Face & Neck Lift

Contemporary facelift surgery differs vastly from the older stretch and tighten procedure, which ten years ago, ignored important principles of aging and facial structure. The older methods, which dealt only with the skin and not its underlying structure, attempted to correct wrinkling and sagging skin by pulling the face as tightly and flatly as possible. This method often resulted in a very unnatural, mask-like or flattened appearance that did not last. Today, revolutionary face lift techniques focus on creating dramatic, yet solid, long-lasting changes that are natural in appearance. They correct underlying skeletal structural deficiencies and effectively reposition and contour the underlying muscle layer and skin. For these reasons, the surgeon must have the necessary training to understand and effectively deal with the anatomy and underlying structures of the face.

Facelift surgery is performed on both men and women, and corrective procedures vary from person to person. While one individual may need a complete face and neck lift, another may only require elevation of sagging eyebrows or fat removal from the lower eyelids. Another may need only correction of an early double chin. A person whose facial appearance is very weather-beaten may also require a chemical peel or laser resurfacing. Someone else may require all of these procedures to maximize the outcome of the facial rejuvenation process. This is the basis for the “multi-modality or multi-level approach” to facial rejuvenation.

The primary goal begins with correctly analyzing and understanding the deficiencies or deformities present in the anatomy of each individual patient and isolate these problems that may be present. By analyzing and treating the aging face, we have to understand why facial structure is so important and the rationale for the type of face lift or facial rejuvenation procedure we choose. This will determine how we can logically approach the problems of aging in order to select the most appropriate procedure or procedures for each patient.

This process lifts the deeper soft tissues, fat and jowls. Lifting these tissues must be done in a way that just doesn’t pull the face. Rather, the surgeon must have the experience needed to access the areas of the face which will enable him to elevate and anatomically relocate the midfacial soft tissues and the jowl vertically upward and back to where they were years before. This is what will ensure no distortion of expressive features. The surgeon must realize that it is not only the skin that has dropped, but the deeper elements of the soft tissues which form the jowls have also dropped. The soft tissues must be relocated upward and suspended at a higher location. That is the most effective way to treat this type of problem. My face lift procedures utilize the vertical mid face lift as the gold standard to effectively withstand the test of time.

In order to successfully elevate the face, the deeper SMAS-type of face lift procedures are performed. The facelift is now designed to relocate and recontour the soft tissue and muscle layers of the face. It must also redistribute, smooth out, and remove the excess skin from the face and neck. The facelift operation usually takes between 3 1/2 to 4 1/2 hours to perform. Incisions, which will heal into flat, nearly invisible scars, are made in unobtrusive areas such as inside the hairline and/or in natural depressions around the ears. Usually, the incision for facelift surgery begins in the hair near the temple and continues in from the front of the ear, around the earlobe, behind the ear and into the hair in order to prevent easy detection. At the temporal area, the incision is carried below the hairline so that the hair can always be worn in any desirable fashion.

In time, the platysmal muscle falls and drags the skin down with it. This is what causes the bands to develop over the anterior or front part of the neck. We provide a more ideal neck contour by utilizing this muscle. We actually isolate, relocate, and use the muscle to produce a supportive neck sling so that it reinforces the neck rather than merely pulling the skin.

There are a few options for neck lifting. To be effective, they all involve treating the redundancy of the platysma muscle in one form or another. In cases of minimal redundancy, the neck may be approached through an incision under the chin. The muscles can be sutured together and the neck contour improved. In many cases, what might appear as fullness or excessive fat, particularly in the “turkey gobbler deformity”, might actually have very little fat present. In these cases, it is important that fat NOT be removed. The presence of a layer of fat under the skin is essential for smoother and more youthful quality to the neck skin.

In cases where there are larger degrees of redundancy, we do not merely isolate or tie the muscles together. We actually produce a muscular sling from a bidirectional approach. In the midline, under the chin (the submental area), the muscle is isolated from the skin and underlying tissue and then rotated in an upward direction where the muscle is reinforced at a new location and a muscular sling is created. This improves the contour over the lower part of the neck in the more central locations of the neck. The platysma muscle is also isolated from the back of the neck and advanced backward, repositioned and resuspended as an extension of the SMAS component of the face lift. This upper part of the platsyma procedure creates a well-defined jaw neck even in the most difficult cases.

Having the opportunity to follow my patients for over 10 to 15 years, this bidirectional playtsma method has proven to provide the longest lasting results in neck lifting than any other type of procedure.

In younger patients who have enough elasticity of the skin and/or a specific area of excess fat, liposuction have proven to be an excellent modality to sculpting the neck. After a certain age, however, liposuction can cause negative effects. Some of us need that cushion under the skin to insure that the it looks healthy and vibrant. Excessive fat removal, particularly in older, thinner patients, with a sagging of the muscle, can cause a depressed area under the chin which is referred to as a “cobra” neck deformity (a common occurrence from excessive liposuction of the face or direct removal of the submental fat.

Recently a short scar or short flap technique for younger patients has been proposed. The indications for this procedure are for younger patients to treat early development of the jowl. This is a limited approach and does not have similar benefit in terms of the long term results obtained with the vertical midface lift.

This procedure has also been highly advertised as one with invisible scars. This procedure is performed for cheek elevation when the neck and jowls do not need lifting. The indications for this procedure are also designed for younger patients. The scars are usually above or in the hairline. An incision may also be made intraorally, similar to performing a mid face implant procedure. The procedure is performed usually in conjunction with an endoscopic forehead lift.

Liposuction of the jowl or nasolabial folds may cause problems in soft tissue irregularities. One seldom encounters fat within this area. The problem is a redundancy of tissue that gathers within these areas, rather than an accumulation of fat. Dr. Binder maintains that the tissues need to be lifted, rather than removed, In other cases, fat can be trimmed successfully and safely during the face lift procedure.

Radiofrequency devices have been introduced recently. Heating the skin via radiofrequency or by most any energy source will result in edema to the skin that makes it appear less wrinkled. I have found the results of such treatments to be short lived and advocate them only if the patient understands the limitations of these procedures.

The media quickly picks up on new plastic surgery procedures and people very often hop on the bandwagon. This procedure which uses sutures to suspend the face has been embraced by various cosmetic doctors who may or may not be surgically oriented. It is not without complications. After my thorough review of the results of this technique, So far, I am unimpressed. I will reserve judgment until a more a double blind study is published showing long term follow up with discernable results.