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Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.
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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All views of this lift and peel patient:
face lift and chemical peel
lift and peel
current: Right oblique
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 This a Normal Result After Septorhinoplasty?
I got septorhinoplasty almost 5 months ago and i am depressed how my nose looks from the front and am so self concious now when i smile. I had deviated septum fixed, dorsal hump removed and deprojection of my nose done and NO TIP Work done. My nose looks great from the side profile but looks huge and like a shapeless potato from the front when i smile. Is it normal for it to look that way? Can steriod shots help? Please help!! thank you
(Questioner submitted photos)

Dr. Denenberg's answer: It's possible to improve the frontal view, depending on what was done to your tip cartilages
Hi. Forgive me if I try to address your frontal view by starting with your profile. When a hump is removed, it can make a nose look longer, so we often shorten the nose. Making the nose shorter can help the frontal view by presenting less of a vertical height of the nose. See my "Web reference" link for a morph I made of your profile view.

Since you had no tip work done, the tip of your nose probably didn't deproject, because deprojecting the tip of the nose, and shortening it, require complicated work on the tip. In my morph, I raised your tip and deprojected it.

Further, when a hump is removed, it's important to look at the very top of the nose, just below the eyebrows. If that part of the nose isn't reduced as well, the profile can take on a little bit of a Roman statue look, where the forehead seems to slide right onto the nose. You'll see in the morph animation that I brought that part of your nose closer to your face. If you find yourself thinking about a revision to get the frontal view looking better, you might think about these changes to the profile, too.

I personally don't think steroids would work very much this late after surgery. I would hope that at least part of the problem is due to the fact that no tip work was done, because that would make it more predictable to make some improvements: we are better at modifying cartilage than controlling the thickness of skin or scar tissue under the skin.

Link to this question on RealSelf.com



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