Procedures::Face
Facelift
Our face is the constantly visible part of our body; it is our identity. It shows the world how we feel, our stress level, how happy we are and how kind we are. We have to respect our appearance, our expressions and our beautiful features.
The face lifting is one of my favorite operations, because I can design it to the needs of each patient. The idea is to use the least amount of incisions and maximize the aesthetic benefits. Facial harmony is the key to the success. The sense of proportion using the concept of the golden proportion will not only produce a natural result, but will also enhance the beauty of the face.
To understand what needs to be done, one has to understand what makes the face older-looking. If you look at your photos or you mother’s photos, you can see that as a baby the face is chubby and the bones are smaller. As a young adult, the face is fuller, the skin tighter and the bones stronger. With age, the skin loses the elasticity, there is less fat under the skin and the bones are smaller and weaker. This makes the skin and the soft tissues of the cheek to migrate lower. The face that was round and then triangular becomes more rectangular.
To turn the clock back and establish an appearance of youth, we ideally need to reverse all these changes. Face lifting alone will counter laxity, which was caused by the loss of elasticity. Therefore, we tend to reverse laxity, knowing that we can’t reverse the loss of elasticity. We try to reposition the soft tissues to their original position. We can counter the effect of fat loss and bone loss (loss of volume) by fat grafting, facial implants or simply injectable fillers. We can also restore the skin surface by resurfacing and skin care. True rejuvenation requires attention to all of these issues.
My facelift procedure is highly individualized to the needs of the individual patient. Some patients need the full face and neck lift, while others just need their cheeks lifted. Some may do fine with volume alone. It all depends on how far the aging process has gone and how much the patient wants to do. I feel obligated to analyze the whole face and have a long discussion with the patient, so that we can reach a mutual decision. I have made modifications to the facelift procedures to make them safer, less invasive and minimize complications.
My practice in New Jersey is made by word of mouth, and I can’t tolerate any problems. I know that a patient with a good result may decide not to tell anyone about their surgery, but a patient with a bad result or a complication has no choice but to tell everyone. Aside from that, I must say that I love my patients. They come to me and trust me with their appearance and I am obligated to care for them as if they were my closest family.
The Facelift is often combined with eyelid surgery or brow lift. In fact, the lower eyelid position and appearance is dependent on the position of the cheeks (mid-face). As the face descends, the lid cheek junction is lowered, creating a groove between the cheeks and the eyelids. The lifting of the cheek to a higher position improves this situation, and there is less downward traction on the lid. The brow position has the same relation with the upper lid.
Because the neck and face are connected, changes in the face will affect the neck, and vice versa.
In general, I try to preserve all of the fat in the face, except in cases where the face is round and ill-defined. In those situations, I remove some fat from the deep planes (buccal fat pad). In some cases, the buccal fat pad herniates in the area of the jowls. This is a deep fat that has to be removed from the inside the mouth or exceptionally from under the cheek skin. This can only be done by direct exposure. I have seen patients in whom a doctor, unaware of this condition, tried to remove this fat by liposuction. This resulted in worsening of the deformity.
In contrast to the face, the neck often has excess fat that needs removal; usually from under the chin. This fat is removed by liposuction or by direct excision through a small incision under the chin. I make sure to leave a good layer of fat under the skin to create a smooth angle and contour in the neck. At the same time, the muscle bands that create the turkey neck can be interrupted and sewn together to create a sling under the chin. Then, by lifting the muscles (platisma muscle) from the cheeks, the sling is further tightened, giving the neck a smooth and youthful appearance. I do not like to pass any sutures in the neck, as I think this will create an exaggerated sharp angle between the under chin and the neck, which is not harmonious and aesthetic.
I have developed a method of administering local anesthesia, which makes it possible to use mild sedation to relax the patient and have their cooperation during the surgery, especially during eyelid surgery.
The patient’s cooperation makes the procedure very pleasant and is an important factor for the success and the recovery. For example, I ask the patient to open her mouth and look up when I remove skin from the lower eyelid. This is done to make sure that adequate amount of skin is removed and there is no pull on the lower lid margin. The patient is asked to extend the neck when we work under the chin.
Contrary to what one might think, the procedure is well tolerated by the patients. During the surgery, we often have interesting conversation with the patients, or listen to music. I remember one patient who was an opera singer who sang for us during her facelift. Please don’t be afraid of local anesthesia; I really have mastered it for your benefit, but if you are still concerned, it is always possible to use other methods of anesthesia. You can also talk to one of my patients and ask about their experience.
After the procedure, the patient goes directly to the second stage recovery with a head dressing. They will sit with their family and have something to eat or drink before the discharge.
They are seen in the office the next day, in three days, in a week, in a month and six months to a year.
Short Scar Facelift, S Lift and Mini Facelift
These are modifications in face lifting that apply to certain specific cases. Whenever these lesser techniques are applicable and will achieve my patient’s desired outcome, I will present them with these options. Our goal is to achieve the best results through the shortest scars and in the least invasive way.
