Archive for the ‘Facelift Surgery’ Category
Facial cosmetic surgery is a very personal and monumental decision. Universally, all patients want the best outcomes. In today’s corporatized America, with heavily influential marketing spin, pharmaceutical companies, medical device companies, and even practitioners promote a less is more mentality to push products and services that often over promise and under deliver on the results. In no way can skin creams, injectables, or lasers deliver the types of results once can achieve with surgery. In a similar manner, minimally invasive sounding surgeries are in no way a substitute for time tested peer reviewed procedures that provide quality long lasting results.
Unfortunately not every person will achieve acceptable results with Botox or injectable fillers such as Juvederm, Restylane, and Radiesse. These products have their place in facial aesthetic practices, in properly selected patients, but in general should be viewed as temporary treatments with less impressive results when compared to surgery. Their primary advantage is that they have minimal social while providing a benefit. Botox is being used more and more as a preventative cosmetic medicine that delays wrinkle formation. Fillers camouflage initial signs of aging, but ultimately putting too much filler in a face, the liquid facelift, can alter ones appearance creating an artificial overinflated appearance. Using filler to augment facial structures can be useful to patients wanting to get a general idea of the appearance prior to permanent surgical procedures such as lip and cheek enhancements procedures. Creams reverse the signs of photo aging and contribute to collagen formation and production but are limited in their effectiveness. Lasers are an excellent option to delay the signs of aging and treat sun induced skin photoaging, but in no way can they tighten skin like facial cosmetic surgeries such as a facelift.
Surgical procedures are the best option for impressive endurable results. Rhinoplasty can dramatically affect ones facial appearance in a way that almost no other cosmetic surgery can. The nose can cause undue and unnecessary attention drawing attention away from other attractive facial features. Aging face surgery has many layers of effectiveness based on the surgical techniques used and how they are applied. In general, minimally invasive techniques can produce an artificial appearance and or short-term results. When considering aging face surgery most sophisticated patients are looking for surgeries that will last as long as possible with the most dramatic natural appearing results. There are no shortcuts to achieving optimal results and when applied, shortcut techniques frequently under deliver on the surgical results end.
Becoming an informed patient who understands the benefits of finding the right intervention or surgery for the right patient will ultimately save one time and money over the long haul. Getting things done right the first time is of paramount importance to achieving optimal outcomes with a high degree of patient satisfaction, while avoiding problems and bad outcomes.
Posted by: Benjamin C. Stong MD
Atlanta facelift surgeons are variable in the extent of their training and the techniques they use to rejuvenate the aging face. A facelift describes a procedure that rejuvenates the lower third of the face (jowls) and neck. As we age, skin looses elasticity and subsequently, elongates and sags. A facelift is designed to remove the excess skin while tightening the muscles of the face, the SMAS. The longevity associated with a particular facelift technique is solely dependent on the technique used to tighten the muscles of the face because the SMAS supports the lift. The primary reason that facelifts fail early is that the majority of surgeons perform abbreviated, less comprehensive SMAS lifts because they are uncomfortable with the delicate anatomy of the face and unfamiliar with more comprehensive techniques.
With less comprehensive techniques, such as plication or lateral SMASectomy procedures, there is less skin removed, the results do not last as long, and they are not as dramatic. Although much of the marketing about the less comprehensive techniques is geared towards promising minimal healing times with equal results, the counter opposite is true. Healing times are equal or even shorter with more comprehensive techniques such as the mini deep plane facelift, and the results are better with improved longer term results. The most comprehensive facelift is designed to last eight to ten years, but with other techniques results can fail as early as one year after surgery.
Most patients prefer to have fewer surgeries with the longest lasting outcomes. Revision facelift surgery is done for two reasons: because of suboptimal results from a previous suboptimal surgery, or as a natural consequence of the continued aging process after a facelift. Even with the best facelift techniques, patients may undergo several facelift surgeries in their lifetime to maintain a youthful look over the last two to four decades of their lives.
