Modern Facelift Techniques: Individualizing the Technique to the Patient

In the modern age of facial rejuvenation, a multi-technique approach is utilized to achieve a youthful refreshed look.  Some techniques have stood the test of time and other techniques are a more recent reflection of our greater understanding of the soft tissue anatomy of the face.

In this blog article, I will focus primarily on the midface and neck.  I will address the brow and forehead in another article.

Over time our faces become aged by the forces of gravity, genetics, and stresses of our environment.  We lose volume, elasticity, and elevation of the soft tissues.  Our bones also change in variable ways as a functional matrix of the stresses placed upon them.  In approaching a total facial rejuvenation, all aging phenomena need to addressed simultaneously or as part of a plan in order to achieve a predictable and harmonious result.

Skin is often overlooked when thinking about surgical options, but is critical to the final outcome.  If not already part of your daily routine, I can help you develop a skin regimen that will help create a revitalized youthful cover for our underlying surgical procedures.  There are various excellent product systems on the market and even more that are a waste of money.  I have found the Obagi system to be best in class in my experience.  At the very least, your system must have Retin-A as part of the treatment plan.  You will need a plastic surgeon or dermatologist to prescribe this for you.  Lasers, dermabrassion, TCA peels and other techniques can be tailored according to each individual’s needs.

The next component to consider in facial rejuvenation is soft tissue descent, laxity, and volume loss.  This is highly variable between patients.  For a fuller face, I may use a mid-level dissection plane and remove the redundant tissue after elevation is complete.  For a thinner face, I will use the same mid-level dissection plane (sub-SMAS) but overlap the tissues in the cheek areas giving an augmented cheek look that is only present in the youthful face.  I feel very strongly that accessing the robust, mid-level tissue planes (SMAS) is critical to achieving a long lasting result that will continue to look good for a decade or more.  By accessing the mid-level planes, more swelling results and with more swelling comes a slightly longer healing time.  Many patients want the facelift with the quickest healing time.  In many cases this is also a cheaper facelift.  Win win right?  I would caution against the quick fix.  In my experience, these are usually skin only facelifts that maintain their shape until the skin stretches out to its previous position.  This usually doesn’t take long and philosophically doesn’t make much sense to me as a surgeon.  A long lasting result must move the descended face to an elevated position that will maintain its shape in a lasting way.  This is why I insist on taking the time to address the mid-level planes of the face and restore them to their previous positions before gravity displaced them over the nasolabial folds of the cheeks and jowls of the jaw line.  The basic principles of this approach have stood the test of time and have reliably produced long lasting results.

Fat grafting has become an important of my facial rejuvenation repertoire.  The fat compartments of the face have been studied extensively and published in the scientific plastic surgery literature over the past several years.  Fat grafting has allowed facial rejuvenation to be tailored with a degree of precision not previously attainable.  This has allowed true volume restoration and allowed previously great results to become truly phenomenal.  This has gained huge popularity with celebrities and can be used alone or in conjunction with facelift techniques depending on each person’s individual needs.  It is rare that I do not combine fat grafting into my facelift.

The last and often most important part of facial rejuvenation is creating a youthful appearing neck.  The goals of a neck lift are to eliminate excess fat pads, tighten the skin, eliminate jowling, and create a beautiful jaw line that contours nicely with the mandible.  This is created by tightening, repairing, redirecting, and securing the deeper tissues of the neck.  The skin will follow the deeper tissues and allow the neck to remain youthful for a decade or more.

If you are interested in facial rejuvenation, I encourage you to schedule a consultation.  During your consultation I will perform a physical exam and we can talk about your goals and desires.  We will then formulate a plan to restore your youthful face.

–Jason Mussman MD

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