Gulfshore Life Column


Ask Dr.Fox

Dr. Fox answers questions about cosmetic breast surgery.


Q:  Dear Dr. Fox: A women I know had a facelift from you five years ago. I think she looks about 20 years younger, and I have never seen anyone else
look like these with just a facelift. What do you do along with your facelifts that other people are not doing?

A:  Good facelift surgery is about understanding architecture, restoration, and physics to bring
normal aging to normal rejuvenation. If we look at pictures of ourselves in our 30’s and 40’s, our facial structures are in a higher position (different architecture), thus the architectural portion of plastic surgery returns these structures to their original position. To make a patient look even younger, restoration of facial volume has to be part of the surgical procedure. You will also notice in your pictures that you had a softer, more youthful appearance. By adding permanent fat injections, you can replace the volume (restoration) which has been lost with time. The physics component to the surgery is to make the operation results last as long as possible against gravity.This is accomplished by having the least amount of tension on the skin as possible, which not only looks
better, but will also preserve the longevity of the facelift. 


Q:  I have never had anything done, and I think I’d like to start small. You did the best lips on
my girlfriend, they are not too big and they look natural. She looks young without looking overdone.  I know there are different types of fillers, but which one is best?

A: My philosophy with fillers is this-get the longest lasting filler with the best overall results-meaning I don’t just fill in a line, I make your entire face look younger. For example, areas of the face respond better to different fillers- Radiesse is much better for marionette lines than juvederm and in addition it lasts longer. You may need a little bit in the cheeks, you may need the corners of your mouth, or even some in the chin, mere milimeters can make a difference, making you appear more youthful and refreshed.


Q: I am a 57 year old woman and am so disappointed when I look in the mirror and see how I have aged.  I know I need a facelift, but how do I make sure that I just look younger and don’t look like I’ve had any work done?

A:  It’s important to understand how your facelift surgery is performed. In order to remain looking exactly like yourself without any distortion, your facial muscles and connective tissues need to be elevated to their original position. Particular attention must be paid to the jowls , the corners of the mouth, the neck, and of course, the eyes. We pay special attention to these areas as they show the most significant signs of aging. In order to avoid looking like you’ve had work done, you have to choose a surgeon who can elevate your tissues to their original vertical positions without displacing them at a new angle toward your ear or towards your cheeks.


Q: I had a filler placed by a dermatologist up north in the hollow area below my lower eyelid and above my cheek to hide the dark circles around my eyes and now I have bulges under my eyelid in the wrong spot. Why did this happen and can you fix what another doctor did with his filler?

A:  Yes, absolutely this problem can be improved by removing the Juvederm. Often doctors will suggest using another injection to decrease the excess filler, however this also can decrease your own tissues so I do not recommend it. Very importantly lower eyelid area should not ever have fillers placed for two reasons. One, immediately after placing Juvederm or Restylene in this area the substance is gel like so smiling causes the filler to be pushed up into the area you described. The second reason not to put filler in this area is because the skin is thin. Fillers placed in the area can be visible and cause a blueish tint to the skin. My recommendation is not to take risks with fillers that a simple lower eyelid procedure can improve without problems of displacement. Camouflaging the lower eyelid excess bags or the tear trough area with fillers is not as sound a procedure as removal of the fat bags or a light laser.


Q: I know the difference between your facelifts and the marketing ones I see on TV. But the idea of local anesthesia seems easier to me. Is local anesthesia better for me than twilight or general anesthesia?

A:  Your facelift procedure needs to be safe, long lasting and beautiful. When one compares the safety of local versus twilight or general anesthesia Twilight is the best for procedures. (This is the same anesthesia used for colonoscopies). Patients wake up quickly and alertly with twilight. 


Q: Dear Dr. Fox, I went to the dermatologist and they suggested that I do some sort of skin tightening laser which I did. I was very disappointed in the both the cost and the results. Do you have a better skin tightening procedure that actually works?

A: There are lots of machines on the market that claim no down time with great results.  I believe in consistent results, which is why we try all the new equipment that is out there. If the machine does not perform as touted, we will not carry it. Often you will notice the new machines are not in the media much past six months because their claims are not substantiated. We prefer to use the best Laser, which improves red spots, brown spots, tightens tissue, reduces lines and wrinkles with predictable results.


Q: Dear Dr. Fox, I have been watching “The Real Housewives of Beverly Hills” and one of the women on the show had her lips done. I think she looks like a duck. I would like fuller lips, but certainly would not want to quack. Is there a way to do this procedure without that terrible effect?

A: You can make lips larger as long as you stay within appropriate anatomy. Often surgeons will add too much volume outside of the boundaries of the upper lip which results in fullness in the incorrect areas giving the appearance you are referring to. When the lip retains its original form and has slightly more fullness then the benefits include elevating the corners of the mouth, improving lines around the mouth and better application of lipstick.