FaceLift FAQS

A facelift, a mini facelift, a neck lift and other facial cosmetic or plastic surgery terms are all very hard to sort out as to what they are exactly and what would be best for you.  The best facelift for you is the lift that deals with your issues and is directed at achieving your cosmetic goals.  From your photos, you have loss of facial volume resulting in a hollowness under your eyes (the so called tired look of aging), moderately deep nasolabial folds or smile lines as well as marionette, jowls and loose skin of you neck.  A simple lower facelift will address all of the issues.  You could always chose to have a less aggressive procedure but the downtime and complications are about the same either way and usually the longevity of the lesser procedures is not very good.  Some filler for the lower eyelid area would be of benefit and a good addition to any plan you decide upon. 

Here is an article aimed at clearing some of the confusion surrounding facelift nomenclature.

 

 

“How to find the best surgeon for a Neck Lift or a Facelift?” is a question that perhaps you should change to “how to find the best surgeon for you?”.  It is easy to say, “just come to me!” but not all patients are suited to every surgeon. 

The first step is to look for Plastic Surgeons who are certified by the American Board of Plastic Surgery.  While there are many surgeons who call themselves plastic surgeons and even who may be very good, they may not be certified by the ABPS.  An easy way to tell if they are, is to look for surgeons listed on the American Society for Aesthetic Plastic Surgery website, www.surgery.org.  That way you know you are at least getting the highest trained surgeons available.  

Do not look to far afield.  I always recommend finding one in your local area as travelling past great surgeons to find the “best” can backfire if you have a complication at home after your surgery. 

“How to find the best surgeon for a Neck Lift or a Facelift?” is a question that perhaps you should change to “how to find the best surgeon for you?”.  It is easy to say, “just come to me!” but not all patients are suited to every surgeon. 

The first step is to look for Plastic Surgeons who are certified by the American Board of Plastic Surgery.  While there are many surgeons who call themselves plastic surgeons and even who may be very good, they may not be certified by the ABPS.  An easy way to tell if they are, is to look for surgeons listed on the American Society for Aesthetic Plastic Surgery website, www.surgery.org.  That way you know you are at least getting the highest trained surgeons available.  

Do not look to far afield.  I always recommend finding one in your local area as travelling past great surgeons to find the “best” can backfire if Faceyou have a complication at home after your surgery. 

Once you identify some surgeons in your area, you should look carefully at their website.  Study their before and after photos and the information about a facelift and neck lift carefully and even their YouTube channel if they have one.  That way, you can get to know the surgeon before you even meet them.  You should also look at reviews and then go for a consultation.  You do not necessarily have to go to multiple surgeons but just find one you are comfortable with.

This is an age-old question and the simple answer is that the best age is when you are ready, and you would benefit from a facelift.  Everyone ages differently according to factors like their health, sun/smoking exposure and genetics.  The first thing a surgeon must consider is the risk/benefit ratio.  In other words, we must decide if a face lift will make enough of a difference to outweigh the potential risks from a facelift or a neck lift.  The first step towards answering this question to ask yourself if you are ready to find out more about the possibilities or potential solutions that are available for your facial aging concerns.  If you are ready to see someone to get your plastic surgery concerns answered, it is you surgeon’s job to determine if you are a candidate and make the determination about if you are a candidate.  If you are a good candidate and you are ready; then is the best time for a facelift.  

The answer to this question depends upon your need.  If you truly need an eyelid lift you can have it done separately (before or after your lift surgery) or you can have it done at the same time.  An eyelid lift and a facelift or a neck lift are frequently done together in a facial rejuvenation procedure.  

A facelift, a mini neck lift or lower facelift can all be done under either local or twilight anesthesia (also known as conscious sedation or monitored sedation).  In fact, this is a preferable way to do these procedures.  Conscious sedation or straight local anesthesia has been shown to reduce complications like post operative bleeding, infections and DVT’s.  It helps to speed recovery as well.  This is because after the surgery you have almost no pain.  As a result, no narcotics are needed at all.  In fact, I have not had to prescribe an opiate for a facelift patient for 4 years.   For facelifts or neck lifts, all that is required for post op pain control in facelift or necklift patients who have had local only or local plus sedation anesthesia is an anti-inflammatory like Aleve (naproxen) or Aspirin. 

Here is  a video of a patient who had a face lift with conscious sedation.

 

Your photo is very helpful.  They show that you would benefit from neck rejuvenation.  Direct excision is not a great solution as the scar form that procedure is problematic for many reasons, not the least of which is that it is very unsightly.  A very simple approach would be a lower MACS lift that deals with the neck.  The beauty of a MACS lift is that is scars can hardly be seen and it gives a very natural look that will last for years.  It can also be done in the office setting under local anesthesia, which some patients prefer.

I have added a video of a patient who had this done that may be of help to you as well.

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A MACS lift utilizes has a shorter scar and then suspends your tissue to your facial bones to give long lasting and natural facelift and or neck lift results.

A MACS has been shown to last at least 8 years before it shows its wear and avoids a lot od the complications that accompany the larger lift procedures without sacrificing results.  It also produces a very natural looking face/neck lift that my patients are thrilled with even after years.  It will not affect your cheek bones or malar area and should not alter your ear shape at all.  It can even be done under local anesthesia if you prefer.  I use a 24 hour rapid recovery technique as well so that you can get on with your life quite quickly.

