Understanding Facelifts

by Maurice Sherman, M.D., F.A.C.S.

Newer techniques, improved safety, and modern
instrumentation continue to change the art of face-lifting.

Aging of the face is inevitable.   As years go by, the skin begins to lose n on the face and neck.  Crow's feet appear at the corners of the eyes.  The jawline softens into jowls, and beneath the chin, a double chin with vertical bands appears.  Heredity, smoking, and sun exposure contribute to the aging face.  With our ever increasing population, and people living longer more productive lives, face-lifting has become the second most desired facial plastic procedure, next to eyelid rejuvenation.

What Is A Facelift

 Despite the uniform excellent results, understanding the limitations of face-lifting and the need to utilize other procedures is crucial for success.  First, our patients learn that a facelift means lifting of the cheek, jowls and neck.  Incisions are placed in the hairline and around the ear, as illustrated (see figure 1).   In all cases, these incisions are placed in a natural skin crease for camouflage and without the need for shaving of hair.  The surgery can take 2-4 hours, usually performed under intravenous sedation, and without any patient discomfort.  Following surgery, a dressing is applied to protect the face and is removed the day after.  In our practice, we use daily magnetic resonance imaging (Soft Pulse), massage and ultrasound to hasten postoperative healing.  Most patients are cosmetically sociable in 10-14 days.

The facelift does not involve lifting the forehead, correcting sagging eyelids, straightening or refining the nose, nor does it correct flat cheeks or weak chins.  It also does not alter wrinkling of the lips, crow's feet, or improve sun damaged skin.  An entire menu of other procedures, such as forehead lifting, blepharoplasty, rhinoplasty, cheek and chin augmentation can be considered to augment the final surgical improvements.  However, the facelift is the cornerstone and the single most effective technique used in facial plastic rejuvenation.

To Facelift or Laser?

Facial laser surgery, both the CO2 and Erbium, have been popularized recently with claims that a facelift appearance will result.  With any new technique, original hopes fall short of long-term results.   Wrinkling and blotchy pigment irregularities are certainly improved, but skin tightening is minimal and usually transient in nature.  However, in patients with both sagging of tissues and aged complexion with sun damage and wrinkling, we emphasize the need to combine procedures to produce optimal results.  This concept of realistic expectations and patient awareness of the limitations as well as risks of any one technique is at the core of a concerned, caring cosmetic surgery practice.

     How Long Does A Facelift Last?

A facelift cannot stop aging nor can it turn back the clock.  What it can do is help your face look its best and give you a healthy and a more youthful appearance.  A uniform side benefit is the increased self-confidence and improvement in self-image.  Most changes last 5-10 years, but this can vary from patient to patient.  Due to improved techniques, the neck (once considered the most difficult area to maintain) holds its shape perhaps longer than other facial areas.  The mid-face and cheek, due to active muscles of facial expression, may need to be revised earlier than other areas.  In any event, despite continued aging, our patients always maintain significant benefits from face-lifting compared to their hypothetical identical twin who had not undergone the procedure.

Facial plastic surgery makes it possible to correct any facial flaws and signs of premature aging.  Newer techniques, improved safety, and modern instrumentation continue to change the art of face-lifting.   The ever evolving, improving nature of facial plastic surgery continues to keep me excited about the future possibilities we can offer our patients.

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