| If you are considering a face lift or any | | | | applying it to extensive soft tissue filler |
| facial rejuvenation procedure it is important | | | | injections |
| to understand what a face lift can and cannot | | | | |
| achieve and the many variations of the face | | | | The newer skin tightening technology uses |
| lift technique that are designed to correct | | | | radiofrequency energy or infrared energy to |
| individual variations in facial aging that | | | | heat the deep layers of the skin to cause |
| appear on different faces. Your face is | | | | contraction and tightening but first cools |
| unique and your face lift or facial | | | | the skin before the energy is applied to |
| rejuvenation procedure needs to be customized | | | | prevent injury and ablation of the |
| to create a pleasing result on your face. | | | | superficial skin by the heat energy. Thus the |
| | | | skin is tightened but the surface is not |
| Excellent results and beautiful rejuvenation | | | | ablated, thus non-ablative skin tightening. |
| can be achieved safely with modern face lift | | | | There is no down time following non-ablative |
| techniques: | | | | skin tightening unlike the older CO2 laser |
| | | | resurfacing skin tightening. |
| Most important for you is the skill and | | | | |
| experience of your doctor. Honest expert | | | | Several new skin tightening machines are |
| evaluation of your face and a clear | | | | available. The LuxIR by Palomar, and the |
| explanation of the procedure that is best for | | | | Titan by Cutera utilize infrared energy for |
| you are essential. I have written a book | | | | skin tightening. The Aluma by Lumenis and |
| called Save Your Face and in chapter 10 you | | | | Thermage utilize infrared energy for skin |
| will find an important guide on how to choose | | | | tightening. Refirme by Syneron uses a |
| a plastic surgeon, questions you should ask, | | | | combination of light energies with |
| and warnings about potential situations that | | | | radiofrequency for skin tightening. |
| I think you should avoid. | | | | |
| | | | All of the machines achieve about similar |
| What a face lift can achieve | | | | results when used properly. Generally there |
| | | | is less discomfort with the Infrared skin |
| · Restoration of a full youthful cheek | | | | tightening machines. Complications have been |
| | | | minimal although some serious complications |
| · A smooth tight jaw line | | | | occurred with Thermage skin tightening early |
| | | | on. |
| · A youthful smooth neckline | | | | |
| | | | In my practice I find that non-ablative skin |
| · Some elevation of the lateral brow | | | | tightening is most helpful for younger |
| | | | patients who do not have severe aging changes |
| · Removal of jowls | | | | and significant sun damage, people in their |
| | | | 30’s and 40’s who want to correct |
| · Correction of loose skin around the | | | | or tighten early skin sagging along the jaw |
| mouth | | | | line or jowl area, neck and cheeks. I use the |
| | | | LuxIR on these larger areas. For skin |
| · Improvement in Marionette lines and | | | | tightening around the eyelids I use the Aluma |
| Nasal labial fold lines | | | | which has a smaller treatment head and a |
| | | | suction device that will pull the delicate |
| What a face lift cannot achieve | | | | peri ocular skin into the treatment chamber |
| | | | for skin tightening. |
| · Wrinkle removal | | | | |
| | | | The field of non-ablative skin tightening is |
| · Eyelid rejuvenation | | | | in its infancy and will definitely become |
| | | | more effective in the years ahead. The |
| · Removal of crow’s feet | | | | companies are improving their products |
| | | | frequently. For now however the people who |
| · Removal of eye bags | | | | benefit most from the skin tightening |
| | | | machines today are younger people who still |
| · Removal of eyelid hooding | | | | have thick healthy skin with early aging |
| | | | changes. |
| The different Types of Face lift Procedures | | | | |
| | | | The use of the term non-surgical face lift to |
| There are so many different names used to | | | | describe non-ablative skin tightening is an |
| describe the face lift that it can be very | | | | overstatement with technology available for |
| confusing for you the patient. Terms like | | | | skin tightening today. At best a 30% result |
| week end lift, mini lift, S lift, | | | | is possible when compared to a traditional |
| non-surgical face lift, thread lift, | | | | face lift. |
| lifestyle lift are often used and it is hard | | | | |
| for you the patient to know what these terms | | | | Result Oriented Face lift |
| mean. Below I will try to describe the | | | | |
| variations of the face lift procedure | | | | A face lift can create a truly beautiful and |
| hopefully shed some light on this subject for | | | | refreshed look to your face: |
| you. | | | | |
