How to go from 50+ to looking 20+ with plastic surgery rejuvenation.

[Otto8]

Let me send you a PM, in a bit.

No no, don't. I did not mean to be so nosy.

I sincerely wish you well.

Anyways, I will go and see Mr Rhodes in August. He had a cancellation but I cannot do that date.

August it is. Surgery in October, I think.

I will pm you privately my post-op pictures.

I am not as brave as @MissOrange.

 

[Otto8]

Today my surgeon got back to me and I found out I got smas plication in my facial retightening! Wow! From macs suspension to smas plication with 3-0 pds. He normally does his VR with permanent ethibond sutures but had to use long acting dissolvable 3-0 pds on me due to my contact dermatitis. Still hoping my face holds up in 3 more months. I’ll do more selfies this weekend.

I was chatting with a British lady who had skin laxity post DP at 6 months by the surgeon who has been suspended a year by the GMC regulator and it turns out that not only was she not prescribed postop steroids but also told not to wear head compression garments! Ladies make sure you get both postop steroids to prevent facial swelling and skin stretching and wear your compression garments day and night for the first week!

@MissOrange, Please can you explain why 3-0 pds are better? You mention it with Dr Dongman Park as well.

I thought the VR facelift was smas plication. Is there a difference?

Thank you.

 

[MissOrange]

@MissOrange, Please can you explain why 3-0 pds are better? You mention it with Dr Dongman Park as well.

I thought the VR facelift was smas plication. Is there a difference?

Thank you.

3-0 is the thickness of the suture. PDS is the longest lasting dissolvable suture so it lasts long enough for the 2 cut ends of the smas to close and heal.

The VR is like a macs suspension lift. Smas plication is folding up the excess smas and then suturing in place which is normally part of a full facelift. Both have limited longevity so I shall wait and see how long the latter now lasts.

 

[MissOrange]

I am now 4 weeks post retightening and all is well although I did get questioned when using my bank card as they thought it was my mother’s and I was a teen kid! lol. Don’t blame them. I weigh 93 lbs, BMI 17.6 and am wearing a 10 yo boy’s ralph lauren shirt! I forgot I am in a hypermetabolic catabolic state post surgery that may last up to 3 months which means I cannot gain weight no matter how much I eat.

 

[catlover6]

@MissOrange I am in the early days of researching surgeons in the UK, so have been learning quite a lot from your forum posts about the type of facelifts.
Would you not really recommend the smasplication for longevity, as I am wanting the procedure to last me at least 8-10 years. I have researched a few surgeons who I think do smasectomy, so wondering whether to just go with that instead.
You do look great and Dr Nick Rhodes isn’t too far from me, but I don’t want to have it redone in a year or so. Does he have a long waiting list for appointments/surgery?

 

[MissOrange]

@MissOrange I am in the early days of researching surgeons in the UK, so have been learning quite a lot from your forum posts about the type of facelifts.
Would you not really recommend the smasplication for longevity, as I am wanting the procedure to last me at least 8-10 years. I have researched a few surgeons who I think do smasectomy, so wondering whether to just go with that instead.
You do look great and Dr Nick Rhodes isn’t too far from me, but I don’t want to have it redone in a year or so. Does he have a long waiting list for appointments/surgery?

Hi @catlover6 many British ladies cannot afford smasectomy or deep plane FL/NLs and can only afford a macs or a smas plication. No, it will definitely not last 8-10 years in my opinion after a series of British ladies have been sending me their 4-6 month postop fails for macs, smas plication and even deep plane.

I think unless the smas layer is trimmed by 2-3 cms with smasectomy, the facelift cannot last as the excess smas layer with its fat and muscle has a high chance of dropping. I have felt that sensation when the smas dropped for me in December and I had that gut wrenching feeling that the lift was over.

Here is a diagram from Dr Dongman Park. Think of the red line as the sagging smas and the green line as the sagging skin. Unless both are trimmed, facelifts may sag within 4 months to 2 years. I have had 7-8 cms of loose skin trimmed (3.5-4 cms on each side in 2 FLs), ie the green lines. I have not had any smas layer trimmed. The questions remains how long will my smas plication last as the green line has now been trimmed to that of a 20 year old face but the excess smas layer remains in my face folded over until the 3-0 sutures dissolve.

