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The More You Know: What a Facelift Can and Can’t Do

A facelift may not help you look 20 again. What it can do, however, is even more impressive: It can sculpt a wonderfully attractive, youthful face while also producing natural-looking results. And by helping you lift sagging cheeks and heavy jowls, it can take over a decade off your appearance and create a noticeable “lift” that lasts ten or more years.

Why Choose to Have a Facelift?

With injectables (Botox, Juvederm, Restylane ,etc.) getting so much attention in the media, some patients suffering from sagging tissues make the mistake of thinking that they can achieve comprehensive rejuvenation without a facelift. Nothing could be further from the truth. While Botox and fillers are beneficial in the appropriate patient, facelift surgery still holds a unique place as the most effective treatment for certain age-related issues for the following reasons:

1. Facelift Surgery Can Get Rid of Jowls and Loose Neck Skin

If there’s one thing facelift surgery can do, it’s get rid of excess facial skin. Removing excess skin is essential for patients suffering from drooping, sagging skin.

As we get older and our collagen levels decrease, our skin becomes more fragile. As a result, our skin becomes much less elastic and tight. Our other tissues, like the muscles, also start to lose tone. Our fat pads begin to shift along with the sagging tissues. Eventually, the skin starts to stretch and eventually loosen, producing noticeable folds and areas of “drooping” skin, such as jowls.

Once this loose skin exists, there’s no way to get rid of it except to remove it. Some clinicians attempt to use dermal fillers to “plump up” the face (thinking that by adding enough volume to the face, they could fill in loose skin and make it less noticeable), but this approach isn’t effective for patients with substantially drooping skin. Over-using fillers in this manner can cause the cheeks look too bloated and unnatural. A facelift, however, is ideal for fixing sagging skin. It can make the facial features look more defined. Patients can look forward to smoother, well-defined facial contours that look natural.

2. A Facelift Is Best for Patients with Strong Facial Structures

Of course, that doesn’t mean that dermal fillers shouldn’t have a role in fighting aging. When used in proper moderation, dermal fillers or micro-fat injections provide the perfect complement to facelift surgery. Though facelift surgery is excellent for addressing structural issues like loose skin, it may not be able to define the cheeks for patients with a softer bone structure. Because a facelift works with the patient’s existing tissues, it won’t be able to augment certain areas on the face. That is where micro-fat grafts or facial implants can play a role in improving the results of a facelift in patients who need more structural augmentation.

Dermal fillers, on the other hand, are ideally suited to volume-enhancing applications. Many plastic surgeons therefore use dermal fillers to correct hollows under the cheeks or eyes that may still be present after facelift surgery.

3. Facelift Surgery Can Address Drooping Facial Muscles

It’s not just our skin that starts to weaken and succumb to gravity as we get older; the deeper tissue overlying the musculature of the face (the superficial muscular aponeurotic system, or SMAS) also “drops.” As the muscles that support the cheeks fall, they take fatty deposits with them, and this can further contribute to the formation of jowls and facial folds. It also tends to cause facial hollows; as fatty deposits move further down the face, they’re no longer present to cover the cheeks. This can cause the areas around the cheeks to look gaunt, while at the same time, the jowls are accentuated by fatty deposits.

While early forms of facelift surgery only focused on stretching the skin and removing loose skin, modern facelift methods actually lift the SMAS. Plastic surgeons surgically tighten the muscles that stretch across the cheeks and move them higher on the face, thereby repositioning not only the muscles but also the connective tissues and fat deposits they support. This newer approach has numerous advantages: for one thing, it produces very natural-looking results. Historic “skin stretching” facelifts sometimes produced a tight, windswept look, whereas modern facelifts do not. Modern techniques essentially “rebuild” and sculpt the face in addition to lifting the tissues. More importantly, they address all the different tissues affected by aging – meaning different parts of the face won’t age faster than the other. This is crucial in producing a long lasting natural improvement.

The SMAS approach also allows for some of the most natural results a facelift can give; the patient won’t “look like” he or she has had a facelift, he or she will just look like a person who has aged extremely gracefully and the results last longer than a skin only lift.

4. A Facelift Can Create Long-Lasting Results

It goes without saying that modern surgical methods produce extremely long-lasting results. While non-surgical procedures offer little downtime, even the most durable ones can last for a little under two years, usually far less than that. However, a surgical procedure like the modern facelift can produce results that last for a decade or longer. Furthermore, patients have the option of touching up their procedure with a less invasive “mini” facelift if they do notice any skin sagging eight to ten years after having a full facelift. If you have a facelift and an identical twin didn’t you will always look younger and fresher that the twin who didn’t have the procedure, even 25-30 years later.