| | | | The important components of a beautiful Face |
| The Standard Face lift | | | | lift result are: |
| | | | |
| The standard face lift involves an incision | | | | * A smooth, firm neck and jaw line |
| around the ear and undermining or freeing the | | | | |
| loose facial skin from the deeper facial | | | | * A full elevated cheek high on the cheek |
| attachments. Once the skin is free to move it | | | | bone |
| is drawn tight back to a more youthful and | | | | |
| normal position on the face and the excess | | | | * A normal appearing ear lobe |
| skin is removed from the area around the ear | | | | |
| and the incision is closed. This relatively | | | | * Hidden scars |
| straightforward operation can produce | | | | |
| excellent results and has “stood the | | | | * A normal “unoperated” |
| test of time”. Elements of the standard | | | | appearance |
| facelift are used in virtually all of the | | | | |
| facelift variations listed below. The main | | | | * Looking “like you” just younger |
| difference is that the underlying | | | | |
| “musculo-aponeaurotic” tissues | | | | The Face lift is one of the most enjoyable |
| are not always tightened. | | | | surgeries that I do. After 25 years in |
| | | | practice I usually achieve the result you |
| One common variation of the standard face | | | | want and it is a joy for me to share your |
| lift is the SMAS Plication which involves | | | | happiness and enthusiasm for your new |
| tightening the deep layers with a stitch | | | | refreshed look. |
| rather than actually excising or removing | | | | |
| some of the deep tissue layer. The standard | | | | The Face lift requires experience and skill |
| face lift with “SMAS Plication” | | | | and is a complex procedure which requires |
| is the most common face lift I perform. | | | | both artistry and a clear understanding and |
| Published reports document the superiority | | | | shared image of the final look you hope to |
| and effectiveness of this technoique. | | | | achieve. |
| | | | |
| The SMAS Face lift | | | | Your Consultation |
| | | | |
| The SMAS face lift involves dissecting, and | | | | When we meet I will talk with you and ask you |
| tightening the deeper tissue called the SMAS | | | | to explain to me the specific facial |
| layer in addition to the standard facelift | | | | rejuvenation goals you hope to achieve. I |
| dissection of the skin. This is done to | | | | will examine you and tell you my findings and |
| provide additional tightening of the face and | | | | describe the areas where I think improvement |
| presumably provide a longer lasting result. | | | | can be made. I will demonstrate on your face |
| Studies have cast doubt on whether SMAS | | | | the appearance that I believe the face lift |
| lifting provides a longer result, but most | | | | will create on your face. |
| face lifts today include some modification of | | | | |
| the SMAS. | | | | I will then recommend the procedure I feel is |
| | | | best for you. I will discuss the procedure, |
| The SMAS stands for “superficial | | | | your recovery, and expectations and answer |
| muscular aponeurotic system” and | | | | your questions. Photos of your face will be |
| describes a firm fibrous tissue layer beneath | | | | taken. You will be given an estimate or quote |
| the facial skin that attaches the facial skin | | | | of the cost of the procedure. Financing plans |
| to the underlying facial muscles. When this | | | | are available. |
| tissue is tightened during a face lift | | | | |
| additional facial tightening is achieved. | | | | The Face lift procedure |
| | | | |
| The classic SMAS face lift involves | | | | I perform different types of Face lifts |
| dissecting beneath and elevating the SMAS | | | | designed to meet your specific needs for your |
| layer, excising some of the excess and | | | | unique face. |
| suturing the SMAS layer to tighten it. | | | | |
| | | | A Full face lift elevates and firms the |
| I achieve the same effect by “plicating | | | | entire face and neck, including the lateral |
| “the SMAS layer which means I do not | | | | brow, the cheek, the jaw line and the neck. A |
| dissect beneath the layer but fold the layer | | | | neck lift just tightens the neck and lower |
| on itself with a suture to tighten the SMAS. | | | | jaw. A midface lift or cheek lift tightens |
| | | | the cheeks and nasal labial folds. An upper |
| I do not dissect beneath the SMAS because the | | | | face lift or brow lift elevates the outside |
| facial nerves run below the SMAS and I fear | | | | of the eyebrow and the upper face. |
| damage to the facial nerve. In my experience | | | | |
| the placation provides the same result and is | | | | A mini face lift is a less extensive full |
| safer | | | | face lift which is appropriate for people who |
| | | | have minimal facial laxity and need only |
| The Extended SMAS Face lift | | | | minor facial tightening or tuck. The mini |
