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Face Lifts / Rhytidectomy

 

                                   Face Lift or Rhytidectomy on CosmeticSurgeryForums.com

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Lets face it, as we age.......along with wisdom comes wrinkles.  Many of us spend the first part of our lives blissfully unaware of what the future has in store for our faces.  We then spend the second half of our lifecycles trying to eradicate any and all signs of time. 

Moving on past the injectables which have made their mark in the cosmetic surgery world as helping us starve off "father time" with helpings us address varying degrees of wrinkles and folds on different areas of the face.  Eventually, we come to a crossroad that we must make a decision on whether or not we should go under the knife for a more permanent method, such as a face lift.

A face lift is a surgical solution for restoring your face and neck to a natural youthful looking state.  The pulled wind-tunnel look is so passť.  The goal in achieving a naturally rejuvenated result requires much more than just technique. finesse, or artistic sense than just lifting and tightening the skin.  Today's full facelift requires repositioning both the skin and the underlying tissues for (superficial musculoaponeurotic system or commonly referred to as the SMAS Face Lift), than reducing, redistributing and, in some cases adding fat to some faces before re-draping the skin and reducing any excess.  Having a face lift is much more than sculpting and contouring the face....sometimes it means adding tissue in the correct places, not just removing the extra skin in order to make it look natural.

 

 

 

 

PROBLEM:  Loose, sagging skin

SOLUTION:  Brow lift, eye lift or face lift, which address not only skin, but also the underlying muscle to create a smooth, firm, youthful appearance.

 

PROBLEM:  Sun-damaged, rough and wrinkled skin

SOLUTION:  Resurfacing - as wrinkles and fine lines cannot be erased by a facelift alone only reducing excess tissue.

 

PROBLEM:  Volume Loss

SOLUTION:  Fat grafting or injections. The face becomes thinner as we age - so a round face is associated with youth.  Facelifts can be delayed or refined by injecting fat if you have no jowl or neck looseness.

 

 

 

 

 

                                    How a Face Lift is performed - skin has lost elasticity and underlying muscles sag.

                                      2010 Copyright © ADAM, Inc. - Used with permission

 

                                    How a Face Lift is performed - Main incision in hairline, around and behind the ear - Incision under chin for neck lift

                                     2010 Copyright © ADAM, Inc. - Used with permission

 

                                    How a Face Lift is performed - Scars after healing and fading

                                      2010 Copyright © ADAM, Inc. - Used with permission

 

 

A facelift begins with carefully placed incision.  In general, these are made just inside the hairline at the temple and extend along the natural curve of the ear, back behind the ear and horizontally into the hairline.  Well placed incisions should be placed in the natural skin creases and shadow lines, or along lines of skin texture changes.  Beveling incisions within the scalp will permit hair re-growth over any resulting scars.  In cases, where a full lift is not necessary and excess skin  in the jowls or neck is minimal, a shorter or limited incision is possible.

Incisions allow the plastic surgeon to visualize the underlying facial structure and fat before sculpting the face by repositioning muscles and redistributing fat.  The surgeon will reshape your face to return muscles to where they once were and return fat to where it has diminished.  Meticulous detail and vision are needed to create the foundation for a naturally beautiful result.

Once the face has been addressed, your surgeon will focus on the neck, if necessary.  The face does not stop at the jawbone so when the signs of aging affect the neck, it is also worked on during the facelift.  Elements of a facelift that solely involve the neck are often called a "neck lift".  Through the facelift incision and possibly through a small incision concealed beneath the chin, vertical bands in the neck are surgically released and the natural muscle sling beneath the chin is recreated for a smoothing effect.  Excess fat deposits are sculpted or removed through this incision as well.

The final step of a facelift is to drape the skin over the new foundation, carefully reduce just the right amount of excess skin and close the incisions. 

Facelift Incisions are closed with the following:

  • stitches

  • staples

  • skin adhesives or tissue glue

Re-draping the skin requires careful balance.  Even with the best underlying technique in a facelift, reducing too much skin will result in an unnaturally tight look.

 

 

 

 

Liposuction techniques can assist in full or limited facelift procedures by reducing excess fat pockets beneath the chin and in some areas of the mid-face (such as above the nasolabial folds or in the jowls).  Some surgeons will inject fluid that include a local anesthetic and saline or tumescent solution to make shaping and suctioning easier.  Many surgeons feel however; for precise sculpting necessary for natural looking rejuvenation of the face, fat should be meticulously excised rather than having aggressive liposuction.  Liposuction of the neck is only beneficial in limited procedures if the skin does not need to be reduced or redraped. 

