Aesthetic Facial Rejuvenation: Face and Neck Lift Overview

Aesthetic Facial Rejuvenation: Face and Neck Lift Overview

                Greetings and welcome to another installment of my informational blog with full and candid discussions of all things plastic surgery!  Today I would like to discuss a cosmetic surgical procedure that is rising in popularity, especially among the growing number of baby boomers reaching full maturity- face and neck lifts.  There are many reasons people undergo surgery to rejuvenate the face.  Obviously the number one reason people choose to pursue surgery is to look and feel better about themselves.  Leading from this, I frequently hear in my consultations that they feel great and youthful at heart, but their outward appearance does not reflect this due to significant aging changes.  I have also met a number of individuals who have a younger partner and wish to recapture a fresher look to better match their significant other.  Another reason is that these days people live and work longer than ever before, and it is important to maintain a youthful appearance in the workplace to keep that competitive edge, especially in occupations that require frequent public interactions such as sales, marketing, or performing in the entertainment industry.  This has accounted for the growing number of men seeking face and neck lifts in a surgical arena that was previously dominated by women.  I have also noticed that in a society that places heavy emphasis and judgment on women based on their physical attractiveness, aesthetic surgical procedures are linked to power and acts as a status symbol, especially for people who live in affluent locales such as Newport Beach, CA.

                As we get older, there are a series of predictable changes that occur throughout our bodies that lead to an aged appearance, and the face is no exception.  Although babies are born with an abundance of healthy, youthful fat in the face, this fat gradually shrinks and goes away with time leading to a hollowed out and gaunt appearance.  This change, coupled with the effects of gravity and thinning of the dermis with loss of elastin, leads to sagging of the facial skin and the typical ‘aged’ appearance.  Predictable findings we see with time include deepening of the nasolabial folds and Marionette lines (smile lines), as well as jowling and loose, saggy neck tissue (turkey neck deformity).  Weakening and laxity of facial and neck muscles add to contour deformities and neck platysmal banding.  Smoking and sun damage can accelerate and contribute to further aging skin changes such as diffuse fine lines and wrinkles throughout the face as well as sun-damage spots and discolorations, ie. melasma and actinic keratoses.  All these factors also contribute to typical aging changes around the eyes, such as loose hooding of upper eyelid skin with herniation of fat pads around the eyelids leading to puffy lower eyelids with the so-called tear trough deformity and accentuation of the lid-cheek junction along the nasojugal groove.

                The face and neck lift surgery can address and significantly improve many of these changes that occur with aging.  As with all aspects of cosmetic surgery, there are many different techniques and approaches described for face and neck lifts, and if you poll a dozen plastic surgeons on how they perform their lifts, you will most likely hear a dozen different methods.  Some of the methods described include the skin-only short-scar lift, SMAS (superficial musculoaponeurotic system) plication and imbrication lift, SMASectomy lift, deep plane lift, endoscopic lift, and the MACS (minimal access cranial suspension) lift.  There are also hundreds of variations to each ‘traditional’ technique of face and neck lifting that each plastic surgeon has adapted to their practice.  Having performed several hundred face and neck lifts, I prefer using a variant of the SMAS plication technique with liposuction that has produced excellent results with minimal complications.  Certain techniques such as the skin-only lift do tend to have poorer results with limited lifting effect and faster recurrence rate.  However, there have been multiple studies in the literature, including a twin study in the Plastic and Reconstructive Surgery journal comparing different methods of facelifting that ultimately found no long-term differences in results.  The underlying theme of skin elevation, tightening the face and neck muscles separately, then redraping the skin under minimal tension has consistently shown the best results with prevention of the ‘surprised’ and ‘wind-swept’ Joan Rivers or Kenny Rogers look.  A well-executed face and neck lift should improve the sagging facial components, re-elevate the cheek fat, soften the nasolabial folds and Marionette lines, and redefine the neck with a smooth jaw line and youthful neck angle. 

                There are many complimentary procedures that can be done at the same time which can further rejuvenate the face and neck.  Upper and lower eyelid blepharoplasty surgery can remove redundant skin and fat around the eyes to achieve a smooth, rested, and bright eye appearance.  Fat harvesting and injection can help restore lost volume and fill depressions in the face that occur with aging, leading to a fuller, more youthful face.  Common areas of fat augmentation include the cheeks, temples, nasolabial folds, Marionette lines, and lips.  Full face CO2 laser also nicely compliments a facelift by smoothing out fine lines and wrinkles, stimulating collagen growth, and improving dyschromias.  Patients with weak chin projections can benefit from a chin augmentation, usually performed with a silicone implant.  Forehead lifts can also be performed in patients with premature brow descent.  All these procedures work synergistically and can dramatically improve and rejuvenate the face and neck contour and appearance.  Surgeries can be performed under a variety of settings using general anesthesia, IV sedation, or local anesthesia depending on patient comfort level and requests. 

                With our growing aging population, there is no doubt that facelifts and other cosmetic procedures will go into higher demand in the coming years, especially with economic recovery sure to be on its way.  If you are contemplating a facial rejuvenation surgery, as always I recommend you ‘do your homework’ and find an experienced and knowledgeable Plastic and Reconstructive Surgeon in your area affiliated with the American Society of Plastic Surgeons (ASPS).  There are many self-reported cosmetic surgeons with little or no training and I encourage you to explore and evaluate the credentials and training background for every physician you encounter.  Your choice of a well-trained plastic surgeon along with a thorough discussion of your aspirations and goals are important in achieving an optimal outcome.  Please feel free to contact my office for a consultation if you have questions, or to let me know if there are other topics you are curious about for my future blogs.  Until next time, be well and take care of your skin!

Parviz H. Goshtasby MD, aka “Dr.92660”

Newport Plastic Surgery, Inc.

www.newportplasticsurgery.com

949-500-5440