The most proven facelift techniques are the extended sub-SMAS and deep plane facelifts. Both techniques can now be performed through the most state of the art Mini Facelift incisions. Older, more traditional facelift incisions were unnecessarily long, creating more obvious scars that required patients to change their hair styles to camouflage their incisions. With contemporary, shorter incision techniques, patients can wear their hair as the desire, even in a pony tail.
Facial plastic surgeons are highly skilled, specially trained physicians that are exclusively trained in head and neck anatomy and surgery with additional, advanced training in facial plastic and reconstructive surgery procedures. When choosing a facial plastic surgeon, one should look for a surgeon that is dual board certified in Head and Neck Surgery and Facial Plastic and Reconstructive Surgery. This insures that the surgeon has met the rigorous standards required for training and certification to become a facial plastic surgeon. Finally, when choosing a facelift surgeon, a patient should choose a surgeon they trust and have a good rapport with, in order to avoid suboptimal and sometimes disastrous outcomes.
Posted by: Benjamin C. Stong MD
Atlanta GA
Atlanta Facelift surgeon and facial plastic surgeon, Benjamin C. Stong MD of Kalos Facial Plastic surgery is proud to announce partnership with the Partnership Against Domestic Violence (PADV), the largest domestic violence organization in Atlanta and the state of Georgia. At only 34 years old, Dr. Stong has not only positioned himself locally as a leader in the facial plastic and reconstructive surgery community, but has also managed to dedicate his time and efforts to numerous humanitarian efforts. His most recent endeavor is volunteering to be the exclusive facial plastic surgeon for the PADV, providing surgical assistance to victims of domestic violence. Nearly 5.3 million intimate partner victimizations occur each year among U.S. women ages 18 and older. This violence results in nearly 2 million injuries, some of which can require extensive facial reconstructive procedures, such as Rhinoplasty surgery. Dr. Stong’s training in facial plastic surgery provides the most advanced and contemporary procedures in Facial Plastic and Reconstructive Surgery to restore the self-esteem of domestic violence victims.
Dr. Stong resides on the national FACE TO FACE committee; a humanitarian program of the Educational and Research Foundation for the American Academy of Facial Plastic and Reconstructive Surgery. FACE TO FACE is designed for facial plastic surgeons to donate their time and skills to help those in need of reconstructive facial plastic surgery including: victims of domestic violence, children afflicted with congenital birth defects, such as cleft lips and palates, and wounded veterans of the war in Iraq and Afghanistan. “I was astonished at the number of domestic violence victims presently in Atlanta,” said Dr. Stong. “Most of these victims are not only affected emotionally, but also left with physical evidence of the abusive relationship. My goal is to contribute to the healing process by helping repair their physical and emotional scars. Although this is only an initial step, we are optimistic about helping these survivors of domestic violence as well as provide future support to the PADV.”
Northside Hospital will collaborate with Dr. Stong by waiving facility and anesthesia fees for victim’s surgeries. For 14 consecutive years, Northside Hospital has been voted by Metro Atlanta consumers as the Most Preferred Hospital for Overall Healthcare Services. Additionally, Northside Hospital performs more surgeries than at any other Georgia Hospital.
The PADV’s mission is to end the crime of intimate partner violence and empower its survivors. Since 1975, they have provided professional, compassionate, and influential support to battered women and their children in metro Atlanta. It is a prestigious organization that helps restore victim’s confidence. The PADV also works to end domestic violence by restoring self-sufficiency and control to victims as well as educating the public on the dynamics of this complex issue. Meagan Fulmer, the Vice President of Development for PADV, approached Dr. Stong after learning of his generous contributions to other charitable endeavors. “The PADV is excited to welcome Dr. Stong into our family. To have a surgeon of his skill set willing to work in partnership with us to help survivor’s of intimate partner violence not only overcome their emotional and physical barriers, but also help them thrive through the gift of healing,” said Meagan.
