An Often-Overlooked Facial Rejuvenation Procedure Made This Woman Look 10–15 Years Younger

It took Nikki Waters most of 2016 to find the right surgeon for what she was looking for. “I wanted a facelift and some lipo,” she said, “and it took about a year for me to interview various doctors, learn the different procedures and get comfortable with everything.”

After four consultations, Waters decided on San Diego plastic surgeon Gilbert Lee, MD. “Three doctors I had interviewed performed the surgery in office and would place you in a hotel with either a nurse or ‘someone trained’ to be on call overnight on the first evening—this process and recovery was very disconcerting to me,” she explained. “Dr. Lee was the only doctor to perform the surgery in the hospital and provide for overnight stays in the hospital as well. This point of difference was very comforting to me as a patient because if I experienced any emergency, I was in the right spot for care.”

According to Waters, Dr. Lee was also the only doctor that suggested going above and beyond just a facelift. “He suggested the need for fat transfer first, then skin reconditioning from years of sun damage, and then a lower facelift. He also suggested that I might consider straightening my nose, which honestly, that really needed to be done as well. I found it very interesting how different the procedures were as described by different doctors during the consultation. The first doctor I spoke to was more classic—cutting from ear to ear and lifting everything. The second wanted to lift the lower part of my face and then insert strings secured by a notch in the scalp to lift my forehead. These first two surgeons minimized the need for fat injections, and never mentioned the neck tendon issue or possible nose straightening.”

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“I believe that in the modern-day facelift, volume trumps lifting,” explains Dr. Lee. “Volume restoration is probably the least appreciated component of facial rejuvenation. Yet, for Nikki, it was the most vital. We replaced the missing fat from the forehead, eyebrows, eyelids, cheeks, mouth, chin, and jawline with extensive fat grafting to restore the softness, youth, and soulfulness to her appearance. We then did a thorough face and necklift, which transformed her neck and jawline. The aging face always possesses an aging nose as the cartilage continues to grow. A rhinoplasty helped us to match her nose to her younger face. Finally, dermabrasion around the mouth was the most effective means of removing those stubborn wrinkles surrounding her lips.”

“Once I made the decision to go for it, I was anxious to get the procedures done as soon as possible so the healing could begin!” said Waters. “I wasn’t really nervous, but I was excited and anxious. About a month in advance of the procedure, I started taking arnica to reduce bruising and swelling, and eliminated blood-thinning types of medications leading up to the operation. The day of the surgery, I arrived at the hospital at 5:15 a.m. and was taken to the prep room to meet the nurse and the anesthesiologist. Dr. Lee went over the procedure again and we made a few additional tweaks (he included a dermabrasion procedure to remove fine lines around my mouth area). The best was having him draw the ‘roadmap’ in a Sharpie pen on my face of where the fat was to be injected and incisions made—I still remember that the Sharpie was purple!”

“In order to sculpt the face, we need the raw materials in place first,” Dr. Lee said of performing the surgery. “So, we replaced all the missing fat in her face. This is followed by the lifting and sculpting of the neck and jawline. Once we saw the final shape of her face, we sculpted her rhinoplasty to assure her nose matches her new face. Finally, we removed the wrinkles around the lips with dermabrasion. This is a very detailed and exacting operation, which takes about seven hours to perform.”

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From Waters' perspective, seven hours seemed like 10 minutes. "When I woke up, I was not in any pain at all, although I did look like a Smurf with the white bandages covering my face and hair and the purple markings on my face. My mouth area was a bit raw and my throat was sore from the breathing tube, but aside from the grogginess from the anesthesia, I was feeling great!”

Dr. Lee says patients experience recovery differently. However, following this combination of procedures, patients should expect a fair amount of swelling for about three weeks. "During that time, they wear an elastic face and neck support to help minimize the swelling. Most of the discomfort is behind the ears, because the anchoring sutures for suspending the face and neck are placed there, yet pain pills are only needed for a few days for this. By three weeks, the incisions are already looking great and the swelling has diminished, so patients can wear makeup and go out without feeling self-conscious.”

“I slept mostly in recovery for the two days after surgery and only needed Tylenol a couple of times,” said Waters. “I was up and walking on the second day, but chose to stay another night in the hospital to get the anesthesia out of my system. My head just felt heavy, but it was amazing that I was not experiencing any pain. Within 10 days, I was going to the theater with my husband and friends and I was beginning to get some light exercise. My bandages came off the day I left the hospital, and the first set of stitches came out after five days and the second set after eight days. I was fortunate that I did not bruise at all, yet the deep dermabrasion around the mouth was rather raw for the first week. I did need to wear a head wrapper for nearly eight weeks, which was a bit longer than expected, but was not difficult because at about a month post-op, I was wearing it at night only. It truly takes up to one year for a full recovery, but after 90 days, most of the swelling is gone and you look more like yourself.”

“I feel like I look 10–15 years younger and have been told that repeatedly by other doctors and professionals when asked my age,” says Waters. “I’m so pleased that I made the decision to get the procedure done.”

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