Premiere Facelift Specialist David Santos, MD, FACS
Call Us: 425-227-4000 12301 NE 10th Place Suite 101 Bellevue, WA 98005

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I Have What Looks Like A Rope Around My Neck Following Facelift/Necklift

Patrons1 in Henderson, NV asks:

I had a face lift and a neck lift a month ago. As a result, I now have what appears to be a small rope around 1/2 of my neck. Additional my right side of my face is far more doopy than my left, ( which is good). I go back to the Dr. in 10 days for my 6 week evaluation. Is this something that he should fix? 

It has been approximately five weeks since the procedure and generally at this time healing issues, bumps and lumps and “ropey” appearance problems have resolved.  However in a small percentage of individuals this can be a persistent manifestation.  Bumps and lumps and ropey appearance can last longer than five weeks, even into the three month mark.  Generally, according to the appearance of the picture, there is no evidence of infection and this is simply an area that is going to take longer to heal.  The reasons this happens is sometimes unexplainable, sometimes related to the way bandages are placed or it can occur with slow accumulation of fluid and/or blood into the tissues underneath the skin.  Ongoing observation is still the mainstay of treatment.  Massage can be beneficial I believe and sometimes ultrasound treatment to the area can help accelerate the wound healing process. 

David Q. Santos, MD

Seattle Facial Plastic Surgeon

How Long Do the Effects of a Lifestyle Lift Last?


A regular facelift or separate procedures cost so much more, but I’ve been told that the effects last 5-10 years if you don’t smoke, or experience weight changes. How long can I expect the effects of a Lifestyle Lift  to last under similar conditions?

Image via here

The important component of a Lifestyle Lift is tightening of the deeper structures of the face, the SMAS/fascia and muscle structures. This tightening provides a real improvement in the overall appearance, particularly in the neck and jowl area. It is impossible to attribute an exact time period to which you turn back the clock, however as a general rule Lifestyle Lift and/or facelift provide around eight to ten years loss of appearance of aging. It is true that standard facelift procedures do cost more, but Lifestyle Lift provides an efficiency that translates into saved dollars for the individual who desires real aesthetic improvement. Essentially when undergoing a Lifestyle Lift or a facelift by an experienced surgeon, one will expect to achieve a good  improvement in appearance and aesthetic youthfulness and decrease in the overall appearance of aging changes. This is a turning back of the clock. We can’t stop the clock, we can’t stop aging, but we can back it up several notches with a lift procedure. As time goes on, ongoing aging will occur.

David Q. Santos, MD

Seattle Facial Plastic Surgeon

How Do You Correct Too Much Fat Removed During Neck Lift

TJR in Savannah, GA asks:

“If you had too much fat removed from submental liposuction and it caused your muscle bands to show and indentations how would you go about correcting this problem? If you are a PS what would you recommend to fix something like this and what sort of reasonable expectations should a person have in terms of having a normal looking neck again? I am scared and upset so any insight would be appreciated.”

Correction of the described problem can be addressed in several different ways.  Specifically it is important to really get an anatomical evaluation and overall sense of what the underlying issues are.  It is not an uncommon problem/complication to have “too much fat removed in the neck area” as liposuction is a component of facelift surgery commonly.  But also residual band laxity is also not too uncommon.  Bands are the platysmal muscle bands that can remain lax after surgery.

A number of treatments are available including repeat platysmal band tightening.  This will often times resolve the problem by itself.  Other supplemental treatments include fat injections as needed if there is significant contour deformity.  This procedure is less common than a simple platysmal muscle repeat tightening.  Nonetheless this area can be addressed commonly and long term permanent problems is something not seen too often.

David Q. Santos, MD

Seattle Facial Plastic Surgeon

Is it possible to make my smile not as wide?

Photo courtesy of

Jonass in Dallas asks:

“Hi I am 20 years old, when I smile or laugh my mouth opens very wide so it seems that my smiel goes from ear to ear! is there anyway to fix it so when I’m laughing, my mouth won’t open as much?”

This is a significantly delicate and tricky proposed concern.  Overall there is not a recommended surgical procedure.  However, based on your anatomy there is a possibility that some expertly placed small degree of Botox can diminish some of the widening of the smile.  However, nonetheless this has to be done, performed and assessed by a physician who does a significant amount of Botox treatments.  Overall, I think that it is important to get a good opinion from a physician as to whether anything, if at all, should be done.  Try to trust the opinion of the physician that you consult with and if you have a trustworthy physician and a physician who is well recommended and if this physician says don’t have any procedures done then importantly you should listen to this recommendation.

David Q. Santos, MD

Seattle Facial Plastic Surgeon

Is It Uncomfortable to Have Upper Eyelid Surgery with Just Local Pain Medication?

