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Face

The Face is the most visible, anatomically complex, and 3 dimensional area of the human body.  Be sure that your surgeon is competent to operate on your face.

We believe the best facial cosmetic surgeons are those who also perform complex reconstructive procedures on the face. These surgeons are familiar with the anatomy not only of the superfical layers but also of the critical deeper structures, and have many more skill sets than surgeons who only do cosmetic surgery.

It is more difficult to reconstruct a facial part that is absent or deformed and surgeons who are well versed in these reconstructions have many more arrows in their quiver.

Facial Cosmetic Operations

This list below is by no means exhaustive, but provides the most common procedures performed.  See also our section on Non-Surgical Procedure.  Our surgeons will customize the procedure to the individual patient, and not use a “cookbook” approach, as each person has their own unique set of issues.

Face Lift
Full face lift Mini face lift MACS lift
SMAS lift Endoscopic lifts Customized facelifts
Mid Face lift Lip Lift Neck Lift
Blepharoplasty
Upper Lower Ptosis repair (droopy eyelid)
Brow lift
Endoscopic Open Coronal
Hairline Direct supra-eyebrow Mid-forehead
Temporal
Rhinoplasty
Open Endonasal Tip
Full Septoplasty
Otoplasty
Restoring Facial Volume
Fat grafting
Flaps Micrografting

Face Lift

Full face lift
Mini face lift
MACS lift
SMAS lift
Endoscopic lifts
Customized facelifts

Mid Face lift

Lip Lift

Neck Lift

Blepharoplasty

Upper
Lower
Ptosis repair (droopy eyelid)

Brow lift

Endoscopic
Open
Coronal
Hairline
Direct supra-eyebrow
Mid-forehead
Temporal

Rhinoplasty

Open
Endonasal
Tip
Full
Septoplasty

Otoplasty

Restoring Facial Volume

Fat grafting

Flaps
Micrografting

Facelifts

The “facelift” is a name that applies to a variety of surgical and non-surgical procedures: the word is a bit misleading, as many facelifts directly impact the neck as well, and some can be extended into the brow. There are multiple ways of performing a facelift, and this can be confusing to patents. Some surgeons perform the same type of facelift in all their patients, a “cookbook” type approach, however we believe that we can serve our patients best by customizing the facelift for each individual.

There are similarities amongst all people with aging, however each individual is unique in the particular constellation of features of aging that they display. Consequently a particular type of facelift that suits one person may not be ideal for another, and it is important that the surgeon customize the operation for each individual patient.

In general, the more aged a face appears, the greater the degree of surgery required to accomplish the best result. However, many patients are looking for improvement and do not necessarily want to go through a big surgery, and are willing to lower their expectations in order to have a smaller operation. In our consultation we discuss these issues and it is essential for us to understand our patient’s goals and expectations as clearly as possible.

Some different types of facelift
This list is not exhaustive, but contains the more common facelift procedures, and the names in common usage, some of which are very similar.

  • Traditional – subcutaneous lift
  • SMAS lift
  • Deep plane lift
  • Short scar facelift
  • Omega lift
  • MACS lift
  • “Lifestyle lift”
  • Mini-face lift

The facelift may be extended to include a brow lift, if appropriate.
Incisions are placed where the resultant scars will be most inconspicuous, and are customized for each patient.

Anesthesia
Some of the lesser facelifts can be done in our office operating rooms under local anesthesia. The more extensive facelifts are best done under general anesthesia or sedation (MAC) anesthesia in a surgery center.

Length of Surgery
The length of operation will vary much depending on the extent of the facelift, and if other procedures are being done at the same time. The time can range from 2 – 8 hours. It is safer to keep the operating time below 5-6 hours if possible – this will keep possible complications down to a minimum.

Recovery Time
This will vary depending on the extent of the facelift. Lesser facelifts under local anesthesia have a rapid recovery and less bruising. Sutures are in for about 5-7 days, bruising takes 10-21 days to resolve, occasionally longer. The face will feel unnaturally tight for the first few weeks. Swelling varies from person to person, most swelling is down by about 10 days, the last bit of swelling taking longer to resolve, but most onlookers do not notice this. There will be changes in sensation, depending on the extent of the surgery, most temporary, but some changes may be permanent.

MID-FACE LIFT
In general the standard facelift will not address some of the signs of aging in the middle part of the face, and in certain patients the addition of a mid-face lift will greatly improve the overall result. Often in younger patients in their late 30’s or 40’s a mid-face lift may be all that is required. This operation is most often performed through a lower eyelid or a temporal incision. Patients with droopy cheeks that have lengthened the lower eyelids, and prominent nasolabial folds are good candidates.