Suctioning the face rather than redistributing fat can be counterproductive.  As we age, we lose volume in the face.  If too much is removed with suction, the face and neck may look even older and out of balance.

 

 

 

 

 

The alternatives to a traditional surgical facelift go by many different names - but the techniques fall into three basic categories:

  • Limited-incision

  • Endoscopic Assistance

  • Suspension Lifts

Incisions are for access and minimal incisions mean minimal access are most effect for minimal changes.  Although there will be less down time with a limited incision facelift - there is also a less dramatic result.  The limited techniques might not be appropriate for every patient, nor do they mimic the results of a full facelift. 

 

Limited facelifts are most appropriate with patients who are younger with good skin elasticity and little neck looseness or those patients who have already had a facelift and require refreshing.

 

Having your facelift consult with a board certified plastic surgeon will show you all of your options and possible techniques that would be appropriate for you.  Of course the desire for minimally invasive procedures continue to grow, so newer and newer techniques are always under development.

 

 

  • PROS AND CONS OF LIMITED FACELIFTS

PROS:  Smaller incisions - shorter recovery time.

 

CONS:  Limited incision facelifts, cannot result in the same degree of correction as a full facelift.

 

 

ANESTHESIA:  Local with sedation

 

 

INPATIENT OR OUTPATIENT:  Outpatient - performed in a doctor's office or an outpatient surgical facility.

 

 

RECOVERY:  Expect swelling and bruising for several days.  Sutures are removed after six or seven days.  Most patients resume normal activity within seven to fourteen days.

 

 

 

 

 

 

 

 

 

A surgical telescope or endoscope can help your surgeon reposition muscle and fat to create a more youthful-looking result.  The use of the endoscope, most commonly with a short scar technique may even further reduce the size of the incisions by limiting  them to the temple region, inside the lower eyelid, or inside the upper lip.

 

However, the caution is that by using an endoscope your surgeon cannot visualize your aging anatomy as extensively and therefore cannot address it as a whole.  Unless your conditions are truly limtied to a localized region of the face, such as the tear trough,  nasolabial folds or marionette lines - endoscopic assistance may not be appropriate.

 

 

  • PROS AND CONS OF ENDOSCOPIC FACELIFT

PROS:  Smaller incisions

 

CONS:  Focuses only on limited sagging muscle of the face muscle.  Cannot address excess skin.  The potential for asymmetry is greater.

 

 

ANESTHESIA:  Local with sedation or General Anesthesia

 

 

INPATIENT OR OUTPATIENT: Outpatient - performed in a doctor's office or an outpatient surgical facility.

 

 

RECOVERY:  Expect swelling and bruising for several days.  Sutures are removed after six or seven days.  Most patients resume normal activity within seven to fourteen days.

 

 

 

 

 

 

 

 

Surgically designed suture threads are inserted into the skin through a hollow needle.  As the needle is removed, the barbs on the sutures grip the skin and pull it upward.  Most commonly used to raise the skin of a low brow or a sagging cheek region, this procedure neither affects the underlying muscles or reduces excess skin.  The trend is to use the suspension lift as an interim step to a facelift, but not all patients are good candidates.

 

 

  • PROS AND CONS OF SUSPENSION LIFT - FEATHER LIFT

PROS:  Minimally invasive, small incisions, procedure takes less than an hour.

 

CONS:  Skin that is too loose may pucker; skin that is too tightly gathered may also pucker.  Asymmetry and other irregularities are also possible.  Sutures may not hold, and sutures that are too tight may restrict natural facial movements and expression.  Over time, sutures may become visible on the skin's surface.  In addition, infection is possible.  Scar tissue can also form around the sutures and produce visible irregularities in the skin.

 

 

ANESTHESIA:  Local or light sedation.

 

 

INPATIENT OR OUTPATIENT:  Outpatient - performed in a doctor's office.

 

 

RECOVERY:  You may return to work as soon as the next day, with minimal swelling and bruising.  It is important to avoid excessive facial movement for the first two to three weeks.

 

 

RESULTS:  Although the sutures are designed to remain in place permanently, the correction they provide may not be long term   Some patients have seen results diminish within one to two years of treatment.  Suspension lifts do not achieve the same result as full facelifts and can impair the outcome of a traditional facelift should you decide to have one of those in the future.

 

 

 

 

 

 

 

 

 

 

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