Before
After
It seems that it is somewhat ingrained in many patients that if you get a facelift, you have a very unnatural surgical look afterwards. The proliferation of magazines and internet sites that are devoted to revealing which celebrities have gone under the knife with unfavorable results contributes to this misguided perception
Patients’ rationale for fearing facelifts appear reasonable – if a movie star, who is wealthy and has access to the best plastic surgeons in the world, cannot get good results, what is the likelihood that the average person can get a good facelift? The problem with this reasoning is that it only focuses on the small percentage of celebrities who had bad surgery. It completely ignores the vast majority of celebrities who have had good facelifts who have had good facelifts without the telltale signs of surgery.
Many of the patients who already had a facelift done elsewhere, and want a second opinion from, are unhappy because they had inadequate rejuvenation from their first facelift surgery. So rather than the feared “wind-blown” look, these patients look like they hardly had anything done at all! While the overdone facelift can be devastating for the patient, the underdone facelift can also be very frustrating. The overdone face is caused by a technical issue, such as over pulling, abnormal direction of lifting, or the destruction of natural features of the normal face. However, the solution to avoiding these issues is not by under doing the correction that needs to be done to rejuvenate the face.
The main reason that patients undergo surgical facial rejuvenation is to look younger and more refreshed. If the surgery does not deliver substantial improvement; it defeats the purpose of a surgical facelift. The distinction between a real surgical facelift versus the non-surgical facial rejuvenation (lasers, dermal fillers, etc.) is that surgery can make the patient look significantly younger and more refreshed, compare to non-surgical rejuvenation treatments, which can provide only minimal to moderate results. Non-surgical rejuvenation treatments can help the patients buy time, but will never give as significant of a result as a surgical facelift can. The patient should also keep in mind that a significant improvement does not necessitate a surgical look.
It is clear that practically every patient’s face is different. They range from large to small, symmetric to asymmetric, thin to heavy and thin skin to thick skin. The rejuvenation has to be tailored to the patient’s individual need. The goal is to provide the patient with a facelift that significantly improves their appearance as well as a result that can be sustained as the patient continues to age. The issue with some of the results that plastic surgery reality shows depict is that the patients are evaluated only a few weeks after the surgery. At that point in time, the patients still have some residual swelling, which can lead to an overestimation of the long-term result. Even in some of these cases, the most significant component of improvement that viewers see can usually be attributed to the make up and hairstyle.
With my fellowship training in craniofacial plastic surgery, I have significant experience in complex facial reconstruction. By applying the understanding of facial architecture and the comfort level in manipulating the various facial components both skeletal and soft tissue, I have developed a technique called The Multilayer Contour Facelift. The technique is individualized to the patient’s face. It addresses the 3 components of the aging face: the bone structure, the soft tissue and the skin. The deficient bone structure can sometimes be improved with soft tissue augmentation such as fat graft but sometimes need direct augmentation with artificial bone. In cases of prominent bone structure, bone reduction may be performed at the same time as the facelift.
The “submusculoaponeurosis” commonly referred, as the muscle layer below the skin, should always be tightened to improve both the short term and long term results. It is not unusual for me to see during a secondary facelift that the previous facelift did not address this muscle layer. By not tightening this muscle layer, the patient will have premature sagging of the lower face due to the weakness of the lower facial skin and its lack of support from the muscle layer. The tightening of the muscle layer will also correct some of the ridges and contour irregularities that develop during the aging process.
The direction of the pull and the amount of skin resection can also determine the naturalness and longevity of the facelift. In recent years, there has been a trend to do minial amount of skin resection and focus mostly on the tissue contour below the skin. This did not work as well as many of the proponents of the short scar facelift had hoped. The skin is a very significant component of the youthful face. It is unlikely that you would find an individual who has a very youthful face with very loose skin.
Conflicting information can cause much confusion for patients. We have a group of surgeons, usually no-plastic surgeons, who champion the skin only facelift, and another group of surgeons who champion minimal skin excision facelift. The reality is that all aspects of the aging face needs to be addressed to ensure a youthful, natural and long lasting facelift. To obtain this result, there are no short cuts or cutting corners. The Multilayer Contour Facelift addresses all 3 aspects of the aging face; bone structure, soft tissue, and skin. This is very important to achieve the natural and youthful results that all patients desire.