 

[Otto8]

Hi @catlover6 many British ladies cannot afford smasectomy or deep plane FL/NLs and can only afford a macs or a smas plication. No, it will definitely not last 8-10 years in my opinion after a series of British ladies have been sending me their 4-6 month postop fails for macs, smas plication and even deep plane.

I think unless the smas layer is trimmed by 2-3 cms with smasectomy, the facelift cannot last as the excess smas layer with its fat and muscle has a high chance of dropping. I have felt that sensation when the smas dropped for me in December and I had that gut wrenching feeling that the lift was over.

Here is a diagram from Dr Dongman Park. Think of the red line as the sagging smas and the green line as the sagging skin. Unless both are trimmed, facelifts may sag within 4 months to 2 years. I have had 7-8 cms of loose skin trimmed (3.5-4 cms on each side in 2 FLs), ie the green lines. I have not had any smas layer trimmed. The questions remains how long will my smas plication last as the green line has now been trimmed to that of a 20 year old face but the excess smas layer remains in my face folded over until the 3-0 sutures dissolve.

View attachment 5340110

It is understanding which FL is the gold standard.

There is a plethora of confusing information out there, and if you don't know, you end up getting the bog-standard FL the surgeon offers or specialises in. Certainly, when I went to see a consultant two years ago, before Covid, I was under the impression all FLs were the same, and that he is a good surgeon, so he would perform the right and best procedure. And he was not cheap either.

Because during your £250 consultation, the consultant will not tell you, unless you ask.
And you can only ask if you know. And you can only understand the nuances if you are aware.

That is the first hurdle. Knowing what the surgeon is going on about and know what questions to ask.

Then the second hurdle is finding the correct and skilled surgeon.

 

[MissOrange]

It is understanding which FL is the gold standard.

There is a plethora of confusing information out there, and if you don't know, you end up getting the bog-standard FL the surgeon offers or specialises in. Certainly, when I went to see a consultant two years ago, before Covid, I was under the impression all FLs were the same, and that he is a good surgeon, so he would perform the right and best procedure. And he was not cheap either.

Because during your £250 consultation, the consultant will not tell you, unless you ask.
And you can only ask if you know. And you can only understand the nuances if you are aware.

That is the first hurdle. Knowing what the surgeon is going on about and know what questions to ask.

Then the second hurdle is finding the correct and skilled surgeon.

Precisely @Otto8 none of these surgeons will educate you on the best facelift as it is easier for them to do smas plication on everyone or double their prices and do a sub smas lift and call it deep plane. Not one of them will discuss smasectomy as this is the most difficult to perform in my opinion and who wants a patient to have a facelift that lasts for several years when they can make more money charging for revisions.

I learned there is yet another type of smas lift called a triple C smas plication! It is as it sounds, rolling up the excess smas and suturing it in 3 rows! See how they will do anything but trim out the excess smas? Dr Kevin Sadati performs this but his website has a gallery full of smiling afters at 2 months! We know facelifts may sag at 4-6 months and that smiling creates a natural lift!

I think we have to add to the list of questions what the revision policy is. Thus far a patient of Bray’s was refused a smas revision and only offered a DP if she paid for it and a patient of Macquillan was denied a smas plication revision allegedly using the excuse that he didn’t want to operate on scar tissue. She got a second opinion but the second surgeon will not do a revision for 2 years! If the majority of facelifts sag at 4-6 months, then it is imperative one finds a surgeon who includes free revisions within a year else one will end up going back to botox and fillers until another surgeon agrees to do a revision at vast cost!

 

[catlover6]

Hi @catlover6 many British ladies cannot afford smasectomy or deep plane FL/NLs and can only afford a macs or a smas plication. No, it will definitely not last 8-10 years in my opinion after a series of British ladies have been sending me their 4-6 month postop fails for macs, smas plication and even deep plane.

I think unless the smas layer is trimmed by 2-3 cms with smasectomy, the facelift cannot last as the excess smas layer with its fat and muscle has a high chance of dropping. I have felt that sensation when the smas dropped for me in December and I had that gut wrenching feeling that the lift was over.

Here is a diagram from Dr Dongman Park. Think of the red line as the sagging smas and the green line as the sagging skin. Unless both are trimmed, facelifts may sag within 4 months to 2 years. I have had 7-8 cms of loose skin trimmed (3.5-4 cms on each side in 2 FLs), ie the green lines. I have not had any smas layer trimmed. The questions remains how long will my smas plication last as the green line has now been trimmed to that of a 20 year old face but the excess smas layer remains in my face folded over until the 3-0 sutures dissolve.

