“Saving Face”

My favorite facelift story involves a delightful British woman in her 60s who told me “I don’t want to look beautiful… I just want to look “tidy”.  Her sagging jowls and hanging neck made her feel like an unmade bed!

If you analyze the aged face versus the young face, it is clear that the aged face is like a triangle with the base at the bottom while the young face has the point at the bottom. Gravity has pulled skin, fat and muscles south.  A facelift restores the triangle of youth.

A better name for the procedure is a jowl and neck lift. The problem starts with the muscles in the neck called the platysma muscles which cause the bands running from the jaw to the chest that create the “turkey neck”.  These muscles have only one function – to support the plastic surgeons!.  I use an inconspicuous 2 inch incision under the chin to divide these muscles and then I sew them together like a corset for internal support and a clean angle to the neck.

Excess fat in the neck and jowls can create an overly round face instead of the pointed triangle.  Liposuction nicely eliminates that problem. The fat that has slid down from the cheeks to the jowls is lifted in a layer called the SMAS and held up to the cheeks with permanent sutures.

Classically, the skin was lifted in the temples, the face and the neck behind the ears.  This is still necessary in extremely sagging necks.  More recently, the “mini” facelift has eliminated the lift in the neck behind the ears.  This results in a short, inconspicuous scar from the sideburns to right in front of the ears, then behind the tragus (cartilage) of the ear and around the earlobes a short distance behind the ears.  This approach allows a more effective, natural upward repositioning of the skin with all excess skin trimmed away.

My patients prefer to sleep through the whole procedure with general anesthesia by my certified nurse anesthetist.  A typical “mini” facelift still requires four hours to have a dramatic, yet natural, result that will stand the test of time.

Rare but possible risks involve injury to the nerves that raise the eyebrows or depress the lower lip when smiling. Pain is not an issue with facelifts.  Bruising and swelling are mostly resolved in about three weeks. I exchange the bulky dressings with a comfortable Spandex neck and jowl supporter in three days.

A few caveats:

Don’t have a facelift while taking aspirin or blood thinners. This could cause a collection of blood under the skin called a hematoma.
Don’t expect a facelift to “iron out” wrinkles.  It would have to be unnaturally tight (“windswept” look) and skin eventually relaxes.  To eliminate wrinkles, fillers such as Artefill, are the best solution.

What about those “lunchtime” lifts on TV using local anesthesia and looking great the next day?  These are quickie minimal skin lifts that are often performed by non-board-certified, non-plastic surgeons in a “surgery mill”.  The results are half-baked and short-lived.

Is a facelift for you?  Just remember, you never get a second chance to make a great first impression.

From my H-Art,

Yale M. Kadesky, M.D.

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