results, however if a deeper laser is needed I like the erbium which when done with experienc and aggressively can accomplish amazing things
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