Face Lift

Facelifts or Rhytidectomy:

Facelift-Image

The facelift operation is probably the most well known cosmetic surgery procedure dating back many years.

The facelift has undergone significant refinements and currently remains the most predictable and safe procedure that turns back the clock of facial aging.

Despite celebrities that have distorted faces (i.e the “facelift look”) a facelift performed by a seasoned plastic surgeon with artistic ability and a focus toward facial aesthetic surgery can provide facial rejuvenation that looks natural and without easily detectable signs of surgery.

There are many new cosmetic injections and procedures that are reportedly “replacing the facelift”. While many of these new injections (Restylane®, Juvederm, Botox®, fat, Sculptra, etc.) may reverse some changes of aging, a comprehensive facelift remains unique in its ability to “lift tissue” and “elevate” sagging muscles and fat around the face. Distorted faces and “facelifted” looks are due to poor judgment in selecting the facelift technique and not necessarily the surgical skills of the surgeon.

Therefore, the judgment that your surgeon exercises in choosing the proper facelift technique is critical to reaching your goals and maintaining a natural-looking appearance.  Prospective facelift patients should interview several surgeons, and develop genuine trust and a “comfort-level” with the surgeon. You should request to review high quality “before and after” photographs (good lighting, accurate detail) that demonstrate the surgeon’s work.  The single most important factor in obtaining a natural rejuvenated appearance following a facelift is the surgeon that you choose.

Facelift techniques and recoveries vary. In fact, a “facelift” can mean different things to patients and surgeons alike.  In general, a “facelift” means repositioning the skin and deeper tissues of the face, jowl and neck. Improving the neck with a facelift is often considered part of the facelift procedure, however, each patient should confirm whether the neck is included in the “facelift”.

As an example, some comprehensive facelift techniques, such as the “composite facelift”, include lifting of the neck, face, eyes and brow in one procedure. While this technique may be beneficial in some individuals, not all faces require this “total rejuvenation”.

In some cases a simple “limited incision” or “mini” facelift technique may be successful in reversing aging. The “mini” facelift procedure repositions the lower face and jowl tissue. Depending on age and genetic predisposition, a limited incision facelift may provide adequate rejuvenation and still maintain facial harmony despite not modifying other areas of the face. This is where the judgment of the surgeon and the expectations of the patient must be discussed frankly and openly.

In this section, we will discuss the different types of facelift techniques, the pros and cons of these procedures and the varied recoveries that are associated with these facelifts.

Facelift Techniques:

Limited Incision "Mini" Facelift

This procedure elevates the jowl,lower face,and the upper part of the neck. The incision is typically limited to the area just along the edge of the ear and therefore well hidden and associated with a quick recovery (3-5 days back to normal work activities in a normal office setting). This procedure may be done under local anesthesia with mild sedation, there is minimal pain associated with most facelift techniques including this one. There is minimal bruising and most patients can apply makeup to the face within 2-3 days. The results are long lasting (several years) however this technique is primarily for patients who show aging specifically in the jowl (along the jawline) and the lower face with minimal aging in the neck.

Limited Incision “Mini”Necklift

This procedure is performed to establish a youthful, angular jaw and neckline. It differs from the more extensive necklift in that there is only a small incision under the chin from which the fat is removed from the neck, muscles are tightened and in some cases a chin implant placed to re-establish a natural well- defined jawline and neck contour. This procedure is performed in individuals who have adequate skin elasticity to allow the skin to redrape into the new neck contour created by the above maneuvers. The “mini neck lift” procedure is performed under local anesthesia with sedation or light general anesthesia.  The recovery is typically 3-4 days in which the patient is back to normal work activities in an office setting. There is minimal bruising or discomfort associated with this procedure. The results are long lasting, typically more than 10-15 years and quite natural in appearance.

