Facial rejuvenation is like making a bed. It is a two step process. First, one needs to start with clean, freshly ironed sheets. Secondly, the actual bed is made by carefully draping, rearranging, folding and finally tucking these sheets into place. The final results is a soft, harmonious and good looking arrangement that invites company rather than rejects it. How does this analogy applies to the face? We need to imagine our skin as our sheets. The ideal skin should be clean, opalescent and smooth. The skin should be relatively free of disconcerting wrinkles and folds. The skin should be adherent to the underlying facial structures in a natural fashion, free of redundancy and looseness.
In order to iron our sheets, peels in various fashions or lasers
can be applied to render the skin smooth in both maintenance skin hygiene
and facials to keep the skin clean and free of toxic buildup.
Finally, to actually make the bed, a well performed facelift with
fastidious bent towards detail can be utilized in a natural way. The
successfully rejuvenated face should attract rather than detract.
Unlike cosmetic nasal surgery, performing a facelift (synonyms
include rhytidoplasty, meloplasty or rhytidectomy) does not require an
innate aesthetic eye. However, it does require a surgeon with a keen eye
for details, since it is a surgery of minute details – needed to avoid the
tell tale signs of a facelift. This is key to achieving the natural look.
Among these tip-off signs are raised, altered hairline, a distorted tragus
(the cartilage in front of your ear canal), a “pixie ear” (where the earlobe
is attached to the facial skin at the jawline), a widened mouth, obvious
scars and tension bands across the face (from pulling too tight and removing
too much fat).
What is the difference between a mini lift and a full face lift?
A mini facelift deals with jowls and facial laxity only; the neck needs
minimal or no treatment and the incisions behind the ear are consequently
minimized. A full facelift, on the other hand, addresses both the facial
looseness and tackles the aging neck and “turkey gobble.”
Wait. The situation gets more complicated. Does your surgeon
propose a regular skin lift, a skin lift with SMAS (SubMuscular Aponeurotic
System “tightening the facial muscles”), a deep plane lift, a composite
lift, a biplanar lift or just an everyday subperiosteal midface lift? It
depends on the individual surgeon’s philosophy, which has most probably been
influenced by his/her training.
The pendulum is swinging back towards the simpler skin lifts
combined with or without some form of SMAS tightening. The more sexy and
complicated, deeper facelifts (deep plane and composite) classically produce
more swelling with more complications and questionably better results at
Long term follow-up studies as judged by independent panels of
Plastic Surgeons have failed to demonstrate and difference in outcome and
longevity between the techniques.
Where to go from here? Do your homework! There are many Plastic
Surgery “practitioners” who masquerade as fully trained Plastic Surgeons
eager to offer you their expertise at a great seasonal discount.
Ask about their techniques, their “before and afters,” their
board certification (The American Board of Plastic Surgery) and the specific
Keep in mind, however, that patients must be realistic in their
expectation and the surgeon must underscore this. Remember, plastic surgery
reverses time but time still marches on.
Dr. Haworth is a Board Certified Plastic Surgeon who practices
in Beverly Hills.