The Face Lift-understanding the Various Procedures

If you are considering a face lift or any facialtissue filler injections
rejuvenation procedure it is important toThe newer skin tightening technology uses
understand what a face lift can and cannotradiofrequency energy or infrared energy to heat
achieve and the many variations of the face liftthe deep layers of the skin to cause contraction
technique that are designed to correct individualand tightening but first cools the skin before the
variations in facial aging that appear on differentenergy is applied to prevent injury and ablation of
faces. Your face is unique and your face lift orthe superficial skin by the heat energy. Thus the
facial rejuvenation procedure needs to beskin is tightened but the surface is not ablated,
customized to create a pleasing result on yourthus non-ablative skin tightening. There is no down
face.time following non-ablative skin tightening unlike
Excellent results and beautiful rejuvenation can bethe older CO2 laser resurfacing skin tightening.
achieved safely with modern face lift techniques:Several new skin tightening machines are available.
Most important for you is the skill and experienceThe LuxIR by Palomar, and the Titan by Cutera
of your doctor. Honest expert evaluation of yourutilize infrared energy for skin tightening. The
face and a clear explanation of the procedure thatAluma by Lumenis and Thermage utilize infrared
is best for you are essential. I have written aenergy for skin tightening. Refirme by Syneron
book called Save Your Face and in chapter 10 youuses a combination of light energies with
will find an important guide on how to choose aradiofrequency for skin tightening.
plastic surgeon, questions you should ask, andAll of the machines achieve about similar results
warnings about potential situations that I think youwhen used properly. Generally there is less
should avoid.discomfort with the Infrared skin tightening
What a face lift can achievemachines. Complications have been minimal
· Restoration of a full youthful cheekalthough some serious complications occurred with
· A smooth tight jaw lineThermage skin tightening early on.
· A youthful smooth necklineIn my practice I find that non-ablative skin
· Some elevation of the lateral browtightening is most helpful for younger patients
· Removal of jowlswho do not have severe aging changes and
· Correction of loose skin around thesignificant sun damage, people in their 30’s
mouthand 40’s who want to correct or tighten
· Improvement in Marionette lines andearly skin sagging along the jaw line or jowl area,
Nasal labial fold linesneck and cheeks. I use the LuxIR on these larger
What a face lift cannot achieveareas. For skin tightening around the eyelids I use
· Wrinkle removalthe Aluma which has a smaller treatment head
· Eyelid rejuvenationand a suction device that will pull the delicate peri
· Removal of crow’s feetocular skin into the treatment chamber for skin
· Removal of eye bagstightening.
· Removal of eyelid hoodingThe field of non-ablative skin tightening is in its
The different Types of Face lift Proceduresinfancy and will definitely become more effective
There are so many different names used toin the years ahead. The companies are improving
describe the face lift that it can be very confusingtheir products frequently. For now however the
for you the patient. Terms like week end lift, minipeople who benefit most from the skin tightening
lift, S lift, non-surgical face lift, thread lift, lifestylemachines today are younger people who still have
lift are often used and it is hard for you thethick healthy skin with early aging changes.
patient to know what these terms mean. Below IThe use of the term non-surgical face lift to
will try to describe the variations of the face liftdescribe non-ablative skin tightening is an
procedure hopefully shed some light on thisoverstatement with technology available for skin
subject for you.tightening today. At best a 30% result is possible
The Standard Face liftwhen compared to a traditional face lift.
The standard face lift involves an incision aroundResult Oriented Face lift
the ear and undermining or freeing the loose facialA face lift can create a truly beautiful and
skin from the deeper facial attachments. Oncerefreshed look to your face:
the skin is free to move it is drawn tight back toThe important components of a beautiful Face lift
a more youthful and normal position on the faceresult are:
and the excess skin is removed from the area* A smooth, firm neck and jaw line
around the ear and the incision is closed. This* A full elevated cheek high on the cheek bone
relatively straightforward operation can produce* A normal appearing ear lobe
excellent results and has “stood the test of* Hidden scars
time”. Elements of the standard facelift are* A normal “unoperated” appearance
used in virtually all of the facelift variations listed* Looking “like you” just younger
below. The main difference is that the underlyingThe Face lift is one of the most enjoyable
“musculo-aponeaurotic” tissues aresurgeries that I do. After 25 years in practice I
not always tightened.usually achieve the result you want and it is a joy
One common variation of the standard face lift isfor me to share your happiness and enthusiasm
the SMAS Plication which involves tightening thefor your new refreshed look.