| | | | lift is usually appropriate for younger |
| The extended SMAS face lift involves a more | | | | people in their 30’s and 40’s, or |
| extensive dissection beneath the SMAS layer | | | | those lucky people in their 50’s and up |
| in an attempt to get a more extensive | | | | who have very little facial laxity. |
| tightening of the facial skin especially down | | | | |
| around the mouth. In my experience I am able | | | | A good face lift result requires tightening |
| to get this correction by undermining skin | | | | of both the skin and the deeper facial |
| only and plicating the SMAS. | | | | tissues which also sag with age. I tighten |
| | | | the deep layers of the face; the SMAS face |
| I avoid the extended SMAS face lift because | | | | lift, which tightens the deeper muscle like |
| in my opinion the facial nerves are more | | | | layer of the face. This is necessary to |
| exposed to injury by this technique | | | | achieve a good result that lasts. Minor lifts |
| | | | that are advertised as being quick, easy and |
| The Deep Plane Face lift | | | | with no down time usually only involve skin |
| | | | removal and they do not last, often only a |
| The deep plane face lift involves a more | | | | few months. A well done SMAS lift should last |
| extensive dissection beneath the SMAS layer | | | | years. |
| and some of the facial muscles such as the | | | | |
| orbicularis occuli. Proponents argue a more | | | | Face lift Vectors |
| effective correction of cheek laxity and | | | | |
| lower and mid face correction especially | | | | A very important concept in face lifting is |
| around the mouth. Longer lasting results are | | | | the Vector. The vector is the direction of |
| reported and this technique is purported to | | | | pull required to lift the face to a younger |
| be safer for people who have smoked in the | | | | more attractive look. The appropriate face |
| past. | | | | lift vector is unique to your face and the |
| | | | face lift must tighten your face along the |
| Beautiful results have been achieved by the | | | | appropriate vector if you are going to |
| originator of this procedure, Dr Sam Hamra of | | | | achieve the result you want. |
| Texas. Others have experienced an increased | | | | |
| incidence of nerve injury. My own experience | | | | When you see a person who has had a face lift |
| is that while excellent results are possible, | | | | and has the surprised look, or looks too |
| some patients find an objectionable change in | | | | tight, unnatural or like a |
| the appearance of their mouth. | | | | “weasel”, it usually means that |
| | | | their surgeon did not tighten the face along |
| Some studies have shown that the SMAS | | | | the appropriate vector. |
| Plication technique mentioned above provides | | | | |
| superior cosmetic results. | | | | I always examine your face, determine the |
| | | | best most natural vector for your face and |
| Subperiosteal Face lift | | | | draw the vectors on your face before I make |
| | | | my lines to mark my planned face lift |
| The subperiosteal face lift involves | | | | procedure. This helps to assure a natural |
| undermining beneath the deepest facial layer | | | | looking face lift result. |
| adjacent to the bone. This technique is | | | | |
| designed to elevate and tighten all of the | | | | Scars |
| lax soft tissue on the face. Theory holds | | | | |
| that undermining in the area next to the | | | | No one wants scars on their face and everyone |
| bone, deep to the nerves, also helps avoid | | | | is concerned about face lift scars. |
| nerve injury. Nerves still can be injured by | | | | |
| this blind deep dissection. The subperiosteal | | | | Usually face lift scars are not visible to |
| face lift is an extensive operation and in my | | | | those around you. 75% of the face lift scars |
| experience offers no advantage over the | | | | are behind the ear or in the hairline and |
| standard face lift with SMAS placation | | | | people do not see them unless they closely |
| | | | inspect you and look for them. Yes your |
| The Lateral Brow Lift | | | | hairdresser will know, but he/she is likely |
| | | | the only one other than your partner. |
| The lateral brow lift is a modification of | | | | |
| the face lift to treat laxity and sagging of | | | | The 25 % of the scar that is in a visible |
| the upper third of the face, the outside | | | | location is also hidden. This scar is placed |
| portion of the eyebrow and the upper cheek. | | | | into the fold in front of your ear. It is |
| An incision is made in or on the hairline on | | | | usually not visible and is easily covered by |
| the side of the forehead, the skin is | | | | your make up. |
| undermined, pulled tight and the excess | | | | |
| removed. | | | | Your Ears |
| | | | |
| This technique can be effective when only the | | | | In my opinion, the worst sign of a bad face |
