In our monthly Post Your Face column, Dr. Robert Freund answers readers' cosmetic surgery questions, and shows them how they'd look if they underwent the enhancement. To post your own face, visit

The Patient's Question: My neck drags my face down and those big muscles really stick out when I use my face. I'm Irish and have been taking medications for over 20 years for a kidney transplant (yes, Prednisone!). The sags and bags, lines and crevices -- I'd love to still have some wrinkles but not look so down and grouchy all the time. My lips are a great shape in good proportion -- if they weren't so thin, and that long upper lip! My hands are in similar shape, between the sunken areas and thin, bruised (permanent marks) skin they look like old witch hands.

The patient before and after the suggested cosmetic surgery procedure. Photos courtesy of Dr. Robert M. Freund

Dr. Freund's Answer: You have outlined many issues that affect the aging of your skin over time. Let's start by discussing your heritage. You describe yourself as coming from Irish descent. In general terms, northern Europeans commonly present with thin, fair skin that is more prone to sun damage and early evidence of aging. Your light hair color and blue eyes just reinforce these concerns.

Prednisone is a drug used to fight rejection of your kidney transplant. Although important to your daily health, this drug has the side effect of thinning out your skin. So, combined with your heritage, you are at higher risk to have prematurely aged, thin skin.

To combat the strong forces that accelerate your aging process, I suggest you start with some good, healthy living, including:

Daily Sunblock. Regardless of the season, sunblock should be used before you leave the house in the morning. On days when you spend a lot of time outside, sunblock should be applied frequently. Zinc oxide sunblocks are the best type of blocks and EltaMD is a favorite of mine.

Antioxidants. These are topical remedies and oral supplements that fight the free radicals that accelerate the aging process and increase your chances of getting skin cancer. Topical antioxidants include Vitamin C, Revale and Prevage. Oral supplements include fish oil, CoQ10, alpha-Lipoic Acid and Resveratrol. But if you are an all-natural person, a diet rich in colorful fruits and vegetables (bright orange, reds, and purples) will serve the same purpose.

Retin-A. This is a topical form of Vitamin A that will slow the loss of elasticity and collagen. It will also help to thicken your skin. To get the best effect, see your dermatologist for a prescription and a quick primer on how to administer it properly.

Another issue you mention is the loss of volume in your face. Restoration of the volume is best performed with fat transfer. This is when fat is taken from another part of the body and moved to your face. The Viafill system is a great disposable system (less risk of infection) to perform a volume transfer on the face. Sculptra is a synthetic way to achieve volumetric fill. However, this material creates localized inflammation to create the volume.

I prefer the fat transfer option. Fat can be injected into your temples, cheeks, around the eyes, nasolabial folds, lips and hands to give you a rejuvenated result. Another bonus of fat transfer are the stem cells that come along for the ride. These cells may help to rejuvenate the skin.

Finally, from a surgical perspective you have a lot going on. For people like you, I always start with the daily and weekly treatments to prepare your skin for any surgical treatment. Treatments that may help include Fraxel Laser to help improve the texture of your skin and a facelift to remove all the excess tissue of the cheek, jawline and neck.

If you would like more information on these procedures, please read my new book "A More Beautiful You – Reverse Aging Through Skin Care, Plastic Surgery and Lifestyle Solutions."

Respectfully submitted,

Robert M. Freund, MD, FACS

The health or medical information in this article is for informational purposes only and is not intended to be used as a substitute for professional medical advice, diagnosis or treatment. Please consult your doctor or a qualified healthcare provider with any questions.

Read about common cosmetic surgery and procedures on AOL Health.

And click here for 10 reasons cosmetic surgery may not be right for you.