Q. I have been contemplating having a face lift for several years. I have even had a couple of consultations with a plastic surgeon. I want to have the surgery, but I am afraid that I will not look like myself. I have seen people both locally and on television that truly do not look like the same person. This possibility scares me as I want to look like me, just a little more refreshed. How do I know that I won’t look too different after surgery? What do I need to say to the surgeon to convey what I am looking for?

A. Thank you for your question and it is good that you are thinking about this before surgery and not after surgery. I know the look that you are talking about, and it can be frightening. The people who have undergone overly aggressive facial rejuvenation do not look any younger, they just look different, and sometimes they look strange. Looking different is not a complement to anyone who has had a facelift. Often the problem is not that a face has been pulled too tight, it is more a matter that too much filler such as fat or injectables like Restylane or Juvederm have been put into the face. These fillers, if done in excess, change the shape of the face beyond what is normal for the patient. We have all seen overfilled lips, imagine putting too much filler in other areas of the face. Other things that can contribute to the face looking different is the placement of implants such as cheek implants or chin implants or mandibular implants. Implants will definitely, and dramatically, alter the face and can truly make the person look different. Now clearly, there are times when a cheek or chin implant is warranted, such as when the cheek bones or chin are underdeveloped. In this situation, placement of an implant can make a very positive change. But overdoing the grafting to produce abnormally full cheek bones is just not attractive in my opinion. In my practice, I tend to be a conservative surgeon, whose goal is to make subtle changes in the appearance of the face, primarily by lifting what is sagging and if the skin has fine lines, to try to smooth those lines. When you are talking to your plastic surgeon, you need to articulate what your goal is regarding facial rejuvenation, and more importantly, what you are worried about that might happen following a face lift. Your question to me was very clear and I am sure whoever you talk to will understand what you are looking for and concerned about. Your surgeon should be able to very clearly articulate to you what area of the face he/she believes will benefit from rejuvenation and how this will be accomplished in order to achieve what you are looking for. If you do not have a firm grasp on the plan, then seek a second opinion, always with a board-certified plastic surgeon. Good luck.

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