Aside from providing surgical services, Dr. Stong will host a charitable benefit November 4th at the Mason Murer gallery from which all proceeds will benefit the PADV and the national FACE TO FACE program. He and the Kalos Facial Plastic and Reconstructive Surgery staff will also participate in the annual Hearts with Hope signature fundraising event of the PADV. The proceeds from the gala go to support violence prevention, emergency intervention, and long-term advocacy for battered women and children.
Facelift surgery is an intensely personal decision and many patients can have difficulty sorting through the marketing terminology in the plastic surgery industry in order to choose the surgeon and the type of facelift most appropriate for their individual issues. Often, patients can have a significant degree of anxiety and uncertainty when choosing their plastic surgeon. Seeking out a facial plastic surgeon with the latest and most advanced facelift surgery techniques as well as choosing the surgeon one feels most comfortable with will avoid bad and even sometimes disastrous outcomes.
Many of the mini facelift surgery techniques available today can only offer short term corrections for their aging jawlines and neck. Most patients want to have the longest lasting results in order to avoid additional surgeries and healing periods and requiring fewer surgeries during their lifetime. Revision facelift surgeries are often more challenging for the surgeon and more expensive for the patient, and getting it right the first time is of paramount importance.
Expert facelift surgeons agree that the deep plane facelift provides the most superior outcomes and long lasting results in facelift surgery techniques available today. Older, more traditional facelift incisions have been associated with unacceptable scarring that can be difficult for the patient to camouflage. In recent years, cosmetic surgeons have refined facelift incisions to develop the shortest, least noticeable facelift incisions. These incisions have several different names including: the s-lift, short scar facelift, endoscopic facelift, and mini facelift.
Until recently, the deep plane facelift was unable to be performed through the tiny hidden incisions of a mini facelift. A few national and international expert facelift surgeons have refined the technique to be able to perform the deep plane facelift through these shorter facelift incisions. Dr. Benjamin C. Stong at Kalos Facial Plastic Surgery trained with one of these advanced facelift surgeons and now delivers this superior facelift procedure to his clients in the Atlanta metropolitan area and patients throughout the United States as well as the world.
An additional benefit to the mini deep plane facelift, is that it can be performed safely in smokers as well as revision surgery patients with the shortest downtime, thereby getting patients back to work and their social lives as fast as possible. Laser skin resurfacing can also be performed safely during the deep plane facelift avoiding significant complications associated with skin resurfacing procedures with other facelift surgery techniques.
The mini deep plane facelift is safe and effective in all age groups, genders, and skin types. Kalos facial plastic surgery is the first to offer this technique in Atlanta and the surrounding areas. The cost is similar to other facelifts widely available today, just without the uncertainty of the outcomes. Finding a surgeon who performs this procedure is critical to achieving the best and longest lasting results.
Posted by: Benjamin C. Stong MD
Healing following Facelift surgery is of significant interest to patients and practitioners. Millions of dollars are spent on marketing every year, promising less healing and down time, and subsequently, a faster return to daily activities. Practitioners advertise minimally invasive surgical techniques and use prescription pharmaceuticals and homeopathic remedies to facilitate healing following surgery. Bromelain and Arnica Montana (A. Montana) are the two most common homeopathic treatments offered following facelift surgery; they are supposed to reduce swelling and bruising, respectively. One of the most conclusive studies on A. Montana demonstrated no difference in the degree of bruising between the group taking A. Montana and the group receiving a placebo pill following facelift surgery. However, this study did validate an objective computer model to assess bruising, with a superior ability to discriminate subtle color changes over the human eye and eliminating the inherent, subjective bias of visual analog scales and ranking schemes. This allowed the medical community to objectively study the effect of therapies on bruising following surgery, and in particular facelift surgery procedures.
