Facelift

Top Facelift Doctor 2010

For some reason, many people don’t seem to want to talk openly about facelifts. Some feel that it is an extreme option, others uncomfortable with the notion of vanity, discomfort, or the thought of a long recovery time. But all agree on one thing: the “pulled” look is out! Fortunately, facelift techniques have evolved to the point that recovery is rapid and results very natural appearing. The keys are the ability to customize the operation to the patient’s specific needs, a better understanding of what really happens with aging (it isn’t just loosening of the skin), and newer high-tech materials such as tissue “glues” that minimize swelling and bruising.

Regardless of the specific type of facelift (there are many variations) the goal is a natural look. This is achieved by analyzing what actually happens with aging; at first glance, the effects of sagging, less elastic skin are most apparent. So the thinking for a long time was that pulling, tightening the skin should restore a more youthful appearance. But if you look more carefully at pictures of someone in their early adulthood and compare them to pictures when they are older, the most dramatic change is often loss of volume in the face due to loss of subcutaneous fat. It is a 3-dimensional change, and so the correction needs to restore volume, not just tighten skin.

Options range from nonsurgical, to minimally invasive, to the full surgical facelift. The goal with all of these is correction of specific conditions with the most natural-appearing result and the most rapid recovery. An example of a nonsurgical approach is Thermage, which uses radiofrequency currents to stimulate collagen rebuilding in the skin and cause some tightening. Although Thermage is sometimes marketed as a “nonsurgical facelift” in my opinion this is a misnomer, because a facelift isn’t just tightened skin, and the results from Thermage are less in terms of tightening anyway. So Thermage is suitable for someone who needs a little “maintenance” but it will be disappointing for someone who needs a facelift. The two are not interchangeable.

Next is a threadlift, which is also sometimes called a “nonsurgical” option. The procedure does, however, involve incisions and permanent sutures (the “threads) which are placed so as to elevate and suspend the tissue. Because no skin is removed, threadlift is a volume correction. It seems to work best in the cheeks and less well in the neck. Threadlifts can be done under local anesthesia, but there is some swelling and bruising so it isn’t a zero “downtime” option like Thermage.

With a full facelift, incisions are made so as to conceal the scars while allowing for some skin removal and elevation and reshaping underneath. The concept is more “re-draping” than pulling. Note on the oblique view (back of page) how the cheek profile is flat from sagging of the fat layer; in the post-op view, notice the S-shaped curve, a hallmark of youth and beauty. The skin in the neck has been undermined and tightened. Note also the minimal swelling and bruising at one week, from the use of fibrin glue. Not everyone will recover this rapidly but that is the goal.

Click a thumbnail below to see the larger image.

Sometimes something less than a full facelift is needed. For example, if the neck skin is loose but everything above is satisfactory, than a “mini-facelift” involving only the neck may be recommended. With this procedure, the incisions are typically placed behind the ear where they are well-hidden.

Another option is the “S-lift” which addresses the upper neck, the area along the jawline, and the lower cheeks. With this procedure, the scars begin in front of the ear in the same location as with a full facelift, but not into the scalp, and the portion of the incision behind the ear is shorter. Because there is limited access to the cheek area, there is less shaping and elevation there. In this same category is another type of minimal scar facelift called the “MACS” lift.

Occasionally it is primarily the sagging of the deep tissue in the midface, without any true skin laxity, that is the issue. This is often the case with patients who are in their 40’s, and those who have previously had a traditional facelift but with inadequate reshaping in the cheeks. This is best treated with a central facelift, also sometimes called a cheeklift. This procedure takes less than an hour to do and recovery is very rapid. It may also be a component of a full facelift when more reshaping and elevation is needed toward the middle of the face.

How does one choose the best approach? What is most important is to match expectations with the procedure that will deliver the results. This can only be determined in consultation with a qualified plastic surgeon, preferably one who is experienced in all of the variations. Not every new thing stands the test of time, so caution is always advised with new procedures, especially if they promise to produce facelift results with minimal intervention. A good surgeon will never recommend a more extensive procedure than is needed.

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