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

« Back to Blog

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

Swelling and Bruising After Facelift

Cindy MD in Rockville, MD asks:

It has been 3 weeks since I had facelift as part of removing the cyst on my face. I experienced severe hematoma after the surgery, but it seems that everything is healing as expected. I’m concerned about the bruises, since they still look very dark in some areas. The swelling on my cheek and jaw still a bit noticeable and feel so tense. Should I be alarmed? what can I do to better the situation? Thank you for your answer.


It is likely that the hematoma after your procedure has contributed to some of the swelling and discoloration issues. Generally swelling and bruising will take less than three weeks for standard facelift surgery, but with a hematoma then the swelling will last longer. The fact that it is still noticeable and somewhat tense would be not too surprising three weeks after having hematoma formation. Darkness to the skin occurs due to a combination of breakdown of the hemoglobin and metabolism of the hemoglobin due to the deeper hematoma. This contributes to skin discoloration; also hyperpigmentation can occur in these areas. The best therapy is patient observation. Generally with time by itself it will get better. There are medications, topical skin lighteners can help if needed and also other skin treatments such as chemical peels or photofacial laser treatments that can assist. Nonetheless this change at three weeks is expected and not alarming.

David Q. Santos, MD

Seattle Facial Plastic Surgeon


It would be smart to discuss this issue with the cosmetic company prior to the procedure and come to an agreement. This would have avoided the problem. Perhaps she could have gotten it done without the reality tv cameras, and avoid potentially loosing her endorements.

Article from below here


Kris Jenner says the cosmetics company she endorses has NO RIGHT to sue her for getting plastic surgery back in June … because the procedure didn’t affect her face … it just tightened up some loose neck skin.

The company in question — called B&P — sued Jenner earlier this week, claiming she breached a contract to endorse a line of their anti-aging skin care products … when the famous mother publicly admitted to getting a facelift.

By doing so, B&P alleges, Jenner violated her agreement not to harm the reputation of the company and the product she’s endorsing — an eye care line called “Beautiful Eyes in a Bag.”

But sources close to the Kardashian Klan tell TMZ, Kris is adamant … the lawsuit is BOGUS — because Kris’ facelift didn’t affect her eyes in any way whatsoever … JUST HER NECK.

Kris’ alleged agreement with B&P went into effect in March 2011 and was to be effective until March 2012 — but Kris admitted … she got the facelift in June.

Quick shot replacing nip, tuck


Injectable use on the rise as a cheaper alternative to cosmetic surgery

Photo from here

A good visit to your plastic surgeon to do some reasonable botox, or fillers is easy. Not something to be afraid of and more people are doing it. Good results are often seen, but on the other hand remember that you can only get so much, o…nly go so far with “minimal” treatments. Don’t expect great results with minimal invasive treatments of any kind. To get the best results, state of the art techniques are needed and these need some down time, have risks, cost money.

Injectable use on the rise as a cheaper alternative to cosmetic surgery

Article from The Chicago Tribune
By Ed Finkel, Special to the Tribune

July 20, 2011

Demand for minimally invasive cosmetic procedures showed a three-digit increase over the last decade, with Botox leading the way for those seeking to look younger or better.

As of last month, would-be patients can consider a new product that uses their own collagen cells, which are multiplied in a lab to create an injectable substance that smoothes out facial features. Injections typically cost a fraction of surgery and require much less recuperation time.

“It’s taking hold. People are doing (injections) a lot more frequently,” said John Bull, a plastic surgeon in Naperville. “People that are looking for a modest improvement with less down time and no scars typically want to have this done. The best candidates are people with early signs of aging and volume loss.”

Laurette Agee, 51, who is general manager of a McDonald’s in Aurora, was a patient of Bull’s. More than four years after losing her husband of 26 years, Agee was ready to come out of her shell but noticed the aging process taking hold.

She did not warm to the idea of plastic surgery, so starting in February she began receiving different types of injections in her cheeks, lips and along the sides of her nostrils.

“I catch men looking at me now in a different perspective. It makes me feel very good,” Agee said. “At my son’s wrestling meets, other moms were like, ‘Did you have something done, Laurette? You look so good.’ I have no shame in saying, ‘I did this, and this, and this.’”

In the last decade, minimally invasive procedures have skyrocketed in popularity, from 5.5 million performed in 2000 to 11.6 million in 2010 — a 110 percent increase, according to the American Society of Plastic Surgeons. The best-known and most commonly used, Botox, jumped 584 percent.

Cosmetic surgical procedures were done 18 percent less often in 2010 than in 2000, with considerably larger drops in facelifts (65 percent), forehead lifts (57 percent), eyelid surgery (36 percent), chin augmentation (55 percent) and nose reshaping (35 percent), the society reports.

