Facial aging is inevitable.With the passage of time, skin thins and becomes more lax. Water and connective tissue volumes change and shrink leaving skin deflated. Tissues like fat, muscle and even bone decrease in volume. And of course, there is always gravity helping to weigh everything down. Together, these factors lead to sagging of the facial tissues, the development of hollows and depressions that cause unfavorable shadowing, the formation of wrinkles, and an overall aged appearance. These can even cause us to look more tired and depressed – despite feeling bright and energetic on the inside.
There are many reasons that accelerate facial aging. Some of these are out of our control – our ethnicity, genes, gender, and disease processes. However, many factors like sun exposure and smoking have severe, detrimental effects on skin and facial aging. These are in our control. Eliminating them can help slow the aging progress and keep our faces looking their best for longer.
A facelift cannot stop the aging progress. But by eliminating jowling, improving your jaw line and upper neck, and removing excess skin if necessary, a facelift can have a tremendous ability to reset the “clock” back to an earlier time, restoring the appearance of your youth. And more importantly restoring your confidence! When indicated, this is the most direct and dramatic method of rejuvenating the lower face.
What is a facelift?
In many regards, the term “facelift” is a misnomer and somewhat deceiving. The traditional facelift will only address the soft tissue of the face below a line drawn from the corner of the mouth back to the middle of the ear. Surgeries to address the forehead, the eyelids, and even the upper cheeks involve separate procedures. In some cases, this may be all a patient needs or desires, particularly if they are younger and just beginning to experience the signs of facial aging. However, many of my patients are concerned with multiple areas of the face. Therefore, a facelift surgery may be expanded inferiorly to elevate the tissues of the neck, and/or extended superiorly to address the volume and position of the tissues in the upper cheek.
Decades ago, facelifts were performed as skin only operations. Using an incision in front of and behind the ear, skin of the lateral cheeks and upper neck was elevated, pulled back and up, the excess skin trimmed and the incision closed. Unfortunately, this procedure did not address the underlying causes for aging and led to a “pulled”, “wind-swept”, or “operated” look. The result was unnatural, led to unfavorable scarring, and did not last. Since the 1980’s, we have learned far more about facial anatomy and the aging process. This has resulted in modifications, expansion, and individualization of the old facelift procedure.
A major breakthrough in facelift surgery came from anatomy studies that identified something called the SMAS (or superficial muscular aponeurotic system). You can think of this as a connective tissue layer that encases and connects all the muscles of our faces. It also incorporates a thin muscle in our neck called the platysma. Our skin is attached to and supported by the SMAS. This entire “system” can lose elasticity, volume support, and begin to sag as part of the aging process discussed above. Therefore, surgical techniques have grown over time to address this layer, rather than the skin itself. Conventional facelift procedures have many names (“deep plane”, “extended”, “vertical”, “short-scar”, “MACS-lift”, “SMAS plication”, “SMAS-imbrication”) and subtle nuances, but all achieve their results through repositioning and tightening of the SMAS layer. In doing so, many of the unwanted effects of the original facelift procedure can be avoided. In addition, I have performed all of these procedures and base the techniques I choose on the goals, health, and the facial characteristics unique to each individual patient.
Is a facelift right for me? How can I tell?
Are you becoming more focused and concerned about your signs of facial aging? Are there specific facial characteristics that appear more troublesome or worry you? Have you lost self-confidence because of your face, or feel that your facial appearance no longer reflects your vibrant, youthful internal feelings? Do you feel that your facial appearance has started to negatively impact your career, earning power, or employment? Then facial rejuvenation procedures may be the answer for you.
When people begin to recognize the effects of time on their facial appearance, they often have very similar observations. My patients typically dislike hollowing around their eyelids, heaviness of their eyebrows, and excess skin around the eyes. They also notice a loss of cheek volume, the development of jowls, and skin laxity with bands in the neck. They even note areas of both fat gain and fat loss. My patients also notice a change in their jaw line and dislike the development of deep and varied lines or wrinkles in the forehead, around the eyes, and the mouth. Some patients may have all of these concerns while others only have a few. And some patients will find they develop these faster or slower than their age-matched peers. In any case, when someone has a growing concern for any of these issues, it is best to discuss them with a board certified facial plastic surgeon. In some cases, surgery may be the only answer. And in other cases, there may be many alternatives to surgery. The only way to know for certain is to visit in person with a surgeon familiar with all aspects of the face, and with experience treating each of these issues in both men and women of any age.