Facelifts may need ‘help’

Q: I had a facelift about six weeks ago. This was a very traumatic experience for me. While my jowls and neck got better, my nasal folds and turned down corners of the mouth did not. They initially looked good while I was still swollen but that has now all gone away. This is very disappointing since this was one of the main reasons I had the operation. I feel like I wasted my money as my jowls and neck were not that bad.

A: This is a common misconception and occurs either as a result of inadequate education during the consultation or a failure to understand what a facelift does best on your part. Because the tissue pull of a facelift occurs from around the ears, it has the least effect on anything far away. The mouth area is the furthest point from the ears on the face, thus deep nasolabial folds or a downturned corner of the mouth will ultimately remain unchanged. It is just biomechanically impossible to substantially change the center of the face from back in the hairline. This is an issue that has frustrated facelift surgeons for years and many techniques have been tried, few with much success. This is why adjunctive techniques are often done with facelift that address the mouth area directly, like fat injections and a corner of the mouth lift. These can be at the time of a facelift or afterwards as may be desired in your case.


Q: I am a 32 year old and about six months ago an ENT specialist diagnosed me with having a deviated septum. I have not had good sleep in about 15 years, because I have extremely restricted breathing. I do have insurance to cover the surgery but would prefer a plastic surgeon to perform the procedure, so that I may also correct a very large bump on my nose that I have extreme insecurities about. Do you know if your services would be covered by the insurance company? Also, is this a procedure that can be done if I am in my first trimester of pregnancy?

A: Your inquiry has two fundamental misconceptions. First, no elective surgery or procedure is ever performed on any patient who is pregnant. Pregnancy is an absolute exclusion for surgery and anesthesia because unknown and potentially deleterious effects on the developing fetus. Secondly, insurance does not pay for any external change to the nose such as removing a large nasal hump. That is cosmetic surgery and must be paid for as an out of pocket fee. Insurance will usually cover septoplasty and other functional nasal airway surgery but not for any rhinoplasty procedure. The two most certainly, and commonly, are done together but you will have to pay additional surgeon, OR and anesthesia fees for the cosmetic portion.