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Steven M. Denenberg, M.D.
Steven M. Denenberg, M.D.
face lift and chemical peel
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She started out with an excellent position to her eyebrows.  I removed the excess skin from her upper eyelids at the same time as the face lift.  Then, we let her heal up from the first operation for about two months before proceeding with a chemical peel of her entire face.

Note that the peel alone reversed many of the signs of aging in her lower eyelids.  She did not have lower eyelid surgery.

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face lift and chemical peel
face lift and chemical peel

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Questioner: Conflicting information(?)
My goal is to have a lower face/neck and brow lift with bleph all at once. I think it would be the best because it's more economical since one pays for the surgery room and anesthesiologist the one time but more importantly and although more trauma to the face, there is one healing time period. I have, however, read here that I would get a better result by doing the bleph after the face. Is this true? I've seen pics of all done at once and they look great. questions, questions, questions :)
(Questioner submitted photos)

Dr. Denenberg's answer: Staged or multiple facial procedures at once
Dear morgan61:

Thanks for you comment! Your conflict and confusion are well founded. Physicians wish to do their best for their patients but we too are individuals with a great variety of differences in education, skill and talent, perspective, and outcome / results.

Yes, it is always best to perform one surgery and allow tissues to heal and settle prior to performing another contiguous procedure which may depend on the previous one to adjust for. As you point out, there is greater cost and more time in surgery and recovery. On the other hand, a longer procedure with more swelling, bruising and the greater risk of other side-effects and complications may prolong recovery as well and / or require revision procedures. 

Of particular concern with the art of surgery are the individual patient's skin and underlying tissues. How will they stretch, redrape, scar, settle and age. What surgical technique will be used for what end-point or result. 

Considering your inquiry,  it is not uncommon for a patient to undergo a face and neck lift with upper lid blepharoplasty as there is little contiguous pulling between one and the other. 

Browlift and upper eyelid lift or facelift and lower eyelid lift compete with each other as the skin and underlying soft tissues pull in opposite directions and may not settle in the position desired causing disappointment in the result or worse, a complication. 

This is not furniture and upholstery afterall and the fabric is not stretched and pinned into place with no expected further movement. Human tissues are different in that:

  1. they require circulation and when lifted and pulled add potential healing and scarring concerns.
  2. gravity, swelling and other individual patient factors play into the choice and decision called "the risk / benefit"  ratio unique to each patient. 
It is best to be conservative but weigh the risk versus the benefit with your well experienced, Board Certified Plastic Surgeon. 

I hope I have been helpful. All the best!

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