Hyperbaric oxygen (HBO) therapy has been popularized in the main stream media through several celebrities for its anti-aging effects. In the scientific literature it has been demonstrated to hasten wound healing by promoting free radical scavengers, reducing cell damage, and increasing the oxygen delivery and blood supply to wound beds. For years, hyperbaric oxygen therapy has been used to facilitate healing in chronic, non-healing wounds. Ultimately, the common pathway in hyperbaric oxygen therapy is more rapid wound healing. A new, unique application for HBO therapy is to assist healing in facelift surgery.
We performed a prospective, controlled study on thirteen patients undergoing face lift surgery with six electing to undergo HBO therapy immediately before and after their face lift. Seven patients were entered into the control group and received no therapy. Any additional confounding factors were equal and accounted for. Statistical Analysis, digital photography and the previously validated objective computer model were used to assess the resolution of bruising postoperatively. The result was a statistically significant decrease in the degree of bruising in the HBO group over the control group on postoperative days 7 and 10, with a 35% and 30% reduction, respectively. There were no complications associated with the treatment group.
This is the first report of the benefit of HBO therapy on wound healing in cosmetic surgery. To date there has been no more compelling evidence for a particular adjunctive therapy to facilitate healing, with many of the current treatments having little scientific evidence supporting their use. The validated computer model in this study provides the scientific community an excellent resource to objectively measure the resolution of bruising and healing following surgery. Additionally, a larger number of patients enrolled in this study would empower the degree of effect on bruising and most likely become statistically significant sooner in the postoperative course.
When patients are choosing to undergo facelift surgery, they should educate themselves on therapies that do and do not work. This can often be difficult due to the current directed marketing strategies making promises that often go unfulfilled. What the patient truly needs is a consultation with a facial plastic surgeon in order to decipher and discuss the information. Hyperbaric oxygen therapy offers patients a statistically validated and scientifically studied adjunctive therapy to recover faster, following facelift surgery. HBO in otherwise healthy patient’s is a safe, innocuous therapy with little downside. Although it can potentially increase the overall cost associated with the surgery, it does offer patients seeking the most rapid recovery from facelifts a further treatment modality to employ in order to return to daily activities faster. Due to the proven benefits, HBO should be included in the discussion with patients undergoing facelift surgery as a potentially beneficial therapy in the healing process and may be applicable to other plastic surgery procedures such as the midface lift.
Posted by: Benjamin C. Stong MD
Atlanta, GA
A facelift is a procedure designed to restore the neck and the lower third of the face, evolving tremendously over the previous 40 years. The deep plane facelift went through several developmental stages and today serves as one of the very best facelift techniques to provide patients with a long term correction of the jaw line and excess skin and fat in the neck. Early facelift pioneers discovered the SMAS (muscular) layer of the face and its importance in facelift surgery. Releasing the SMAS layer allowed aggressive re-suspension of the facial soft tissues, correcting the jowls and defining of the jaw line. Next the “Bi-planer” facelift lifted and contoured the neck to remove the excess skin and fat in addition to releasing and suspending the SMAS layer. The “tri-planer” facelift was then developed, to mobilize the tissues of the midface below eyelids and treat the nasolabial folds. This technique resulted in a less than satisfactory midface correction. Finally, Hamra refined this technique into the Deep Plane Facelift, releasing the suspensory ligaments just below the midface resulting in a correction of the midfacial drop and a softening of the nasolabial folds in addition to the correction of the jaw line and neck. This offered a unique facelift procedure, because it was much more comprehensive than any technique previously described. Today many of the best facelift surgeons use a variation of this technique.
The deep plane face lift can now be combined with mini facelift incisions to provide the maximum amount of correction available with a single facelift procedure while using the smallest incisions. Many patients falsely believe that the “Deep Plane” facelift will result in longer healing times. In truth, there is actually less bruising and risk of hematoma than with other techniques. With the deep plane facelift the correction in the midface and nasolabial folds is less permanent than the correction of the neck and jaw line. It is not as effective as a separate endoscopic temporal midface lift as a midface lift procedure. Surgeons who perform the deep plane facelift have had specialized training in the technique because it requires an intricate knowledge of the anatomy of the soft tissues of the face and the facial nerve to achieve optimal outcomes and avoid complications.