View attachment 5340110

Thankyou for the explanation that’s helpful. Yes I agree it is expensive to have an smasectomy, but then I was thinking if I had to have the smasplication/macs redone every 2 years, or so then it would work out more expensive in the long run and to be honest I can’t afford £4000+ every 2 years.
I understand from my research that not that many surgeons can do the more complicated facelifts as there is more skill involved, as most seem to just do a macs type lift. I have had a quote from one surgeon but it was about £15000, which is way above my budget. I was hoping to find a surgeon who can do it for under £8000 but maybe that’s wishful thinking. I also would like, if possible to have it done under local and not general, so trying to find someone that can do that.
I was just reading about a surgeon that says all the lifts, even the smasectomy, don’t last and he has stopped doing them now and only does a high lamellar smas lift. You might have read it, but if not I can post it on here if you like.

 

[Otto8]

Precisely @Otto8 none of these surgeons will educate you on the best facelift as it is easier for them to do smas plication on everyone or double their prices and do a sub smas lift and call it deep plane. Not one of them will discuss smasectomy as this is the most difficult to perform in my opinion and who wants a patient to have a facelift that lasts for several years when they can make more money charging for revisions.

I learned there is yet another type of smas lift called a triple C smas plication! It is as it sounds, rolling up the excess smas and suturing it in 3 rows! See how they will do anything but trim out the excess smas? Dr Kevin Sadati performs this but his website has a gallery full of smiling afters at 2 months! We know facelifts may sag at 4-6 months and that smiling creates a natural lift!

I think we have to add to the list of questions what the revision policy is. Thus far a patient of Bray’s was refused a smas revision and only offered a DP if she paid for it and a patient of Macquillan was denied a smas plication revision allegedly using the excuse that he didn’t want to operate on scar tissue. She got a second opinion but the second surgeon will not do a revision for 2 years! If the majority of facelifts sag at 4-6 months, then it is imperative one finds a surgeon who includes free revisions within a year else one will end up going back to botox and fillers until another surgeon agrees to do a revision at vast cost!

I believe consumer laws apply. After all, if you pay with a credit card, under Section 75 of the Consumer Rights Act, you have a time limit of 6 years to claim for a revision. Performance was substandard. The lift dropped after 4 to 6 months, so yes, I would, if the consultant remained adamant he would not offer a revision after reasonable discussion, pursue it with a letter legally.

So:

1. I will pay with a credit card

2. I will ask about techniques and longevity.

3. I will ask why that particular technique the surgeon has chosen would fit me and check expectations. In any case, I don't want to shell out for surgery every year or two years, or even four!

4. I will ask about their revision policy.

But I think paying with a credit card could provide an additional safeguard, even if you have signed many forms.

 

[MissOrange]

I believe consumer laws apply. After all, if you pay with a credit card, under Section 75 of the Consumer Rights Act, you have a time limit of 6 years to claim for a revision. Performance was substandard. The lift dropped after 4 to 6 months, so yes, I would, if the consultant remained adamant he would not offer a revision after reasonable discussion, pursue it with a letter legally.

So:

1. I will pay with a credit card

2. I will ask about techniques and longevity.

3. I will ask why that particular technique the surgeon has chosen would fit me and check expectations. In any case, I don't want to shell out for surgery every year or two years, or even four!

4. I will ask about their revision policy.

But I think paying with a credit card could provide an additional safeguard, even if you have signed many forms.

@Otto8 the problem is when you ask surgeons for their revision rate, they may say 1% or I only ever had one patient I did revision. Then you discover independently when you chat with former patients that many are seeking revision or retightening! This is why word of mouth from past patients is vital. Find past patients and chat with them privately. Follow their journey.

Yesterday a prominent UK facelift surgeon admitted to his patient, “that part is notoriously difficult to hold as it’s the furthest away from the sutures”, “the same would happen anyway in a few months as that is the hardest to address and keep lifted” and that “even deep plane would have the same issue.”

On the one hand we have facelift surgeons globally selling facelifts that last 7-15 years and on the other hand we have surgeons confessing all facelifts relax at 4-6 months or it does not stay lifted after a few months, even deep plane.

And if you do find a lady who claims her facelift has lasted for years, you may then discover she has been using botox and fillers from month 4, so in effect given herself a nonsurgical facelift to maintain her lift.

