In my 10-year journey as a plastic surgeon, I've encountered numerous procedures - some I chose not to perform, others I started and later discontinued. Today, I find myself specializing primarily in face and neck rejuvenation surgeries. As a surgeon who also frequently performs breast and tummy tuck procedures, I can confidently say that facial surgeries present a uniquely challenging field, especially for surgeons.

Why? The answer lies in the social nature of our faces. Unlike other body parts, we can't simply cover our faces with clothing in our daily lives. This reality leads to a common priority among patients: they want to return to their social lives quickly, without any unnatural appearance.

Learning from the Best

I've had the privilege of connecting with some of the world's most talented and experienced surgeons in face and neck rejuvenation. These interactions allowed me to observe their surgeries firsthand. The field of facial rejuvenation is incredibly diverse, with numerous approaches for each area of the face. After implementing various techniques, I've developed my own specialized approaches.

Managing Expectations in the Age of Social Media

Patients reach out to me from all corners of the globe. Almost daily, I receive dozens of photos and videos from individuals seeking consultations about their faces. Interestingly, I end up declining more than half of these cases, citing a lack of need for surgery. Unfortunately, the influence of social media and selfie cameras has led to expectations that often stray from reality.

My Philosophy: From Simple to Complex

For patients who do require intervention, my approach typically follows a progression from simple to complex procedures. Whenever possible, I prioritize recommending interventions that are:

1. Simpler

2. Have fewer side effects

3. Are less traumatic

4. Can be performed under local anesthesia

However, there are cases where I foresee that these simpler approaches won't yield significant improvement. In such instances, I don't hesitate to propose more aggressive treatments from the outset.

The Power of Combination

When rejuvenating the face and neck, I often recommend combined surgeries involving multiple interventions. Since aging doesn't occur in isolation but affects multiple areas of the face, the key to rejuvenation without altering a patient's character lies in addressing all aging areas simultaneously. Contrary to popular belief, this comprehensive approach often yields more natural results.

Common Combinations

Let me share some examples of frequently performed combined surgeries. In my professional experience, the most common age-related changes include:

• Excess skin and sagging in the under-chin and neck areas, leading to loss of neck angle

• Sagging due to excess skin on the eyelids, particularly the upper lids

• Eyebrow drooping

• Elongation of the space between the upper lip and nose

• Volume loss and downward shift of upper facial volume towards the lower cheek and jawline

Each of these issues requires a different approach, but many interventions complement each other. For instance, when planning a face and neck lift, I often recommend brow lifting and eyelid blepharoplasty as well. If the lip-to-nose distance has increased, I might suggest a lip lift procedure. Almost every patient receives fat injections along with face-neck lifts and brow lifts.

The Art of Fat Injection

I perform fat injections using two different methods:

1. Micro-fat injection for volume restoration and addressing contour irregularities

2. Nano-fat injection, rich in stem cells, for rejuvenation without adding volume to the face and neck skin

Tailoring the Approach

Some patients require more aggressive surgeries. For instance, in cases of "turkey neck" where the neck angle is lost, I make an incision under the chin to correct deep neck tissues. In some patients, I even reduce the salivary glands through this incision. I employ all tools at my disposal to enhance the neck angle and jawline, as these areas tend to show the most prominent signs of facial aging.

A Powerful Combination: Liposuction and Thread Lift

One of the most frequent procedures in my practice is a combination of double chin/neck liposuction and thread lifting. This powerful method, which I've been using for years, is ideal for patients who have:

• Slightly lost neck angle

• Excess fat in the double chin area

• Mild skin laxity

This combination allows me to remove excess fat through liposuction while tightening the skin with thread lifting. It's a procedure I'm particularly fond of, as it can be performed under local anesthesia.

Addressing Common Misconceptions

I often hear patients asking about specific techniques like "deep plane face-neck lift" or "SMAS face-neck lift." These are not questions patients should be concerned with. Unfortunately, today's marketing world has led to the technical details of surgeries being used as selling points. The truth is, different surgeons can achieve beautiful results using various techniques. What truly matters is:

• Which technique the surgeon's hands are most adept at

• Where the surgeon's experience lies

• Which technique allows the surgeon to achieve the best results

As a patient, your focus should be on collaborating with your surgeon for results, rather than discussing specific face and neck lift techniques.

Remember, the goal is to achieve natural, harmonious rejuvenation that enhances your unique features while maintaining your character. It's about looking like the best version of yourself, not a different person entirely.