| side or lateral potion of the eyebrow and the | | | | lift by an inexperienced surgeon is the |
| upper cheek are lax. However care must be | | | | “Spock ear” or “elf |
| taken to avoid displacement of the hairline | | | | ear” deformity. This occurs when the |
| and injury to the frontal branch of the | | | | ear lobe is fused to the cheek and pulled |
| facial nerve, which if injured can cause the | | | | down to where it looks like the ear is |
| brow to droop. | | | | attached to the angle of the jaw. |
| | | | |
| The Forehead Lift | | | | I have developed a very specific technique |
| | | | for creating a normal looking ear lobe |
| The forehead lift is a procedure I rarely do | | | | following a face lift-check my photos; you |
| since the advent of Botox. Proper use of | | | | will not see the “Spock ear”. |
| Botox can correct most forehead laxity caused | | | | |
| by contraction of the frown muscles and the | | | | Pre OP |
| standard face lift corrects most lateral brow | | | | |
| laxity of the outside portion of the eyebrow. | | | | The pre operative visit is the time when we |
| | | | will sit down and clearly define your face |
| A forehead lift requires and incision within | | | | lift goals. We will discuss what you hope to |
| or at the hairline all the way across the | | | | achieve and what I believe I can achieve with |
| forehead. The results can be excellent if you | | | | your face lift. I will try to give you an |
| are willing to accept the scar. One problem | | | | honest image of what you can expect for a |
| however is that for a long lasting result the | | | | result. |
| frown muscles must be removed and this can | | | | |
| result in a permanent depression or contour | | | | You will also undergo a history and physical |
| deformity in the mid forehead in the frown | | | | exam to make certain that you are healthy and |
| area. In the past the frown muscles could be | | | | have no medication allergies or |
| neutralized through an upper blepharoplasty | | | | contraindications to surgery. An EKG |
| eyelid incision, but again Botox has made | | | | (electrocardiogram) may be done if you have a |
| this operation unnecessary for most people | | | | history of heart problems or have reached a |
| who want to correct laxity of the middle | | | | certain age. You will also be given |
| portion of the forehead. | | | | prescriptions for post operative medications. |
| | | | You also will be asked to read and sign |
| The Mid face or Cheek Lift | | | | surgical consent forms which outline the |
| | | | risks, potential complications, limitations |
| The mid face lift or cheek lift is designed | | | | and expectations of face lift surgery. |
| to tighten the cheeks and help improve the | | | | |
| nasal labial fold lines. This is a | | | | The Operation |
| modification of the face lift which involves | | | | |
| an incision along the crease in front of the | | | | A full SMAS face and neck lift usually takes |
| top part of the ear extending up onto the | | | | me about 90 minutes to 2 hours. If I am doing |
| hairline. | | | | eyelid rejuvenation or 4 lid blepharoplasty |
| | | | at the same operation, as is often the case, |
| The cheek lift or mid face lift is effective | | | | then the surgery can take 3 hours. Mini |
| for people who have laxity in the cheek and | | | | lifts, neck lifts and cheek lifts usually |
| nasal labial fold lines but have no laxity | | | | take only an hour. |
| along the jaw line and neck. | | | | |
| | | | You are asleep during the surgery. I have |
| The cheek lift or mid face lift is becoming | | | | very experienced superb anesthesiologists who |
| very popular among younger patients who have | | | | will be taking care of you. Safety is our |
| early facial laxity in the midface. Cheek | | | | first concern. We use modern, very safe |
| sagging is often the first facial aging | | | | anesthesiology techniques, and take |
| change to occur, and younger patients are | | | | precautions to avoid nausea after surgery. |
| choosing to have a cheek lift or midface lift | | | | |
| before further facial sagging extending to | | | | Following your surgery you will go to the |
| the neck and jaw line occur. | | | | recovery room where a nurse will take care of |
| | | | you and make sure you are comfortable. |
| The Neck Lift | | | | |
| | | | Some patients prefer the comfort of an |
| The neck lift is designed to tighten sagging | | | | overnight stay in the hospital. In this case |
| neck skin below the jaw line and chin. The | | | | I will examine you the next morning, remove |
| neck lift is a good choice for younger | | | | two tiny drains from behind your ear, remove |
| patients who only have loose skin beneath the | | | | your bandage, and have you shower and comb |
| chin and jaw line. | | | | out your hair, and then discharge you. When |
| | | | you go home a small scarf placed over your |