Usually a simple combination of fillers plus a medical skin care program would fill in your jowl area and improve your skin quality and tightness rather than a mini facelift.  My preference for filler in this area is Bellafill since it is really a biostimulant that makes you make your own tissue and will last years.  A topical combination of Vitamin C plus the retinol form of Vitamin A would help your skin tremendously. 

This approach has far less risk than a facelift or mini facelift since the benefit from that surgery in most 32 year olds is usually minimal.

LifeStyleLift was the trade name for a company that hired plastic surgeons to perform primarily simple short scar skin only facelifts usually under local anesthesia.  They went bankrupt because of mismanagement, overspending on advertising and runaway malpractice claims. 

The technique of a skin only facelift lift where the skin is tightened but nothing is done to support or reposition the underlying structure and it has been around for many years.  

Few surgeons use it as the results do not last and there are far better techniques that utilize short scars and reposition the supporting structures of the face for available now that give a more natural, long lasting results.

The technique I prefer is called a MACS lift which stands for short scar cranial suspension.  This is a wonderful procedure that reduces complications and produces great results.

I hope that helps.

Facelifts and facelift surgery serve to tighten the skin of an aging face and neck by repositioning or tightening not only the skin but the underlying structures of the face.  The earliest facelifts procedures were single layer procedures or skin only facelifts that only tightened the skin.  While good results can be achieved with a skin only facelift, the longevity and the quality of the scar with these procedures were limited by high wound healing tension on the skin of these techniques.  Many, many facelift techniques have been described and SMAS facelift is one of the most popular facelift techniques among surgeons. 

The Superficial MusculoAponeurotic System or SMAS, is a tissue layer between the muscles and glands of the face and the skin.  Tightening this layer of the face will not only lift the face but improve both a facelift longevity and scar quality.   Skin tightening in a facelift is still important, but its lifting role is secondary to the SMAS effect. 

A deep plane facelift lifts the skin and the SMAS together as a single layer.  This provides better circulation for the overlying skin since it is a double layer, but it also hasa greater risk of injury to the facial nerve and its branches deep to it.  Most board certified plastic surgeons have abandoned the deep plane lift because there has been no proven aesthetic advantage ever demonstrated in results.  In addition,  studies have shown that there is little benefit in terms on result longevity of a deep plane facelift over a SMAS facelift or variation of a SMAS facelift.

A SMAS lift raises the skin and SMAS layers separately, rather than together. The advantage is that the SMAS and skin can then be tightened in slightly different directions.  This allows better control and customization in restoring individual facial shape.  Additionally, there are several variations of SMAS layer treatment: either excising part of it or folding it on itself for patients whose laxity is primarily limited to the jowl area, and more extensive inward SMAS lifting for those that also need central cheek lifting. The deep plane method can only do the same thing for every patient. This is regardless of individual differences in facial shape due to bone structure, soft tissue bulk, and skin quality. For these reasons, SMAS lifts are preferred.

There is third technique that has become very popular call a MACS lift (Minimal Access, Short Scar) facelift that does not lift the SMAS but rather lifts it up and anchors it to the bone of the face.  This MACS lift has the same longevity as the deep plane and the SMAS facelifts, but it has a number of advantages.

·        Shorter scars is a big advantage.

·        The ability to list the SMAS in many directions depending upon the facial structure and soft tissue demands of the patient and skin quality to get the best result.

·        Less risk to the nerves of the face.

·        Shorter operative time and faster recovery.

·         A higher level of patient satisfaction due to aesthetic results, combined with rapid recovery and return to normal activities.

·        The reduced operative time makes other nonfacial plastic surgery procedures done at the same time more feasible.

A MACS lift also produces wonderful results.  Here are some before and after facelift photos.

Here is an article that may help sort out some of this out.

 

You have a lot of excess skin of your neck and the sagging of your face that produces jowls, marionette lines and a blunted jaw line.  These issues are what a face lift is designed to deal with.  A facelift that is designed to address these issues may have many different names such as a lower facelift, neck lift, mini facelift, minor facelift among others but as long as the surgery is aimed at dealing with your concerns it does not matter what we call it.  There are also many techniques that surgeons and “Dr. Google” talk about such as a SMAS facelift, a deep plane face lift, a MACS lift and many others.  Most of these techniques are designed to Have the underlying structures of the face back into position so that the procedure gives a quality, long lasting result.  Again, the specific technique used is not as important as making sure that the surgeon’s goal is to address your concerns.

I prefer the MACS lift because it is not as invasive, the complication rate has been shown to be less, the recovery is much more speedy and the results last as long if not longer than some of the other techniques some surgeons employ to achieve similar results.

I hope that helps.

Dark circles under the eye are usually the result of hollows or bags under the eye.  While there are surgical options, a filler is the preferred way to deal with this problem for most people.  

I usually use Bellafill.  It is a natural, long term, filler that produces a wonderful result. There are many examples of patients treated with Bellafill here.

Your photos do show the common aging features of your age group, namely lower lid and lower face volume loss with some neck laxity. 

To correct the lower lid volume loss, I have abandoned surgery for long term or 5 year plus, fillers and the results are outstanding (as seen in these before and after photos) without the cost and complications of implants or lower eyelid surgery like a blepharoplasty.  I have been using Bellafill for 16 years and continue to be amazed at how good this filler is.

The lower face and neck are easily dealt with using a rapid recovery, short scar lower facelift or MACS  facelift.  This surgery can easily be done under local anesthesia and the next day you can be out doing just about anything.  Here is a video testimony about how easy this surgery can be and still get tremendous results.