Ask The Expert: Dr. Melanie Petro


Dr. Melanie Petro
Petro Facial Plastic Surgery

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It’s time to consider surgical options when there is too much skin to give a youthful appearance with non-surgical methods. I’ve seen over the years more and more unnatural results with non-surgical fillers. I think often patients have filler and are still not happy with how they look so they keep going back for more. If this is coupled with a non-surgeon injector lacking the experience to know the limits, it can be catastrophic. Too much filler can interfere with how the facial muscles contract and this creates very strange facial expressions, especially around the mouth and eyes, where the skin can bunch around the filler which can create lines that are not in typical places and a result of the bulk of the filler.

If someone has to much skin but is not a surgical candidate due to medical reasons or simply not wishing to have surgery skin tightening procedures are an option. At this point the skin cannot be tightened like with surgery, but it can be improved.

The “Petro Petite Lift”

The “Petro Petite Lift” is a mini- mini facelift for patients that have moderate “jowling” which essentially describes the lines that form from the bottom lip to the chin. This often results in a “sad” look. Many of these patients feel and are asked if they’re sad because the corner of the mouth appears to be turned down. This can be very frustrating because adding filler such as Juvederm to this area is not typically successful. If you added enough filler to change the appearance of the mouth the face would appear square. I see women who have had filler added in this area and are very disappointed in the results.

This petite lift is designed to specifically target these folds. It is perfect for people with some loss of elasticity that can come from weight loss or simply genetics. I often combine this with laser resurfacing to treat the skin. The skin around the mouth tends to become very thick with age and resurfacing basically acts like sandpaper to the skin. The results are outstanding even for the very difficult to treat upper lip lines (“smokers lines”).

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“Mini- Facelift”

A mini facelift for me is basically a cheek neck lift. The cheek and neck are lifted by re-suspending the SMAS. SMAS stands for the Superficial Musculoaponeurotic System – for the purpose of a facelift, this constitutes the most important part of the face and musculature.

A portion of the SMAS is removed, and can be put in the lips, or naso-labial folds. Absorbable sutures are placed to re-suspend the tissue, making the face look much younger. Sometimes liposuction is required to remove fatty tissue from the cheek and/ or neck. Liposuction done alone can often leave the skin loose, but in combination with a facelift works very well. Excess fatty tissue of the neck cast a shadow causing the lower part of the neck to look very dark. This is a especially apparent in “selfies.” Models have told me how their photographers try to conceal that shadow with make up, and lighting tricks. The excess fat also can conceal the chin. Often after liposuction and a mini lift patients can look like they have had a chin implant as well. This is a result of re-creating the angle between the neck & the chin.

Most women have done this in the mirror many times before coming to see me. Basically taking your hands and pushing the tissue at an angle in line with the nasal labial fold will show you what this can do. As you age the tissue falls and you start to see shadows around your chin and on your cheeks. These have become much more noticeable as with social media there’re many more pictures taken. Sometimes when the skin is lifted from the cheek and neck it causes excess skin to be more obvious around the lower eyelid. If this is the case lower lid blepharoplasty is done to remove this skin.

We all know and have seen people who have very hollowed eyes following blepharoplasty. Old-fashioned blepharoplasty tended to remove more fat from the lower lid, we now know preserve this volume, for we continue to lose it as we age.

When you look at pictures of yourself from 10 years ago you’ll notice the cheek and lower eyelid were confluent, and you didn’t see where the lower lid stopped and the cheek began. Aging results in a lengthened lower lid and this can be corrected by combining a mini lift with lower lid blepharoplasty. The recovery from a mini lift is no more than a week. The incision is in the hairline and extended behind the ear depending on how much excess skin and needs to be removed. There is essentially no pain and a hair can often be used to cover the incisions.
I ask all my patients what types of comments they get from others after this procedure and I hear “did you get a new haircut?” “did you go on vacation?” “you look very rested “you look happy- did you meet someone?” This is exactly as it should be.

This procedure typically takes 2 to 3 hours. The procedure is done in our AAAHC accredited operating room with IV sedation or ” twilight” anesthesia.

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“Facelift”

A full facelift, is a cheek neck lift with the addition of a brow lift which can address the lateral or medial aspect of the brow or both depending on the position of the brow. This is necessary when the cheek and neck are lifted and a “pucker” of skin remains because there simply too much excess skin when the cheek and neck are lifted.

This incision can vary but is hidden in the hair line. The recovery typically is about two weeks. This procedure typically takes 3 to 4 hours.

Patients are typically concerned that the hair would be shaved but this is not necessary. We are able to make small braids to avoid shaving the hair. The hair will actually grow back through the incisions which provides the perfect camouflage.

The most common concerns for patients considering a facelift are first and foremost …
“What are my other options?”
Sometimes there are none because there’s so much extra skin that fillers, Botox, or laser treatments will not make a difference. Sometimes there is a very subtle improvement that can be gained from nonsurgical options. I think it’s very important to insure that my patients understand what can and cannot be accomplished with each and every procedure they are considering.

Another question is “ Will it hurt?”
A facelift simply does not hurt. The most common complaint is muscular tightness in the shoulders from being still for 3 to 4 hours. It is hard to believe that it would not hurt but it simply does not.

“Will I wake up during the procedure?” Most patients sleep throughout the procedure, General anesthesia is an option for patients did take medications that can interfere with IV sedation.

“What about a thread lift?”

I have seen many complications from thread lifts, it is devastating to see someone spend hard earned money on something to make them feel & look better, only to look worse and unnatural. There truly are short cuts, short term ways to tighten the skin and improve your appearance, but thread lifting is just not one of them. It may improve over time, but at this point, I have yet to see thread lifting as adding any value to facial rejuvenation. The incisions when done properly for a facelift are minimal and inconspicuous, so why give up direct visualization of what you are trying to improve for no- visualization and a barbed suture that can be very difficult to remove?.

While it is advertised as “non-invasive” it is anything but non- imvasicePotential complications of a thread lift are puckering where the barb is pulling, visibility of the blue thread through the skin, and threads poking through the skin.

Patients are concerned they will not look like themselves, and this is a real fear. Given the things we see on the news this is certainly very understandable. I tell my patients to look at pictures of themselves 10 years ago as this is my goal. I like a very conservative approach and don’t feel that a ‘tight” facelift is attractive. I think it’s important to look at before and after pictures so that you know what your surgeon thinks is attractive.

I love the face. I think there is nothing more beautiful then the angles and shadows of the face. It is and always will be my goal to restore the appearance of youth to aging faces.

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