FACE LIFT

As we age the almond shaped face goes to a more oval configuration. An oval face goes to a more round shape, and the round goes to a more square shape. The square shaped face ages the least gracefully because even minimal redundancy is noted immediately. Individuals with high cheekbones and an almond shaped face can camouflage laxity of skin and muscle more readily. These people age the most gracefully. Normally there is a groove that runs from the nose to the corner of the mouth called the buccal labial fold. As we age this fold may become more prominent. When it extends below the corner of the mouth and begins to form the jowl, this is the time when most people feel that surgical correction is needed immediately. Other individuals tend to treat this laxity before it extends to this more dramatic end point.

The facelift procedure, or rhytidectomy as it is medically called, treats the neck, cheek, jowl, and lateral temporal or eyebrow area. It gives the ultimate improvement in facial plastic surgery because it addresses all the areas of concern, and will reposition tissues into a more normal, natural position. Essentially, it helps to turn back the clock approximately 10 years in most people.

HOW LONG DOES FACELIFT LAST?

A facelift will essentially last forever, because the excess skin has been surgically removed. However, we will continue to age. The day we have surgery performed, we still continue to age. One needs to think of this in terms of a conveyor belt of time. If one has surgery at the age of 50, following surgery they may look 10 years younger. This means that chronologically they are 50, but physiologically they appear to be 40. Unfortunately, the conveyor belt of time keeps moving and 10 years later, chronologically they are 60, but physiologically they look 10 years younger (50). When they are 50 they desire to have a more rested, youthful appearance. For that reason many desire to maintain this look with repeated surgeries. However, this is certainly not necessary.

SURGICAL TECHNIQUE

In the female patient, incisions are hidden within the skin creases around the ear. This means there is no incision in front of the ear which can be a telltale sign of facelift surgery. The incision then goes behind the ear and back into the hairline. In the frontal temporal area the incision extends superiorly into the hairline. The incisions around the ear are closed with dissolvable sutures in multilayers. The hair is not shaved and incisions in the hair bearing tissues are made within hair parts. Small clips are used in order to allow the patient to shower following surgery. In most cases, a small incision, the size of a pencil, is made in a natural chin crease below the chin. This helps to obtain additional support and contouring in the neck and submental area.


RECOVERY

Following surgery a turban like dressing is used for the first 24 hours. Cold compresses are placed over the neck area. The following morning the dressing is removed and cold compresses are applied to the face and neck areas for the next 48 hours. Hydrogen peroxide soaked q-tips are used to clean over incision lines, followed by showering 4-6 times a day to accelerate wound healing and prevent scabs and crusts from forming. Individuals need to sleep with their head elevated 30° for two weeks and avoid heavy lifting or straining for the first 14 days following surgery. One should also minimize movement of the head and neck for 1-2 weeks following surgery to avoid stretching those newly positioned tissues. This means driving is prohibited for one week.

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Endoscopic Forehead Lift
(Brow Lift)

This is a wonderful example of minimally invasive surgery! It is a newly developed technique that corrects sagging in the eyebrow and forehead area. In this surgery, small incisions are hidden behind the hairline. This procedure is especially helpful for specific areas of sagging, such as the middle and lateral portions of the eyebrow and to help contour muscles in those individuals who have severe wrinkling due to excessive muscle movement. The endoscopes help minimize the amount of swelling and bruising associated with this procedure and greatly reduce the amount of postoperative discomfort.

Tissues are repositioned and secured into place with the use of pins and small clips hidden in the hair. These dissolve or are removed 7-10 days after surgery. Ice compresses are necessary over the forehead area for the first 48 hours. Swelling is usually minimal. In some individuals, however, mild swelling can occur 3-5 days after surgery in the mid-forehead and eyelid area. Most individuals find they can return to limited activity 3 days after surgery and to normal activity within 7 days.

In some cases, laser resurfacing may be performed simultaneously, or at a later date, to help further rejuvenate the forehead tissues and further remove wrinkling.

A sagging or droopy eyebrow and wrinkled forehead can also give you the appearance of a worried or tired look. The eyebrows, like the eyelids are an important feature of the upper face, particularly for conveying emotions. In addition, the forehead and eyebrows are facial features that change when you age. High, arched eyebrows convey a youthful appearance. Droopy brows on the other hand can make you look older and sadder than you feel. Creases between the eyebrows can make you look angry and horizontal lines across the forehead can make you appear more aged. Browlift procedures can raise and reshape the eyebrows, lift and tighten the forehead skin, and relax vertical creases between the eyebrows. There are several different types of browlifts such as endoscopic, direct, mid-forehead, pre-trichal, trichophytic, and coronal. Which technique is right for you depends on the nature and severity of your problem; the degree of correction desired, your age, the elasticity of your skin and whether you are a man or a woman.

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