5. A Full Facelift Mostly Addresses the Lower Half of The Face

A facelift targets the lower half of the face: jowls, cheeks, and upper neck. That means it’s not ideal for patients that want to target a sagging forehead, wrinkles around the eyes (like crow’s feet), and drooping eyelids. Fortunately, the facelift can be easily paired with other procedures like the brow lift, an eyelid lift, and injectables. It can be even paired with a procedure like a neck lift if the patient wants comprehensive facial rejuvenation.

If the patient is suffering from a wrinkled, saggy forehead and frown lines, a forehead/brow lift might be more apt. If the issue is drooping eyelids, the patient can have a blepharoplasty to lift and tighten the lids.  And as we’ve mentioned before, the gaunt areas under the eyes and cheeks can be smoothed out with temporary dermal fillers or long lasting micro-fat grafts.

6. A Facelift Won’t Address Fine Lines and Wrinkles

Because it can smooth out sagging tissues, a facelift will reduce the appearance of deep wrinkles like nasolabial folds (the folds than run from the nose to the corner of the mouth) and marionette lines (the lines that run from the corner of the mouth down to the chin).

However, a facelift won’t necessarily target fine lines and wrinkles – they’re too small and fine. Instead, patients can have their fine lines and wrinkles fixed with injectables. Injectables like Botox are designed to diminish the appearance of wrinkles, crow’s feet, and frown lines. On the other hand, injectables, like dermal fillers or micro-fat grafts, are perfect for deep-seated wrinkles like nasolabial folds and marionette lines.

7. A Facelift Won’t Address Skin Quality

While a facelift will lift and tighten loosened skin, it won’t do anything to the tone, texture, and youthfulness of the skin. Thankfully, complexion issues can be easily improved with good skin care treatments by a medical aesthetician both before and after facelift procedures.

Laser procedures like the IPL Photo Facial and Protégé Skin Tightening will change your skin at the cellular level. With the combination of the facelift and these treatments, you can have beautiful, glowing skin and a more youthful look overall.

Types of Facelift Surgery

While modern facelifts invariably target the lower half of the face, there are a few different approaches to doing so. A handful of different facelift types exist today, giving patients several different options to choose from.

The Traditional Facelift

A traditional face lift is performed by manipulating the SMAS, a layer of muscle and connective tissue under the skin. It’s performed using incisions along the hairline and around the ears. This technique also features the releasing and repositioning of the SMAS system and the removal of loose skin.

To put it simply, a traditional facelift will lift the SMAS, which will then lift the connective tissue, skin, and fatty tissue attached to it. It’s a way for the surgeon to redrape the skin in a way that helps the patient look smoother and younger.

It’s important to be aware that there is no one type of SMAS lift. There are several different surgical techniques used to perform SMAS lifts today, and some of them produce more profound changes than others. It’s therefore important to talk to your chosen surgeon about which method he or she uses and why.

The Mini Facelift

The mini lift is also sometimes called a “short scar” facelift. As the name suggests, this procedure involves the creation of short, rather than longer incisions. Usually, some short incisions are made behind the hairline, but there are several different incision types in use today. A mini facelift is reserved for patients that need minimal lift in the mid-face area. Because it manipulates the tissue much less than a traditional facelift, a mini facelift often results in an easier faster recovery but less correction and not as long lasting.

Obviously, the downside of the short scar approach is that it he or she won’t be able to re-drape the skin extensively or lift the lower half of the face substantially. As such, this procedure is usually recommended for patients that don’t have extensive sagging in the lower face (though, as mentioned previously, it is also sometimes used on older patients who wish to freshen the results of a previous facelift).

There are other types of facelifts in use today, but the surgical methods described above are the most common and most effective. If you’re interested in having a facelift, we recommend choosing the procedure type that best reflects the needs of people in your age group. Though the prospect of invasive surgery can be intimidating, most patients discover that the results of facelift surgery are more than worth the fortnight of recovery—particularly given the fact that facelift recovery generally involves only mild soreness.

Facial rejuvenation needs to be individualized. There is no ”universal facelift” procedure that will work effectively for everyone What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the pros and cons of the various options that can achieve the best cosmetic result for you.

If you’re ready to work with a renowned surgeon for your facelift, contact the offices of Dr. Robert  Singer for a consultation.

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