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Rebric in Albertville, Al asks:

“I will be taking one hydrocodone/apap 7.5/500mg tablet and one diazepam 10 mg 1/2 hour prior to the surgery and given a local numbing injection. Do you know from your experience if this a comfortable option compared to general sedation? Plus have you performed this surgery without the protective eye lens cover?”

Generally upper eyelid surgery can be performed quite comfortably and safely under local anesthesia with addition of Valium sedative and pain medication.  A large majority of patients will do well and tolerate this modality of anesthesia.  The eye is easily well protected when an experienced blepharoplasty surgeon performs the surgery.

David Q. Santos, MD

Seattle Facial Plastic Surgeon

Too Young for Facelift and Cheek Implants?

Photo Courtesy of Dr. 90210

Sammzie in Berkeley, CA asks:

” I’m 20 years old and I’m unsatisfied with the way my mid-lower face appears. I think I’d benefit from getting a mid-face lift with cheek implants. Am I too young to be getting these procedures done? “

Facelift surgery can be performed as early as early 30s, all the way into 80s and late 80s. Each individual is quite unique and each individual has different concerns and potential benefits. This is exactly where experience is extremely key to achieve the best result based on the individual patients concerns. For instance, a young individual with a good deal of adipose deposition or fatty changes to the face can benefit from liposculpture and sometimes some “tightening” (a form of facelift). But on the other hand, it is important not to jump in to have a facelift too soon as it is only in the instance of potentially achieving a real improvement is a facelift or mini facelift warranted. Essentially if an individual is properly motivated even at a young age and if there are moderate changes that could benefit from facelift then facelifting could be entertained. It is not an issue of age so much as it is for motivation, expectation and overall potential benefit determined by an expert facial plastic surgeon. The most common time period whereby individuals desire and benefit from a facelift is in the 50 to 65 year age range, but there are a number of patients who really do benefit in their early 40s. – David Santos MD, FACS

Subtle Change, Natural Result: Halle Berry

These pictures suggest a subtle improvement to the bridge of the nose and an even more subtle thinning of the nasal tip.  I think the result is good and natural.  She has a little more softer appearance, more feminine.  Yes it is perfectly fine to keep what you have and not change a thing, especially when you are Halle Berry.  But this is a personal decision, and she has had a good change for the better, and it probably feels good about this change.  There are risks to rhinoplasty, and up to 15 % of nasal surgeries require a touch up treatment.  “Ethnic noses” are a little more of a challenge to get a natural result. -Dr. Santos

Is It Safe to Have a Facelift After Sculptra?

Eimel in Gold Coast asks:

“I had a Sculptra injection and am supposed to have 1 more in 6 weeks, the doctor’s idea was to make my skin stronger so he can do a threadlift. After doing some research I think this is not for me and I’d like to go back to my original idea of having a traditional facelift – but I am now worried that if I get a facelift when my skin is a bit tighter from the Sculptra treatment it will sag again in 1-2 years once the Sculptra wears off. Can this be a problem after just 1 Sculptra injection?”

It is safe to have a facelift after Sculptra.

Sculptra is a quite successful filling agent that provides fullness to the face and lasts for a prolonged period of time.  Some feel two years and some researchers and physicians feel that it lasts even longer.  It is actually difficult to absolutely state the time that an individual Sculptra might dissipate, if at all.  It does not simply go away completely at two years.

The best time to choose to do a facelift should not be influenced by when fillers such as Sculptra might wear off.  When there are significant sagging components to the face, particularly jowls and neck area, the best remedy is for a facelift.  Indeed many individuals undergo a facelift and also have concomitant filling, whether fat grafting, Sculptra or other fillers such as Restylane.  This provides additional rejuvenation.  If you have a facelift now, there will be changes over time that are for the most part unpredictable.

The best answer is to have a facelift now and as time goes along consider supplemental rejuvenation treatments as needed and as recommended by your physician, such as additional Sculptra or additional other fillers.  On the other hand, if you wait for the Sculptra end point, when all the Sculptra is dissipated, the time period of this waiting period could be two years, could be several years and is unpredictable.

By David Q. Santos, MD -Real Plastic Surgery

What is a Stem Cell Facelift?

Liquid facelifts, or injectables, and non-surgical facelifts have stimulated a great deal of interest. In limited scientific studies, stem cells mixed with hyaluronic acid have been injected into the laugh lines and shown to provide reduction in the depth of the creases. Further studies are needed, but there is a theoretical consideration that fat itself has stem cells within and therefore have unique aging prevention qualities. Fat injected in to the face or the back of the hands seems to do more than just feel in the crease- it can make the skin look younger. Fat grafting has become the treatment of choice for non-surgical face-lifts.

David Santos MD

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