When consulting about facelift surgery, the overall expenses in addition to the healing period are foremost considerations. Most informed patients are seeking to have a procedure that will offer the longest term and most complete correction, thereby decreasing the overall cost from unnecessary revision surgeries. The deep plane facelift is currently one of two “gold standard” procedures, to correct the aging jaw line and neck, the other being an extended Sub-SMAS facelift. It is the only procedure to offer a correction of the midfacial soft tissue drop and the nasolabial folds with a single procedure.
Facelifts are often combined with other procedures, including: upper and lower eyelid blepharoplasty and brow lifts for a “full facelift” surgery. In addition, a skin rejuvenation plan is important to add to surgical procedures to attain superior results. Laser surgery and medical grade skin care products are often combined to offer the state of the art in skin rejuvenation therapy. Consultation with an expert facial plastic surgeon is critical to developing a strategy to restore and preserve ones youth and beauty.
Benjamin C. Stong MD
Atlanta, GA
Today, the vast majority of surgeons perform lower eyelid blepharoplasty or eyelid lift techniques using a transconjunctival approach with fat removal and a skin pinch to rejuvenate the lower eyelid. Additionally laser treatments or chemical peels may be used to improve skin texture and smooth wrinkles. The evolution of this treatment resulted from concerns of postoperative ectropion or lower eyelid malposition associated with more traditional techniques and lack of familiarity with the measures required to prevent these complications. The transconjunctival approach makes an incision on the inside of the eyelid and while it is a safer approach in less experienced hands, it has also resulted in an incomplete lower eyelid and midface rejuvenation.
The characteristics of the aging process of the lower eyelid and midface include decent of the midface soft tissues and fat pad, elongation of the lower eyelid, pseudoherniation of fat from around the eye resulting in puffiness, formation of the tear trough deformity, and redundancy of the skin and muscle of the lower eyelid. The transconjunctival lower eyelid blepharoplasty with fat removal and skin pinch fails to address several of these issues. Removal of fat from around the eye can lead to a hollowed appearance of the lower eyelid and an abrupt transition from the lower eyelid to the midface that appears unnatural and artificial. Additionally, a skin pinch removal from the lower eyelid fails to remove the excess muscle underneath the skin and shorten the eyelid. When considered in whole there are several problems with this technique and it fails to address several of the issues that occur with age in the lower eyelid and midface.
The skin muscle flap blepharoplasty with fat transposition is the most contemporary technique available in lower eyelid blepharoplasty, and it corrects several of the issues that the transconjunctival blepharoplasty with fat removal and skin pinch fails to address. First, and most importantly, the fat from around the eye is conserved and repositioned in the tear trough (the groove that forms between the eyelid and the nose and midface) obliterating it and resulting in a smoother more natural transition between the lower eyelid and midface. The skin muscle flap blepharoplasty also removes muscle as well as skin for a more natural correction of the redundant soft tissue of the lower eyelid. When the eyelid is properly re-suspended during the procedure the risk of permanent post procedure ectropion is virtually eliminated.
Shortening the lower eyelid is best accomplished by performing a midface lift at the same time as the lower eyelid blepharoplasty. The medical literature supports that by adding a midface lift to a lower eyelid blepharoplasty more skin and muscle can be removed resulting in a shorter more youthful lower eyelid. Most midface lift techniques do not effectively release and re-suspend the soft tissues of the midface. When considering a midface lift it is important to find a surgeon who performs a transtemporal extended subperiosteal midface lift to ensure an excellent outcome. When performing a skin muscle flap blepharoplasty with fat transposition along with a midface lift the aging characteristics of the lower eyelid and midface are more completely addressed resulting in a natural, more complete periorbital and midface rejuvenation.
