With so-called mini-lifts or Life Style lifts, a small area is undermined around the ear and the skin pulled back for a very temporary improvement but the muscle sagging is not addressed – we see many patients who have chosen these lesser procedures and are back to see us a year later because the jowls have recurred or the neck laxity has returned, understandably so as the sagging muscles causing these issues have not been repaired.
The history of cosmetic facelift surgery.
No one knows who performed the first facelift procedure, but they were being performed by a few German surgeons and the rare surgeon in the USA by 1910. These procedures were associated with much secrecy for a number of reasons. First of all, there was much public disdain for surgery performed for vanity reasons, both by the general public as a whole and by the well-known surgeons of the day. The top academic plastic surgeons, as late as the 1980’s, frequently published numerous articles about reconstructive surgery yet rarely published articles on aesthetic surgery – yet these same surgeons not infrequently performed aesthetic procedures to supplement their income. These same academic surgeons were less than complimentary of surgeons who chose to pursue a career doing solely aesthetic surgery. In the early 1990’s, there was also a secretive attitude by aesthetic surgeons – in part because of a desire to avoid the wrath of plastic surgery leaders, but also in an effort to keep their surgical techniques a secret from other surgeons! This combination of factors caused aesthetic procedures to be performed in private nursing homes and clinics, far from the eyes of peers or young plastic surgeons trying to learn the trade.
Relatively few articles appeared in the plastic surgery literature about facelift surgery prior to the 1970’s. From a technical point of view, a rather primitive, skin only procedure was performed by most surgeons until the mid-1970’s. At that time, a very forward-thinking Swedish plastic surgeon, Tord Skoog, analyzed the aging face and came up with the understanding that the main culprit in sagging facial tissues was a drooping of underlying muscles and deeper tissues – he came up with the idea of lifting these underlying muscles in an effort to produce a more long lasting and more natural facelift procedure. Unfortunately, Dr. Skoog did not live long after this groundbreaking article and did not get to see how he revolutionized the field of facial rejuvenation.
In the last 40 years, there has been an explosion of articles and textbooks on facial aesthetic surgery and many top plastic surgeons openly have decided to pursue careers in aesthetic surgery, and aesthetic surgery is being openly taught in university centers to plastic surgery residents. Today, a plethora of techniques exist to address the aging face ranging from mini-lifts such as the “Life Style Lift” to skin only facelifts and a variety of deeper plane procedures which address the underlying sagging muscles. Interestingly, most of the procedures can produce a significant improvement in facial improvement but they vary greatly in the longevity of the results. Yes, a lot depends on patient expectations, but most of my patients do expect a longer lasting result and a natural appearance, and this can only be achieved if the underlying muscles are lifted and repositioned where they were in youth.
In order to achieve a long lasting and natural appearing facelift, we believe that is necessary to elevate the skin, replace the muscles where they were in youth, and to resect excess skin, but NOT to pull the skin tight. Young people do not have sagging muscles, but they do not have tight skin!
What are the common facial rejuvenation procedures when doing a facelift Sacramento?
An ancillary procedure is something that you do at the time of another procedure, and a good example would be the other smaller procedures we do at the time of a facelift. Examples include fat grafting, chin augmentation, eyelid surgery or brow lifts. When we do a facelift Sacramento, we will very frequently harvest and transfer a little bit of fat into areas from areas where an excess has built up to where fat has been lost. If you look at most normal, thin people as they age, their faces become thinner, and you restore a more youthful look by adding some fat to the cheeks, to the Marionette lines or nasolabial folds, and also to lips. Especially in females, if lips get thinner, the lady will look older. Adding some fat to the lips will restore a more youthful look.
For me, by far, the most common ancillary procedure during a facelift Sacramento is fat grafting, especially to the cheek areas to restore the ‘V’ look of youth with the fullness over the cheeks instead of the deflated tire “A” look with heaviness down in the jowl area. Well, the second most common area would be the nasolabial folds, the marionette lines and the lips. But if you ask what the second most common ancillary procedure is besides fat grafting, I’d say eyelid surgery and brow surgery. If you define a facelift and you’re talking basically about the jowls and the cheeks, you’re not addressing the eyes, but a lot of folks who come in to have their faces done have baggy eyes or lose skin around their lids or have low brows. Not addressing these issues at the time of a facelift is analogous to painting half of your room or remodeling and leaving one wall unpainted when remodeling the house – when you are done, all you will be able to focus on is the unpainted portion. Likewise when doing a facelift, if you leave baggy eyelids undone, most people will fixate on the eyelids after surgery until they come back to have them addressed. The ancillary procedures are designed to balance the final result.
I have seen two other facial plastic surgeons in Sacramento about facial rejuvenation and am a little confused as to how to proceed. I know that my neck is lax and my eyes look old and I would like to have both corrected. But to be honest, I am a little afraid and would feel more comfortable doing the procedures in stages. Can you help me decide “how much is too much” for one sitting?
Assuming that you are a candidate for both eyelid and neck rejuvenation procedures, you would first have to decide if you indeed would like both improved, and that can only happen after you have had a thorough consultation with a qualified plastic surgeon. If you decide that you would like both the eyes and neck done, my advice would be to do them together at the same sitting for a couple of reasons. The first is time spent recovering. If you do just the eyes, you will be uncomfortable and bruised for up to two weeks, and likewise when you have your neck done; if you combine theses procedures, the total recovery time will still be about a total of two weeks (instead of losing two weeks twice). Aside from time considerations, you will save money by going into a surgery center only once versus twice. And probably the best reason of all is that you will be able to enjoy a uniform improvement over your entire face as soon as you have healed. This would be akin to enjoying a house that has been totally cleaned, rather than only half done.