deep layers with a stitch rather than actuallyThe Face lift requires experience and skill and is a
excising or removing some of the deep tissuecomplex procedure which requires both artistry
layer. The standard face lift with “SMASand a clear understanding and shared image of
Plication” is the most common face lift Ithe final look you hope to achieve.
perform. Published reports document theYour Consultation
superiority and effectiveness of this technoique.When we meet I will talk with you and ask you
The SMAS Face liftto explain to me the specific facial rejuvenation
The SMAS face lift involves dissecting, andgoals you hope to achieve. I will examine you and
tightening the deeper tissue called the SMAS layertell you my findings and describe the areas where
in addition to the standard facelift dissection ofI think improvement can be made. I will
the skin. This is done to provide additionaldemonstrate on your face the appearance that I
tightening of the face and presumably provide abelieve the face lift will create on your face.
longer lasting result. Studies have cast doubt onI will then recommend the procedure I feel is best
whether SMAS lifting provides a longer result, butfor you. I will discuss the procedure, your
most face lifts today include some modification ofrecovery, and expectations and answer your
the SMAS.questions. Photos of your face will be taken. You
The SMAS stands for “superficial muscularwill be given an estimate or quote of the cost of
aponeurotic system” and describes a firmthe procedure. Financing plans are available.
fibrous tissue layer beneath the facial skin thatThe Face lift procedure
attaches the facial skin to the underlying facialI perform different types of Face lifts designed
muscles. When this tissue is tightened during ato meet your specific needs for your unique face.
face lift additional facial tightening is achieved.A Full face lift elevates and firms the entire face
The classic SMAS face lift involves dissectingand neck, including the lateral brow, the cheek, the
beneath and elevating the SMAS layer, excisingjaw line and the neck. A neck lift just tightens the
some of the excess and suturing the SMAS layerneck and lower jaw. A midface lift or cheek lift
to tighten it.tightens the cheeks and nasal labial folds. An upper
I achieve the same effect by “plicatingface lift or brow lift elevates the outside of the
“the SMAS layer which means I do noteyebrow and the upper face.
dissect beneath the layer but fold the layer onA mini face lift is a less extensive full face lift
itself with a suture to tighten the SMAS.which is appropriate for people who have minimal
I do not dissect beneath the SMAS because thefacial laxity and need only minor facial tightening or
facial nerves run below the SMAS and I feartuck. The mini lift is usually appropriate for
damage to the facial nerve. In my experience theyounger people in their 30’s and
placation provides the same result and is safer40’s, or those lucky people in their
The Extended SMAS Face lift50’s and up who have very little facial
The extended SMAS face lift involves a morelaxity.
extensive dissection beneath the SMAS layer inA good face lift result requires tightening of both
an attempt to get a more extensive tightening ofthe skin and the deeper facial tissues which also
the facial skin especially down around the mouth.sag with age. I tighten the deep layers of the
In my experience I am able to get this correctionface; the SMAS face lift, which tightens the
by undermining skin only and plicating the SMAS.deeper muscle like layer of the face. This is
I avoid the extended SMAS face lift because innecessary to achieve a good result that lasts.
my opinion the facial nerves are more exposed toMinor lifts that are advertised as being quick, easy
injury by this techniqueand with no down time usually only involve skin
The Deep Plane Face liftremoval and they do not last, often only a few
The deep plane face lift involves a moremonths. A well done SMAS lift should last years.
extensive dissection beneath the SMAS layer andFace lift Vectors
some of the facial muscles such as the orbicularisA very important concept in face lifting is the
occuli. Proponents argue a more effectiveVector. The vector is the direction of pull required
correction of cheek laxity and lower and mid faceto lift the face to a younger more attractive look.
correction especially around the mouth. LongerThe appropriate face lift vector is unique to your
lasting results are reported and this technique isface and the face lift must tighten your face
purported to be safer for people who havealong the appropriate vector if you are going to
smoked in the past.achieve the result you want.