It is also important to consider adding a skin resurfacing procedure to improve wrinkles and skin texture and quality of the lower eyelid and finish the rejuvenation. This can be accomplished through either chemical peels or ablative laser procedures. Contemporary laser procedures allow for excellent skin resurfacing and rejuvenation with shorter healing periods when compared to chemical peels and more traditional laser procedures. The state of the art laser skin resurfacing techniques combine an epidermal laser peel with a fractionated deep dermal laser resurfacing to treat both superficial and deep wrinkles and brown spots. The Pearl Fusion procedure combines the Pearl and Pearl Fractional procedures to offer the most advanced laser technology while providing the safest outcomes.
Finding a plastic surgeon who understands how the different surgical techniques correct the aging characteristics of the lower eyelid and makes informed recommendations based on the patient’s particular issues is important to achieve superior outcomes and avoid complications. Midface lifts can correct the drop of the cheek soft tissues, efface the nasolabial folds, and shorten the lower eyelid. While a deep plane facelift can also lift the cheek soft tissues and smooth the nasolabial folds, the midface lift offers a greater effect and more permanent change to the midface soft tissues and nasolabial folds. Performing a skin muscle flap blepharoplasty with fat transpositions along with a midface lift offers the most complete periorbital and midface rejuvenation available today.
Benjmamin C. Stong MD
Atlanta, GA
The fourth and fifth decades of life are a time when people often begin to become more aware of age and committed to facial plastic surgery procedures. Accumulated sun damage and prior skin care rejuvenation regimens affect when patients begin to consider blepharoplasty, brow lifts, and facelifts during these decades. Often, patients will also add staged or simultaneous skin resurfacing rejuvenation procedures to maximize and augment surgical results. There is often a misconception that surgery and procedures need to be delayed as long as possible to avoid additional surgeries in the future. The truth is there is no good or bad time to under go surgical and skin rejuvenation procedures; it is only appropriate when a patient becomes bothered enough by the issue to consider surgery and is an intensely personal decision. The most important consideration to avoid bad outcomes and unnecessary surgeries is to find a practitioner who uses techniques that will provide superior, long lasting results.
Eyelid lift surgery or blepharoplasty offers a long lasting procedure and when performed correctly is often not necessary to have repeated in the future. Similarly, Brow Lifts usually only need to be performed once if the surgery addresses the laxity issues in the forehead, upper eyelid, and brow complex and adequately releases and re-suspends these tissues. Minor touch up procedures may be included in future treatments to maintain and maximize results from blepharoplasty and brow lifts. Revision surgery becomes important when considering revising suboptimal results from poor, inadequate techniques and is more difficult due to scar tissue from the previous surgery and is more expensive. Having a procedure performed correctly the first time is of paramount importance.
Facelifts are procedures that can be performed multiple times over a patient’s lifetime. To avoid unnecessary and costly revision surgeries, finding a surgeon who effectively releases and re-suspends the SMAS layer, the primary support layer, of the face is important. Many surgeons believe they get equally effective results with less aggressive work on the SMAS layer, but there is no short cut to providing superior long lasting results. When performed properly, a facelift can provide patient satisfaction for ten years, or more. A facelift addresses an aging jaw and neck line, resetting the clock, but it does not stop the clock from restarting. Some patients who want to be aggressive about hiding their age may choose to undergo two or three facelifts during their life. Another popular misconception is that undergoing multiple facelifts will result in a pulled or windswept look. The truth is that when the skin and deeper SMAS layer are pulled in the correct direction, a facelift can be performed as many times as desired to maintain a more youthful jaw and neck line. An additional misconception is that a comprehensive and thorough jaw, cheek, and neck lift can’t be performed through an abbreviated mini facelift incision. This notion is also false; a thorough facelift can be performed through the short scar, abbreviated, mini, s-lift facelift incisions safely with superior outcomes. Consultation with a knowledgeable facial plastic surgeon will allow for a comprehensive facial rejuvenation plan over the years when a patient is interested and healthy enough for surgical procedures.
