Appearance of the face is affected by many factors such as age, disease, sun exposure, obesity or weight loss. Men and women of different ages seek facial rejuvenation desiring to give impression of beauty or elegance, vitality, sensuality, masculinity or femininity. Fortunately due to social media and medical shows patients are more educated than ever and come to our office with specific requests for face lift, neck lift or fillers and etc. But most often patients need a combination of procedures to obtain the best results.
Aging face is a result of three problems: Skin damage, skin sagging, fat deflation. In order to achieve the best results and a youthful aesthetically pleasing face all three factors must be addressed. Therefore, we discuss skin care regimen with all patients seeking facial rejuvenation. This is a very extensive topic that will be customized based on your skin color, tone, race, and lifestyle. If indicated patients will be advised to add laser, chemical peel or neurotoxins to their surgical package.
Skin laxity and excess will be addressed with face lift through inconspicuous incisions that are made behind or within the hairline and in natural folds of the face and ears and will heal nicely. To avoid a face with stigmata of surgery it is important to avoid tension on the skin. The appropriate level of tightness will be achieved by tightening the deeper layers of SMAS and muscles. Skin will merely be redraped as it is not strong enough to achieve sustainable results.
Skin redraping however does not correct the loss of volume that happens with aging in areas such as lips, cheeks, jaw line and temporal area. Majority of patients presenting for facial rejuvenation will require fat grafting to different areas to replenish the volume loss.
Same principles also apply to neck lift procedure. The neck lift is a component of facelift. It is very rare that patient would benefit from neck lift alone; more often if done alone it will create disharmony between already aging face that is not corrected and a youthful neck that exaggerates aging of other parts of the face.
Forehead and brow are closely connected to periorbital region both functionally and aesthetically. This intimate relationship is frequently unrecognized and could lead to suboptimal surgical outcome. For example sagging brows could contribute to hooding of the upper eyelids which in unexperienced eyes might be merely an excess eyelid skin issue. Presence of deep transverse lines in the forehead could be due to aging or compensation for droopy eyelid or brow.
While eyebrows’ position is a strong indicator or person’s emotional state such as sadness, anger, fatigue, surprise, its ideal aesthetic location is variable depending on patient’s age, race and overall frame of facial anatomy. Just as described in facial rejuvenation section, aging of periorbital region also occurs as a result of three phenomenon: Skin damage, skin laxity and fat deflation.
Eyelid surgery is one the most commonly performed procedures among men and women. Eyelid position is a strong indicator of person’s emotional state such as sadness and fatigue and could lead to functional issues by obstructing the visual field or causing dry eye.
Aging of the eyes is frequently noted before other signs of facial aging. Treatment of the upper eyelid could be a simple skin excision which can be done under local anesthetics or it might require fat removal, fat grafting or muscle repair depending on the etiology of the problem.