Traditionally, your plastic surgeon makes an incision within the hairline and within natural contours in front of and behind the ear. The incision starts in the temporal area, extends in a natural line just inside the cartilage at the front of your ear (Tragus), then behind the earlobe to the top of the ear, and then finally down the hairline along the posterior scalp. The relationship of these incisions with respect to the hairline might vary among women depending on their hairstyle, and among men depending on the extent of balding and the location of the receding hairline. Besides this incision, another one is also made under the chin fold to access the neck muscles.
First, the neck is contoured by removing the excess fat and by tightening the neck muscle (Platysmus) in a corset-like fashion. Therefore, this technique is called a “corset Platysmaplasty”. It is one of the most important parts of the Facelift, in that it creates the sharp angle under the chin, thus removing the neck bands and the “Turkey Gobbler”. At times the sagging salivary glands that hang below the level of the jaw line and make the neck look fuller and less defined, are also repositioned back to their original location.
Second, the skin of the face is partially lifted off from the sides via the incisions described above. At this point, it is curtailed to tighten and elevate the sagging underlying structures including the cheek fat pad (SOOF), Superficial Musculo Aponeurotic System (SMAS), and the outer neck muscles. These structures are re-suspended by sutures, barbed surgical strings (“Contour Threads”), or absorbable hooks.
Third, the facial skin is re-draped and its excess removed. Drains are placed in the depth of the tissue in order to remove excess fluid build-up. Incisions are carefully closed with deep and superficial dissolvable sutures.
Attention is then directed to the rejuvenation of the eyes by performing a lower and upper Blepharoplasty (Eyelid Surgery), if needed. A Forehead Lift is at times combined with a facelift, in order to rejuvenate the forehead, lessen the frowns, and to lift sagging eyebrows, thus also being called a Brow-Lift.
At times when there is loss of facial volume and fullness as a result of aging, the cheeks, chin, or lips are also augmented with implants, fat grafts, or other fillers before closure of the skin.
Finally soft protective bandages are placed around the neck, ears, and the face.
Depending on the patient’s needs, and the plastic surgeon’s preference, the Facelift surgery is varied to different degrees.
A Mini-Facelift is similar to a full Facelift, with the exception of not including the Neck Lift. This procedure is usually reserved for those who have deep Nasolabial Folds, jowls, and sagging facial structures, yet still have a firm and well- contoured neck. The extent of deep tissue tightening is usually not as detailed as a full Facelift. This procedure can also be combined with other procedures such as Eyelid Surgery, Blepharoplasty, Forehead Lift, and skin resurfacing.
The Superficial Musculo Aponeurotic System (SMAS) is an anatomical layer of thickened deep tissue and supsensory ligaments that encase the cheek fat pads and facial muscles and holds them in their normal position. With aging and gravity, the cheek and the subcutaneous structures descend. Resuspension of these tissues by elevating and securing the SMAS is an integral part of a good facelift that lasts. This technique has been modified by a variety of surgeons to include different layers of the deep facial structures leading to the development of “Composite Facelift” and multiple plane Facelift.
In the pursuit of a superior correction of the deep Nasolabial Folds and to better elevate the deep tissues of the face and the cheeks, the Deep Plane Facelift was developed. This technique is similar to the SMAS facelift with the exception that the cheek fat pads and some of the facial muscles are freed off the facial bones in order to be able to mobilize them better. This procedure is technically more challenging than the traditional facelift and also carries a higher risk of facial nerve injury, and should be performed only by a plastic surgeon who is very experienced in it.
In the Subperiosteal Facelift, the deep facial structures are completely separated from the underlying facial bones and elevated to a more normal position. Like the Deep Plane Facelift, this procedure also achieves a better correction of the deep Nasolabial Folds and the sagging cheeks. The disadvantage of this technique is that it carries a longer period of facial swelling afterwards.
In some circumstances, mostly in the younger patients, the facial sagging is predominantly limited to the mid-face — the area between the two cheeks. In these people the Nasolabial folds are deep, the cheeks are sagging, yet there is not a significant degree of jowling or sagging of the neck. In these people, a Mid-Facelift rejuvenates the face, without the need to undergo a more drastic surgery such as a full Facelift. The incisions are rather small, and are placed either in the mouth or through the lower eyelid incisions that are usually used for lower Blepharoplasty. The results are rather dramatic and the recovery rather short. It is often combined with Eyelid Surgery — Blepharoplasty.
The Skin-only Facelift does only lift and pull the facial skin and does not tighten the underlying facial ligaments, muscles, or structures. Because of the poor elasticity and laxity of the aging facial skin, the pulled facial skin usually re-sags within six to twelve months; making the longevity of this Facelift rather short. The primary reason that this procedure is performed is that it is not as technically demanding and time consuming as the SMAS Facelift.
This is another term for the tightening of the neck muscles. After a small incision is made beneath the chin, your plastic surgeon removes fat that has collected in the neck or jowl area with Liposuction. After the fat is removed, the cosmetic surgeon tightens the muscles of the neck. This procedure eliminates a double chin and it will also remove any vertical bands that have formed in the neck. The improvement in the neck helps to achieve the rejuvenation of the entire face.
In patients whose facial aging is focused in the neck with no evidence of jowling, the neck skin can be tightened and pulled back towards the earlobes. The remaining excess skin is removed through an S-shaped incision that travels from the front of the earlobe, to behind the ear, and along the hairline of the lower scalp. At times this procedure is combined with a Corset Platysmaplasty to further tighten the neck muscles and in order to eliminate the neck bands or cords.
When facial aging is minimal, the facial skin can be lifted and tightened with the aid of Contour ThreadLift™ sutures. These sutures are non-absorbable Polypropylene barbed sutures that are threaded under the skin through small stab incisions behind the hairlines. The subcutaneous tissue is then loosened away from the deeper structures and then advanced over these sutures to a more elevated position. The advantage of this technique is that it is “minimally invasive” and can be performed without general anesthesia, and with very little down time. Because it is a rather new technique, its drawbacks and limitations have not been fully tested. In my experience, it can achieve rather dramatic results, as long as there is not much redundant facial skin. If there is much redundant skin, this excess skin must be excised as in a standard Facelift or it will gather in bunches on the sides of the face. Furthermore, the sutures can also fail their pulling capacity, be visible or palpable from under the skin, or even extrude through the skin. In case of extrusion, they can be very easily pulled out and trimmed. More so than other surgical procedure, the Thread Facelift technique’s success is very dependent on the skills of the plastic surgeon and his/ her ability to direct the vector of the facial pull in a direction that will give a natural result while still making a difference.
The duration of a Facelift is obviously relative to its complexity and the techniques used. Since other procedures such as Blepharoplasty and Forehead Lift are commonly performed along with a Facelift, the length of the entire procedure can take from four to seven hours. Your plastic surgeon should thoroughly discuss with you the extent of surgeries that can be safely performed at once.
Dr. Younai is a Board Certified Plastic & Reconstructive Surgeon with experience in all aspects of Facial Cosmetic Surgery including Facelift or Rhytidectomy, eyelid surgery or blepharoplasty, neck lift, forehead or brow lift, rhinoplasty, etc. He is skilled and experienced in all techniques of facial rejuvenation surgery and strives to create a face that is natural and normal looking. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you before-and-after pictures of other patients with facelifts, who might be similar to you.
Dr. Younai performs his surgeries at the state-of-the-art Regency Surgery Center which is certified by Medicare, AAAHC, and AAAASF.
Our center also includes the Regency Surgery Center which is a state-of-the-art outpatient surgery facility certified by Medicare and accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc., (AAAASF).
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