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Steven M. Denenberg, M.D.
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face lift and chemical peel
 
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This woman had a face lift operation and a chemical peel of the skin around her mouth.  But she also had another procedure, called a pre-jowl implant.  The jowl makes a bulge in the jaw line, and there usually appears to be a dent just in front of the jowl.  The face lift pulls the jowl's excess skin up and back toward the ear to smooth the jaw line, but the smoothing can be more effective if we put something underneath the skin to push out that dent at the same time.

That something is called a pre-jowl implant, and as the name suggests, it fills out the depression in front of the jowl.  The implant looks very much like a chin implant, but it is shaped so that it doesn't make the chin stronger from the profile view.  The face lift surgery tutorial contains a chapter devoted to the topic of pre-jowl implants (the surgery tutorials contain explicit photographs taken during surgery).


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face lift and chemical peel

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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: Is my nose tip broken?
As a child I had a bad fall on my nose. Ever since it has gradually got worse over the years. I have trouble breathing from my left nostril and I have a poor sense of smell. I can feel a split at the front of the tip. Also if I squeeze my nose tip it feels springy. I'm not sure if this is related, but I suffer with nose bleeds alot too
(Questioner submitted photos)

Dr. Denenberg's answer: Your nose isn't broken, but you must be very careful in selecting a surgeon.
The split and the springiness and the size of your tip are all related to the fact that the two cartilages that form the tip of your nose are fairly large and asymmetric. Your skin is thin, so it's easy to see, and even feel, the contour of those cartilages under the skin.

This all means that if you decide to have a rhinoplasty, you must be very, very careful about selecting the right surgeon. The vast majority of rhinoplasty surgeons do not have the skill and expertise to handle your tip cartilages, which cartilages pose a significant technical challenge.

When evaluating surgeons, you must insist on seeing before and after photos of their other patients. Look to see whether the doctor has been able to handle large tips like yours. If the photos only show profile views, like shaving off a hump, that's not good enough evidence for your situation. Generally, the three-quarter views show the tip cartilages best.

Link to this question on RealSelf.com