Skin resurfacing rejuvenation procedures are important to consider when augmenting and maximizing surgical results. In addition to noninvasive lasers such as IPL LimeLight and YAG Laser genesis procedures, ablative resurfacing procedures become necessary to maintain youthful looking skin. Finding a practitioner who offers the state of the art laser rejuvenation procedures is necessary for excellent outcomes with the shortest healing times. Currently, combining confluent and fractionated laser modalities offers the best treatment for both superficial and deep discolorations and wrinkles as well as stimulating collagen formation. It also avoids complications and prolonged healing times from more traditional chemical peels and lasers. Laser resurfacing rejuvenation procedures can be performed as often as necessary to restore and maintain youthful, vibrant looking skin.
Botox, facial fillers, medical skin care products and other preventative and maintenance therapies should be continued in the forties and fifties to maximize the longevity of surgeries and skin rejuvenation procedures. Consultation with a knowledgeable facial plastic surgeon, who applies a global perspective when discussing patient goals and their future considerations, will put the patient at ease and establish trust that the practitioner is making thoughtful recommendations based on his expertise and training.
Posted by: Benjamin C. Stong MD
The topic of neck rejuvenation requires a discussion of skin rejuvenation, liposuction, facelift surgery, and direct skin excisions. Age related changes in the neck occur simultaneously with the age related changes in the face. These changes include sun damage to the skin, accumulation of excess fat and skin, and the formation of vertical bands. There is no absolute predictable pattern to how a neck will age and is intensely affected by an individual’s anatomy, genetics, diet and exercise patterns, and sun exposure. As such, there is no single way to address a patient’s concerns and a rejuvenation plan must be tailored to a patient’s specific issues.
As with any area of skin, the neck skin accumulates sun damage over years. The skin of the neck is thinner than the skin of the face and is more prone to complications with aggressive rejuvenation procedures such as phenol peels and traditional CO2 laser resurfacing. In general, the goal of laser skin rejuvenation is to be as aggressive as the tissue allows while balancing results with safety. Although most laser companies do not recommend the use of ablative lasers on the neck, clinicians routinely use laser rejuvenation therapies with excellent outcomes. A critical element to good outcomes is to use lower settings on the resurfacing laser or less aggressive chemical peel than in the face.
Many patients believe they are good candidates for liposuction as a sole rejuvenation procedure. In fact, the opposite is true, only a select few individuals are candidates for liposuction in isolation. As we age the skin loses elasticity and subsequently its ability to contract. The ideal candidate for neck liposuction is someone in their 20’s or 30’s with minimal sun damage or excess skin. These individuals usually have skin that will contract back down following liposuction with good results. Once sun damage has occurred and excess skin has accumulated, removal of skin becomes necessary. Excellent liposuction techniques are also critical for great results.
Most patients in their 40’s and 50’s have enough sun damage and excess skin to require removal. There are two primary ways to address this issue. The first is with a facelift or neck lift. An abbreviated mini facelift incision can be used. The neck skin is removed from the portion of the incision placed behind the ear. Some surgeons may offer patients an isolated neck lift procedure using only the portion of the facelift incision behind the ear to avoid more obvious incisions in the neck. Patients must understand that in no way will this address the excess skin and jowling of the face and is performed to avoid placing incision directly in the neck skin. During the facelift or neck lift procedure the vertical bands are addressed by tightening the platysma muscle which acts as a corset for deeper neck fat that protrudes as we age. The second way to address the excess skin of the neck is with a direct neck lift using a direct skin excision technique such as the Grecian Urn or another such procedures. It is offered as a primary procedure almost exclusively in men. Sometimes residual skin following a face or neck lift will be removed with smaller direct neck excision techniques, but in general it is a bad idea in women as a primary procedure because it will leave visible scars. In men, because of their bearded skin, a direct neck excision can be a good alternative to a facelift procedure. During a direct neck excision, the vertical bands should be addressed by tightening the underlying platysma muscle during the skin excision.