Additional techniques that can be used to minimize scars:
Endoscope use: particularly useful as a less invasive type of browlift, however can also be used for certain types of face lift, particularly mid-face lift, when performed through a temporal incision.

Lesser surgical options
“String lift” – long spanning sutures (often special barbed sutures) are placed in the droopy tissues to lift and support them as an alternative to open surgery. Whilst avoiding open surgery sounds very attractive, unfortunately these techniques are not suitable for many, and problems are encountered frequently – the sutures may be uncomfortable and easily felt beneath the skin, they may be visible as an unnatural sharp band, and the lift effect often does not last for long before the sutures “cheese-cut” through the tissues. These procedures are often touted by doctors who are not surgically trained and cannot perform open facelifts.

Ancillary procedures:
1. Chemical Peel and Laser Skin Treatments
The overall result can be enhanced with the selective use of treatments to the skin. Many patients have textural changes or pigmentary changes to the skin that will be improved with the use of chemical peels or laser treatments. Sometimes these are performed at the same time as the facelift, sometimes later.
2. Facial Creams
More simple treatments that can be applied by the patient, include the use of facial creams containing Vit A or Vit C, and a number of other compounds, that improve fine wrinkles, texture and pigmentary changes. These can be started prior to the facelift, and often take several months before beneficial effects become evident.
3. Fillers
A variety of fillers are available, from using of your own tissues, to off-the-shelf items, all of which have their advantages and disadvantages.

Brow-lifts

As one ages, the brow droops (Brow ptosis), with the eyebrows coming to encroach on the upper eyelids and often interfering with vision.  If special tests show that the visual fields are impaired to a certain degree some insurances will provide benefits for a brow lift. As the eyebrows droop, the “lifting” forehead muscles work harder to try and pull the eyebrows up, resulting in wrinkles across the forehead.

Frequently a person will have several factors involved all contributing to the problem.  Droop of the brow is accompanied by excessive skin on the upper eyelids (Dermatochalasis) which further impairs vision, and by stretching of the muscle/tendon that open the upper eyelids, causing the eyelids themselves to droop over the cornea (Eyelid ptosis). The best result is attained by careful attention to each of these problems and each may need to be surgically addressed.

Brow-lifts come in several varieties, in all of which the goal is to raise the brow.

1. Direct brow-lift
Skin is excised just above the eyebrows, leaving a scar at the upper border of the eyebrows.  This is a relatively simple operation and can be done under local anesthesia in our office operating rooms.  The patient needs to be willing to accept a scar in this location, although in most cases the scar is not that noticeable once it has matured.

2. Mid-forehead Lift
Skin can be excised in the middle of the forehead, along the wrinkle lines.  This technique is most suited for older men who have deep wrinkles in this location and do not mind exchanging the wrinkles for a scar.  Local anesthetic can be used.

The techniques below are usually done under sedation (MAC) anesthesia or General anesthesia.

3. Open Hairline Brow-lift (pre-trichial)
The incision is placed at the junction of the forehead skin and scalp/hair.  This brow-lift works well for patients who have a high forehead.  In these patients placing the incision within the scalp would result in making their forehead even higher, which would not be pleasing.

4. Open Coronal Brow-lift
The incision is placed within the scalp hair, often about 5-8cm above the hairline.

All the above techniques result in excess skin being trimmed and discarded, and will provide the most long-lasting results.  For patients who desire less invasive surgery and lesser scars there is an alternative:

5. Endoscopic Brow-lift
The endoscopic brow-lift was developed (at Emory University) to provide a less invasive alternative.  Several short (about 1cm) incisions are made in the scalp or hairline, and an endoscope and special instruments are inserted. Under direct vision the surgeon elevates the forehead tissues off the skull, and repositions them in an elevated position using special bone anchoring tacks, that absorb later.  In some patients the endoscopic brow-lift does not last as long as the open techniques.

Blepharoplasty and Brow-lifts

A note of caution.  
Some surgeons perform upper eyelid blepharoplasty (removal of excess skin from the eyelids) without paying proper attention to the position of the brow.  If the brow has drooped significantly then this needs to be lifted first. Once the brow is in the correct position, then the excess skin on the upper eyelids can be removed. (This can be done at the same operation). Removing the eyelid skin first can result in a deficiency of skin on the eyelids and fixes the eyebrows in an unnatural low position.