Then we have the dark side of facelift surgery, ie when things go wrong. Very few medicolegal lawyers may take on a case as it is nigh impossible to find surgeons to give expert testimony against a fellow surgeon. I would absolutely hold off on deep plane as it may be a last ditch facelift in my opinion because very few if any surgeon will take on revision of someone else’s deep plane and instead cite they do not want to deal with the scar tissue and the additional risk to the facial nerve from changes to the facial anatomy. If you do find a surgeon who will revise a DP, then they will charge whatever they like to compensate for the additional risk and difficulty.

After May 31 (4 months post), if I do sag again, I shall use conservative measures, like smiling exercises, limit my fat intake, keep my weight down to reduce jowling around the mouth and go back to radiesse dermal fillers. The worst sag days after the VR were never as bad as they were prior to VR so there was improvement. This gives me hope that if and when my smas drops, the bad sag days will not be as bad as they were before and I shall continue to work out what gives me good face days, ie avoiding freezing temps, avoid dehydrating alcohol and keep well hydrated.

 

[Otto8]

Yesterday a prominent UK facelift surgeon admitted to his patient, “that part is notoriously difficult to hold as it’s the furthest away from the sutures”, “the same would happen anyway in a few months as that is the hardest to address and keep lifted” and that “even deep plane would have the same issue.”

And so in this case, ask for his revision policy. Your advice is excellent here. Perhaps try to persuade the consultant to agree to a reasonable one before surgery. Check the consultation letter. Or go for a second consult again to clarify.

On the one hand we have facelift surgeons globally selling facelifts that last 7-15 years and on the other hand we have surgeons confessing all facelifts relax at 4-6 months or it does not stay lifted after a few months, even deep plane.

Therefore, if what they say on paper or their sales tag does not match their actual performance, you could have reasonable grounds for asking for a revision, within a reasonable time period.

I would absolutely hold off on deep plane as it may be a last ditch facelift in my opinion because very few if any surgeon will take on revision of someone else’s deep plane and instead cite they do not want to deal with the scar tissue and the additional risk to the facial nerve from changes to the facial anatomy.

This is excellent advice! I must remember this.

Regarding credit card payments and Section 75, I believe that if we try to discuss with the consultant, and if he is unwilling, a legal letter stating your reasonable grounds could sometimes help the consultant to see your point of view, and carry out a revision. I think each case would depend on the length of time, what was stated in the original consulting letter, and reasonable expectations. Unless you show you are serious, sometimes the consultant will try to brush you off with a no.

I am not clear of the specifics of the Bray case, but he is not the surgeon for me, mainly because he is very dear. Additionally, to have to shell out another £20k for a revision by Bray after a year or two is not feasible, as a matter of principle, rather than economic concerns.

I would prefer a sympathetic surgeon who would try his best, a surgeon who is able to see sense and understand that 4 to 6 months in terms of facelift longevity is unreasonable, a surgeon who would want to set out to correct this short-lived facelift. Note that I am not saying the surgeon is terrible for performing a facelift that lasts only 4 to 6 months. I understand that there is a certain element of the unforeseeable where cosmetic surgery is concerned. However, it is only morally ethical, if charging £20 XXX amount, that a revision is carried out at the patient's request, if reasonable. Of course, the law is not about moral ethics at times.

I believe medicolegal issues are complicated and stressful. I have tried to put this down very simply. Every case differs.

It is only good to consider and think of all avenues or recourse.

 

[MissOrange]

I found Dr Dongman Park’s one hour interview on facelifts really fascinating. I watched with poor English subtitles but got some gist of what he was saying. He divides skin into thick and thin categories. I fit the thin category so needed fat grafting to replace loss in volume! He says thick skin suffer from large pores and fat hypertrophy! But that liposuction then leads to drooping! I wish I could fully understand the dialogue but there were diagrams to follow in English.

 

[MissOrange]

Yesterday I tried HRT for the very first time as a patch! It is used by trans individuals who end up looking very young and feminine! Hoping it replaces lost estrogen post menopause and gives me an even younger face! I stuck one on my left buttock. You leave it on and then change it 3 days later and change the site. Hoping it builds up my lost bone mass density in my face too! Adding magnesium, vitamin K2 and zinc to my daily vitamin D3 and calcium supplements to rebuild bone mass density.

 

[Lien]

That transformation is amazing!!

I also need to try HRT, as I am also post-menopausal. I'd be interested in hearing how you fare with it.