Beautiful results have been achieved by theWhen you see a person who has had a face lift
originator of this procedure, Dr Sam Hamra ofand has the surprised look, or looks too tight,
Texas. Others have experienced an increasedunnatural or like a “weasel”, it usually
incidence of nerve injury. My own experience ismeans that their surgeon did not tighten the face
that while excellent results are possible, somealong the appropriate vector.
patients find an objectionable change in theI always examine your face, determine the best
appearance of their mouth.most natural vector for your face and draw the
Some studies have shown that the SMASvectors on your face before I make my lines to
Plication technique mentioned above providesmark my planned face lift procedure. This helps to
superior cosmetic results.assure a natural looking face lift result.
Subperiosteal Face liftScars
The subperiosteal face lift involves underminingNo one wants scars on their face and everyone
beneath the deepest facial layer adjacent to theis concerned about face lift scars.
bone. This technique is designed to elevate andUsually face lift scars are not visible to those
tighten all of the lax soft tissue on the face.around you. 75% of the face lift scars are behind
Theory holds that undermining in the area next tothe ear or in the hairline and people do not see
the bone, deep to the nerves, also helps avoidthem unless they closely inspect you and look for
nerve injury. Nerves still can be injured by thisthem. Yes your hairdresser will know, but he/she
blind deep dissection. The subperiosteal face lift isis likely the only one other than your partner.
an extensive operation and in my experienceThe 25 % of the scar that is in a visible location is
offers no advantage over the standard face liftalso hidden. This scar is placed into the fold in
with SMAS placationfront of your ear. It is usually not visible and is
The Lateral Brow Lifteasily covered by your make up.
The lateral brow lift is a modification of the faceYour Ears
lift to treat laxity and sagging of the upper thirdIn my opinion, the worst sign of a bad face lift by
of the face, the outside portion of the eyebrowan inexperienced surgeon is the “Spock
and the upper cheek. An incision is made in or onear” or “elf ear” deformity.
the hairline on the side of the forehead, the skin isThis occurs when the ear lobe is fused to the
undermined, pulled tight and the excess removed.cheek and pulled down to where it looks like the
This technique can be effective when only theear is attached to the angle of the jaw.
side or lateral potion of the eyebrow and theI have developed a very specific technique for
upper cheek are lax. However care must becreating a normal looking ear lobe following a face
taken to avoid displacement of the hairline andlift-check my photos; you will not see the
injury to the frontal branch of the facial nerve,“Spock ear”.
which if injured can cause the brow to droop.Pre OP
The Forehead LiftThe pre operative visit is the time when we will
The forehead lift is a procedure I rarely do sincesit down and clearly define your face lift goals. We
the advent of Botox. Proper use of Botox canwill discuss what you hope to achieve and what I
correct most forehead laxity caused bybelieve I can achieve with your face lift. I will try
contraction of the frown muscles and theto give you an honest image of what you can
standard face lift corrects most lateral brow laxityexpect for a result.
of the outside portion of the eyebrow.You will also undergo a history and physical exam
A forehead lift requires and incision within or atto make certain that you are healthy and have
the hairline all the way across the forehead. Theno medication allergies or contraindications to
results can be excellent if you are willing to acceptsurgery. An EKG (electrocardiogram) may be
the scar. One problem however is that for a longdone if you have a history of heart problems or
lasting result the frown muscles must behave reached a certain age. You will also be given
removed and this can result in a permanentprescriptions for post operative medications. You
depression or contour deformity in the midalso will be asked to read and sign surgical
forehead in the frown area. In the past the frownconsent forms which outline the risks, potential
muscles could be neutralized through an uppercomplications, limitations and expectations of face
blepharoplasty eyelid incision, but again Botox haslift surgery.
made this operation unnecessary for most peopleThe Operation
who want to correct laxity of the middle portionA full SMAS face and neck lift usually takes me
of the forehead.about 90 minutes to 2 hours. If I am doing eyelid
The Mid face or Cheek Liftrejuvenation or 4 lid blepharoplasty at the same
The mid face lift or cheek lift is designed tooperation, as is often the case, then the surgery
tighten the cheeks and help improve the nasalcan take 3 hours. Mini lifts, neck lifts and cheek
labial fold lines. This is a modification of the face liftlifts usually take only an hour.
which involves an incision along the crease in frontYou are asleep during the surgery. I have very
of the top part of the ear extending up onto theexperienced superb anesthesiologists who will be
hairline.taking care of you. Safety is our first concern.