Mid-face lift or Cheek lift

The mid face lift or cheek lift procedure rejuvenates the upper cheek and lower eyelid region. The incision is made just beneath the eyelash margin and contours the lower eyelid appearance.  The fatty bulge (bags) beneath the eye is often repositioned over the cheekbone and the muscle and skin of the lower eyelid and upper cheek are lifted.  This re-establishes the youthful contours of the lower eyelid and upper cheek that are lost with aging. This procedure avoids the  “sunken” or “hollow eye” look that often occurs following more traditional lower eyelid procedures where significant fat is removed. The recovery from this procedure is typically 7-10 days. There is minimal discomfort associated with the procedure however the outer part of the eye is temporarily pulled upwards to support the lower eyelid during the healing phase giving the patient a slightly upward slant to their appearance. Moisturizing eye drops are recommended for 2-3 weeks following surgery to avoid dryness of the cornea during the healing phase. While this procedure may have a slightly longer “downtime” the stunning results are unobtainable with other techniques.

Lower Face and Necklift

This is a more comprehensive rejuvenation including elevation of the lower face and neck skin and tightening of the neckand facial (SMAS) muscles.  Fat is removed from the neck and face if needed.  The “lower face and neck lift” beautifully rejuvenates the neckline, jawline and the lower face. The recovery is similar to the “Mini” facelift, although, the incisions extend further behind the ear to allow for optimum neck rejuvenation.The results are long lasting (several years) and allow for a more complete rejuvenation of the lower face and the neck. The upper face, brow and eyes are not typically included in this technique.

There are many new names that have been attached to the “lower face and neck lift”. Many surgeons have come up with trademarked names for otherwise traditional face and neck lift techniques to establish a marketing advantage.  Corporations have been created to “hype” the benefits of “weekend” facelift procedures and so-called new procedures (Lifestyle lift, etc) despite the technique having been around for many years.  It is therefore important for each patient to be educated by their surgeon regarding the specific technique planned and whether the rejuvenation goals will be predictably met by the selected technique.

Composite Facelift

The “composite facelift” is a comprehensive technique to elevate the neck, face, cheek, lower eye and brow in one procedure.  Another term used to describe this option is a “balanced vector facelift”.  The ‘balancing of the vectors’ implies that all the components of the face and neck are elevated in unison so that an untreated segment of the face does not look “out of place”.  While the composite facelift is well established and performed by many experienced surgeons, the technique is clearly not necessary in all patients.  Facial aging proceeds in a predictable fashion, although people vary in the degree of aging in different parts of the face.  As an example, not all patients need lifting of the brow and eyes if the majority of aging is reflected in the lower face and neck.  Furthermore, staged facial rejuvenation is often desirable so that appearance is more gradually upgraded as aging occurs.  Specifically, the browlift portion of the composite facelift can often be modified or eliminated with excellent results in many individuals.

The composite facelift, performed by Dr. Choucair at his Dallas and Plano practices, offers a more effective and advanced alternative to the traditional facelift if necessary.  Unlike a traditional facelift that pulls the face in one direction only – toward the ear – the Composite Facelift addresses the gravitational fall of the aging face by using a two-direction lift (‘balanced lift’). In a Composite Facelift, all “parts” of the face

The key to facial balance is elevating tissues in the proper direction or “vector”.  The vector of skin (direction) pull is the most important factor in avoiding a “facelifted look”. The primary direction of lifting is upward (vertical) which avoids distortion of facial features.

The Revision Facelift

Dr. Choucair is a specialist in secondary or revision facelifts.  A significant part of his practice focuses on re-do surgery.

If you’re looking to refresh a previous facelift or find that the results of your facelift are not optimum, Dr. Choucair can perform a revision facelift. By utilizing innovative, advanced facelift techniques, he can correct the typical “facelifted” appearance and create a natural rejuvenated look.

Together, revision facelift surgery and cosmetic eyelid surgery can help recreate youthful contours and restore balance to a patient’s face.

A secondary facelift, or facelift revision, can correct most common problems associated with previous facelift methods and allow patients to age gracefully.

The most obvious problem associated with the many facelift techniques is a “swept-back” look (wind tunnel appearance) of the lower face. Often, the direction of pull for facelifts is toward the ear. This may distort the mouth and create a “pulled mouth” look. This is more obvious in patients with thin and sun-damaged skin, where the wrinkles and lines of the face are pulled into an unnatural direction.

A secondary facelift or “facelift revision” by Dr. Choucair corrects this abnormal pull or vector by repositioning the skin and deep tissue (SMAS) orientation to a natural direction.  This establishes a youthful and natural contour, eliminating the stigma of the “facelifted look”.

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