| In some cases the neck lift can be | | | | head and a pair of sunglasses will usually |
| accomplished through a small incision beneath | | | | hide the fact that you have had surgery. |
| the chin which is well hidden. This procedure | | | | |
| is also called a platysmaplasty or corset | | | | For those of you who want to go home the same |
| platysmaplasty. In some cases with more | | | | day after surgery, you will spend about 2 |
| extensive neck laxity an incision behind the | | | | hours in the recovery room with a nurse |
| ear is also required. | | | | taking care of you. As soon as you are |
| | | | comfortable, able to drink and eat a bland |
| The Short Scar Face lift | | | | food such as crackers or cookies, and able to |
| | | | go to the bathroom, you will be discharged. |
| The short scar face lift describes a face | | | | The nurse will escort you by wheel chair to |
| lift performed through an incision which runs | | | | your car. |
| only in front of the ear in the skin crease. | | | | |
| The incision behind the ear and above the ear | | | | We require that someone bring you to the |
| in the hairline is avoided. | | | | surgery center and take you home, and that |
| | | | you have someone staying with you the first |
| Some authors show very impressive results | | | | night after your surgery. |
| showing improvement in face and neck laxity | | | | |
| with this technique. This procedure is | | | | Post op- What to expect |
| effective for younger patients with mid face | | | | |
| laxity and less extensive neck and forehead | | | | My patients do not always complain of pain |
| laxity. The smaller incision is advantageous | | | | following a face lift. Your face and neck |
| cosmetically and should require less healing | | | | will feel tight, which means that I have done |
| and down time. | | | | my job correctly. After a few days the tight |
| | | | sensation will go away as the facial tissues |
| The Mini Lift | | | | relax. If you have had a blepharoplasty for |
| | | | eyelid rejuvenation you will have ice packs |
| The mini lift or mini face lift means many | | | | on your eyes to reduce swelling and bruising. |
| things to many people. Most commonly the mini | | | | |
| lift term is used by patients who want a face | | | | I place a bandage around your face which |
| lift but don’t want to call it a face | | | | comes off the next day and you may shower and |
| lift! | | | | wash your hair on the first day after |
| | | | surgery. I usually place a tiny drain behind |
| To me a mini face lift is a smaller procedure | | | | each ear which is removed the first day after |
| than the standard face lift and is useful in | | | | surgery. |
| patients who have early facial laxity in the | | | | |
| cheek and jaw line who do not have extensive | | | | Bruising on the face is unusual; bruising |
| neck laxity. | | | | when it does occur is usually on the neck and |
| | | | upper chest and is usually minimal and easily |
| Usually I can use a short scar or an upper | | | | covered with make up. |
| scar along the upper portion of the ear | | | | |
| crease into the hairline. | | | | Usually after 1 to 2 weeks you will be |
| | | | comfortable being seen in public and will be |
| The mini lift or mini face lift is a less | | | | back to most normal activity. I ask you to |
| extensive procedure and works well for | | | | wait 3 weeks before heavy weight lifting or |
| younger patients and older patients with | | | | aggressive work outs. |
| minimal facial laxity. | | | | |
| | | | I have you take an herbal supplement called |
| The Lifestyle Lift | | | | Arnica Montana before and after surgery which |
| | | | helps reduce bruising. I also have excellent |
| I include the lifestyle lift here because so | | | | mineral cover up make up to cover any visible |
| many people ask me about it. I only know what | | | | bruising. |
| I read. I have not trained in nor have I ever | | | | |
| done or seen a lifestyle lift performed. I | | | | Consultation with Dr Seckel |
| have seen patients who claim they have had a | | | | |
| lifestyle lift. As advertised the lifestyle | | | | I can tell you a great deal more about face |
| lift is done without general anesthesia or IV | | | | lift and how it would work for you if I see |
| sedation and claims are made that recovery is | | | | you in person. Call me 978-844-3116 or |
| less than a traditional face lift. | | | | contact me by email at If you would like to |
| | | | email me your photos I can email you my |
| The Non-surgical Facelift | | | | thoughts about how I think a Face lift would |
| | | | work for you. For more information on face |
| When most people use the term non-surgical | | | | lift read my blogs on face lift. |
| face lift they are talking about skin | | | | |
| tightening with the various new skin | | | | I look forward to meeting you. |
| tightening machines. Some misuse this term by | | | | |