Face Lift

Let’s talk about facial aging. Plastic surgery has really improved outcomes over the years

because our understanding of what is going on deep inside your face has improved.

Your face basically has four layers. Skin, fat, muscle and bone. Everything changes with age.

The most obvious is the skin: loose, loss of collagen, pigmentation issues, texture. Fat just

disappears, making you look more like a prune then a plum. The muscles sag. Even your

bones start to re-absorb.

In the last century, facial rejuvenation surgery centered on the skin. Lift it up, pull it back as

tight as possible. DONE. But people looked “done” like their skin was lifted up and pulled back

tightly. Not natural at all.

What was the next step?? Underneath your skin is a thin layer of muscle. Think of a Christmas

ribbon 3-4” wide that starts up on your face near your nose and heads over to your ear. Very

thin, but wide like a ribbon that hangs from your cheek, runs down over your jaw, then heads

over your neck all the way down onto your chest. Like a curtain draped from cheek to chest.

As we age, this muscle, the platysma (pla-tis’-ma), starts to sag. It goes from shapewear,

acting to keep a nice tight firm jawline and face, to baggy, saggy pants. The next step was to

address the muscle. And here we are today. Still worrying about that layer of muscle.

Tightening the muscle really gives a more natural result. The skin is just re-draped over it. The

now more common high lateral SMAs lift, MACS lift and SMASectomy all rely on redraping,

lifting or cutting the muscle. They have all worked well.

But now, a more robust surgery entails more than tightening the muscle. It’s re-hanging the

curtain. The muscle curtain is thus resuspended on the cheek, lifted up and re-hung back up on

the cheek from whence it fell. This is called a deep plane facelift. Sounds kind of scary! But

really, it’s just going underneath the muscle and re-hanging it, or re-suspending it, or just re-

draping it up. This allows us to get all the way over to basically your nose and around your

mouth where those muscles start.

Have I lost you yet? Almost done. In your neck, the edges of the ribbon muscle become

apparent. That muscle on both sides, right and left, manages to take a short cut across your

neck. The two middle edges of the muscle start to appear as two bands under your chin, one

on the right, one on the left. The final step is to lace these two suckers together in the middle.

Like a corset. Finally, we pull the lateral edges back behind your ear and tack them up. Like

when you look in a mirror, and pull your neck back with your fingers. The greatest advantage of

this deeper plane approach is around your mouth—it does more to soften the folds in that

area, which heretofore were not reliably addressed. However, as with all surgeries it is

probably best to be seen and have us evaluate what your best options are.

This is all done in one surgery. It takes the morning. You have a dressing on, that gives a Telly

Tubby credit. The big wrap stays on for two days. Then you can shower and wash your hair.

But you must keep your head up for several weeks. Avoid heavy lifting, stooping, bending. You

know the drill. Most people can head to the grocery store in a week or so, but for a big event

like a wedding allow several months for recovery. Risks include bleeding, problems with

wound healing, nerve injuries, unsightly scarring, asymmetry, pain, and swelling to name just a

few. Ouch! Surgery is surgery.

I hope this helps take some of the mystery out of facial rejuvenation surgery. Here are some examples

of what surgery did for a few individuals. I have many more pictures at my office.

Before and After Photos

Patient A

PATIENT B

Many working people have this surgery not necessarily to look younger, but just to look and feel better groomed, and to have a neater, crisper looking jaw line. This young lady had an inherited a trait of a weak chin that just ran in her family. The “I have my father’s jaw line” and the “I know what I will look like if I don’t have surgery gene.” The after photo is take over 4 years after her surgery – but she has had some little things done in the office in the meantime (BOTOX and other injectables) to maintain her youthful look.

Patient C

This young lady just had set a timetable for herself. When she reached a certain age, she had decided she would have something done – both while she was still young enough to enjoy it and young enough that most people didn’t even notice she had something done. If you don’t like your neckline when you lean over, maybe you should consider surgery – sometimes without it, every day it looks worse.

Patient D

This lady just wanted a little freshening for a big family event. She had her face and neck rejuvenated along with some fat grafting. The volume that the fat provided really gives a nice refreshed look to her face without making it look too pulled. Her incisions are well concealed by her hair, but run along in front and in back of her ear, as well as a small incision under her chin.

Patient E

This woman had upper and lower eyelid surgery and her face and neck rejuvenated, along with fat transfers. She followed up with her aesthetician with some light peels as well. Again, the removal of the extra skin combined with the tightening of the muscles underneath and the restoration of volume, all work to provide her with a more relaxed look. I think her eyes just really sparkle! And they don’t look hollowed out or tired anymore.

Patient F

This lady feels like a kid; working, running around, busy, busy, busy. But suddenly, she looked down one night, and realized there was extra skin on her neck. She put her hands up to her face in the mirror and pulled up gently, and liked what she saw. She felt her face looked tired, not fresh any more. And remember – the more you have done, the longer the healing time, but also, the results may last longer, too. The take home message: if it can be done in an hour, and you are home for dinner, then the results probably will not be as long lasting. Make a commitment, get the results. She has a refreshed look that I know will last for years. Her facelift was done in the office with local anesthesia, much like going to the dentist’s office. The numbing medicine does sting, but once it’s numb you won’t feel anything! She spent the afternoon with us, and spent the night resting with her head up. Within a day or so, she was able to shower, wash her hair, and be out and about. It is at least a week before you are presentable with a little cover make-up!

Patient G

This 50 something year old had a few medical problems, and really wasn’t a candidate for any big surgical procedures, so she opted for something a little less surgical, but that fit her budget and recovery time schedule. A family reunion was coming up, and she just wanted to feel a little better about herself. I did a bit of liposuctioning under her chin, just under local anesthesia to remove any extra fat from right up underneath the chin. Then 4 weeks later she had a Thermage procedure in the office – a non-surgical method of skin tightening. No skin was removed! And the only incision she has is a .5″ scar under her chin. Wonderful and so fun for her!