The cheek lift or mid face lift is effective forWe use modern, very safe anesthesiology
people who have laxity in the cheek and nasaltechniques, and take precautions to avoid nausea
labial fold lines but have no laxity along the jaw lineafter surgery.
and neck.Following your surgery you will go to the
The cheek lift or mid face lift is becoming veryrecovery room where a nurse will take care of
popular among younger patients who have earlyyou and make sure you are comfortable.
facial laxity in the midface. Cheek sagging is oftenSome patients prefer the comfort of an
the first facial aging change to occur, and youngerovernight stay in the hospital. In this case I will
patients are choosing to have a cheek lift orexamine you the next morning, remove two tiny
midface lift before further facial sagging extendingdrains from behind your ear, remove your
to the neck and jaw line occur.bandage, and have you shower and comb out
The Neck Liftyour hair, and then discharge you. When you go
The neck lift is designed to tighten sagging neckhome a small scarf placed over your head and a
skin below the jaw line and chin. The neck lift is apair of sunglasses will usually hide the fact that
good choice for younger patients who only haveyou have had surgery.
loose skin beneath the chin and jaw line.For those of you who want to go home the
In some cases the neck lift can be accomplishedsame day after surgery, you will spend about 2
through a small incision beneath the chin which ishours in the recovery room with a nurse taking
well hidden. This procedure is also called acare of you. As soon as you are comfortable,
platysmaplasty or corset platysmaplasty. In someable to drink and eat a bland food such as
cases with more extensive neck laxity an incisioncrackers or cookies, and able to go to the
behind the ear is also required.bathroom, you will be discharged. The nurse will
The Short Scar Face liftescort you by wheel chair to your car.
The short scar face lift describes a face liftWe require that someone bring you to the
performed through an incision which runs only insurgery center and take you home, and that you
front of the ear in the skin crease. The incisionhave someone staying with you the first night
behind the ear and above the ear in the hairline isafter your surgery.
avoided.Post op- What to expect
Some authors show very impressive resultsMy patients do not always complain of pain
showing improvement in face and neck laxity withfollowing a face lift. Your face and neck will feel
this technique. This procedure is effective fortight, which means that I have done my job
younger patients with mid face laxity and lesscorrectly. After a few days the tight sensation will
extensive neck and forehead laxity. The smallergo away as the facial tissues relax. If you have
incision is advantageous cosmetically and shouldhad a blepharoplasty for eyelid rejuvenation you
require less healing and down time.will have ice packs on your eyes to reduce
The Mini Liftswelling and bruising.
The mini lift or mini face lift means many thingsI place a bandage around your face which comes
to many people. Most commonly the mini lift termoff the next day and you may shower and wash
is used by patients who want a face lift butyour hair on the first day after surgery. I usually
don’t want to call it a face lift!place a tiny drain behind each ear which is
To me a mini face lift is a smaller procedure thanremoved the first day after surgery.
the standard face lift and is useful in patients whoBruising on the face is unusual; bruising when it
have early facial laxity in the cheek and jaw linedoes occur is usually on the neck and upper chest
who do not have extensive neck laxity.and is usually minimal and easily covered with
Usually I can use a short scar or an upper scarmake up.
along the upper portion of the ear crease into theUsually after 1 to 2 weeks you will be
hairline.comfortable being seen in public and will be back
The mini lift or mini face lift is a less extensiveto most normal activity. I ask you to wait 3
procedure and works well for younger patientsweeks before heavy weight lifting or aggressive
and older patients with minimal facial laxity.work outs.
The Lifestyle LiftI have you take an herbal supplement called
I include the lifestyle lift here because so manyArnica Montana before and after surgery which
people ask me about it. I only know what I read. Ihelps reduce bruising. I also have excellent mineral
have not trained in nor have I ever done or seencover up make up to cover any visible bruising.
a lifestyle lift performed. I have seen patientsConsultation with Dr Seckel
who claim they have had a lifestyle lift. AsI can tell you a great deal more about face lift
advertised the lifestyle lift is done without generaland how it would work for you if I see you in
anesthesia or IV sedation and claims are madeperson. Call me 978-844-3116 or contact me by
that recovery is less than a traditional face lift.email at If you would like to email me your
The Non-surgical Faceliftphotos I can email you my thoughts about how I
When most people use the term non-surgical facethink a Face lift would work for you. For more
lift they are talking about skin tightening with theinformation on face lift read my blogs on face lift.
various new skin tightening machines. SomeI look forward to meeting you.
misuse this term by applying it to extensive soft