The new product, called laViv and approved by the Federal Drug Administration in late June, is what Chicago plastic surgeon Julius Few describes as “another tool in our chest.” It will take awhile to reach market and will be more expensive than other injectables, at least initially, Few said.

“It’s not going to be one of these things where people are going to put down their other options like Botox overnight,” he said. “As this continues to develop and is modified and enhanced as an application, hopefully it will approach a cost point similar to some of the other options and have a broader application. … My experience, given past history, is that the concept of using a patient’s own material and then enriching it is expensive.”

Thomas Mustoe, a plastic surgeon and professor of surgery at Northwestern Memorial Hospital, also expects laViv to be costly and expressed skepticism that it will necessarily work better than other nonsurgical options. He said the FDA approval indicates that the procedure is safe and can work, but patients should not necessarily conclude more.

“This is certainly significant that you have approval,” Mustoe said. “It is going to be simple to inject. But what is unknown is whether it is going to turn out to be better than other fillers. We’re still sorting out what is possible with a needle and an injection.”

Part of the reason for the popularity of injectables is the cost. Bull said they typically are no more than half the cost of surgery, which can run from $5,000 to $20,000, depending upon the areas of the face affected and technique used.

Few said some minimally invasive procedures can cost $3,000 or more. Botox is “a third or less of that,” he said, but needs to be redone every three to six months, while other products can last “on the order of years.” Plastic surgeons have been combining regimens to “get a result that is better than either (product) alone,” he said.

Susan P., 57, a Chicago resident and executive assistant who asked that her last name not be used, has been seeing Few for about four years. He has injected Botox and Restylane around her eyes, the sides of her nose and her forehead, and she estimates she spends about $3,500 per year.

“There’s no giveaway that I’m doing anything, which is really appreciated,” she said. “The longer you do this, the less often you have to go. There’s a cumulative effect.”

Agee estimates she spent a little less than $2,500 for a combination of Radiesse for her cheeks, Botox around her eyes and Juvederm for the sides of her nostrils. Though initially apprehensive about possible side effects, she said, she’s more than willing to repeat it.

“The process was a lot easier than what I anticipated,” she said. She had worried: “My God, what happens if I look like a freak? I work in public nine hours a day. I have like 50 employees under me. I’m going to look like Frankenstein.”

Mustoe said the key to avoiding such results is proper pacing of treatments and not overdoing it.

“Some patients look overly plumped up. There are limits to what you can do,” he said. “You only have to look at the folks in Hollywood to see that a series of (too many) small procedures can have a very strange effect.”

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

What is the Difference Between a Lifestyle Lift and a Mini Lift?

Image Courtesy of






clp1988 in Chattanooga, TN asks:


“What is the difference between the “Lifestyle Lift” and a regular “mini face lift” of the bottom half of your face?”


A Lifestyle Lift is a mini-lift. The definition of a mini-lift is a shorter dissection procedure. Traditional “old type” facelifts dissect all along the face, outward towards the cheekbones and the nasolabial fold laugh lines. This is called an extended lift and there are individuals that still utilize this technique today. But a mini-lift only dissects a short degree, perhaps to 3 to 5-cm outward and downward from the ear. The shorter the dissection the less surgery performed, the less discomfort and swelling and potential for fluid collection, bleeding or infection.
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

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

The New Face of Suzanne Somers


We see another transformation from one of the loveable people in whom we have watched so much over the years.  Suzanne Somers is a beautiful woman and has been the likeable star of Three’s Company, and the leader of ThighMaster.  She wants  to keep her youth and beauty, she wants to look better.

When making this decision it is imperative to make sure that the plastic surgeon is board certified and has performed a good deal of the particular rejuvenation procedure. We do not know exactly what was done, but, these pictures suggest fillers of some nature.  Fat grafting is the present day most popular rejuvenation filler  although temporary fillers such as juvederm(R) or Restylane (R) are common as well.  Her new look is very unnatural, grainy, doughy, sponge like.   The best guess, as to what was placed, would be that of fat grafting.

With fat grafting the fat is harvested from the abdomen or thighs, and injected expertly into the face.  Great care must be taken to place the fat in deeper tissues and to apply the right amount in the right places.  Also expert techniques are required again, which further qualifies the importance of having a surgeon who has doe this a lot provide the service.

Generally, a good deal more of fat is placed in areas than ultimately desired, so that increased overdone bulkiness of areas treated is common and normal.  Some studies suggest 30% of fat ultimately takes to provide the desired effect.  We do not know how long it has been since Ms. Somers procedure and so there is real hope that the plumpness will recede over time.  In fact if this was soon after the procedure she could actually have a good result, but this may be overly optimistic.  Time will tell.

Nonetheless, if there was too much fat placed then it certainly will certainly ultimately look unnatural down the road.

We care about Suzanne and hope her the best.

David Santos MD

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

Back To Top
Call Us: 425-227-4000 Schedule Your Consultation Today With Dr. Santos