Total neck rejuvenation in older patients should include removal of the excess skin by a method the patient and the physician are comfortable with, along with tightening of the platysma muscle and liposuction as indicated. A staged skin rejuvenation procedure may be performed either before or after surgery to complete the rejuvenation. Consultation with a knowledgeable and skilled facial plastic surgeon will help avoid bad outcomes and disappointing results.
Post provided by: Benjamin C Stong MD
Since the advent of facelift surgery, the pursuit for optimal outcomes has been balanced by safety for the patient, the comfort level of the surgeon, and healing time. Today, marketing strategies are directed towards advertising minimally invasive, short scar procedures with minimal down time. Even more confusing to the body of information are terms such as the “nonsurgical face lift” and “liquid face lift.” “Nonsurgical” and “Liquid Facelift” procedures involve laser procedures and facial fillers respectively, tightening the skin or filling in the normal loss of facial volume that occurs with age. In no way do they involve tightening the deeper support structures of the face, a critical element to true facelift surgery. Many people seeking facial rejuvenation believe that aggressive skin rejuvenation procedures can provide comparable results to facelift surgery and are often dissatisfied with the final outcomes.
Minimally invasive and short scar facelifts are synonymous with the “s-lift” procedure. In these procedures an abbreviated skin incision is used, compared to traditional facelift incisions, but they have nothing to do with how the support tissues in the face are released and suspended, the technical sophistication or longevity of the procedure, or the degree of lift achieved. Facelifts are performed primarily to treat the jowls in the cheek and the vertical bands of the neck while removing excess skin from the face and neck. The procedure can be modified based on the patient’s specific concerns and issues pertinent to their case.
Commercialized, assembly line facelift procedures that promise minimal healing time often fail to deliver satisfactory results to patients because they either ignore tightening the deeper support structures of the face or do not adequately release and suspend these structures to gain an effective lift. As such, there are diverging thoughts on the correct procedure to achieve an excellent long lasting outcome, with experienced surgeons falling on either side of the argument. The most effective way to adequately achieve long lasting optimal results is to release the deeper support mechanisms of the face from the facial skeleton and suspend them with an abbreviated, camouflaged skin incision that does not effect the position of the sideburn or temporal hair tuft.
To date, the two most universally effective ways to release the support structures of the facial soft tissue are the deep plane facelift and the extended subSMAS facelift. Although these techniques have gone through an evolution and have been modified over time, they effectively release the retaining structures of the cheek and neck allowing for greater elevation and suspension and a youthful more natural look that can last 10-12 years. These procedures can be performed with the shorter skin incision techniques in order to have a well camouflaged incision that does not alter normal facial structures. A common concern among patients considering facelift surgery is avoiding a wind swept or pulled look. Contrary to popular belief, the technique used to tighten the deeper facial support structures has nothing to do with avoiding the “pulled look.” The most important element is the direction of pull on the skin when closing the skin incision, so even “minimally invasive” surgeries can result in this problem depending on the direction of pull during closure.
Healing after surgery is an important concept when considering the procedure. After excluding obvious medical conditions, there are several routine medications recommended that have questionable benefit to affect a more rapid recovery. Two herbal remedies that are routinely prescribed with facelift surgery include Arnica Montana and Bromelain for bruising and swelling, respectively. There is no conclusive data to support the benefits of Arnica Montana and Bromelain, but there is also no significant risk of adding the medications to the operative regimen.
Comfort with your surgeon is of primary importance when considering facelift surgery. Being an informed consumer is essential in order to avoid disappointing results and negative outcomes. Knowledge about all the techniques relevant to performing facelift surgery is a very important characteristic when choosing a surgeon in order to achieve optimal outcomes and avoid complications. There is no short cut to achieving good results in facelift surgery; in most cases patients are interested in one effective procedure during their lifetime, and as such it is necessary to understand the myths and truths behind the term “facelift.”
Post provided by: Facelift Surgery Atlanta GA | Benjamin C. Stong MD