Facelift & Neck Lift

Facelift & Neck Lift

Contents


Introduction to Face & Neck Lifting


The face and neck lift is the ultimate procedure for restoring a youthful neckline, jawline, and cheek. It produces a result that surpasses any nonsurgical treatments. Since people age differently, the lift is customized to the patient. We utilize an assortment of adjunct maneuvers to give each patient the best result possible. Advances in medicine have allowed us to live longer and feel younger at any age. It has done less to prevent our faces from looking older and older. 

Candidates for this procedure often feel a conflict between how they feel and how they look. Often they have noticed a change in the overall shape of the face with facial jowls, excess fat below the chin, and/or loose muscle bands in the neck. Many desire the great improvement they see when they pull their faces up in the mirror. Others have been frustrated with skin tightening lasers and such that, at best, provide a modest improvement. This is not a feminizing procedure so both men and women are candidates.

We use an advanced lifting technique that is truly anti-gravity -- superior to other types of lifts. The anti-gravity direction of pull gives the most natural appearing result. No wind-tunnel or pulled look is acceptable. Moving all the tissue (the midface, lower face, and neck) as one unit is important to preserve their relationships and prevent an artificial look. By elevating sagging muscles and fat pads to their previous youthful position, we help restore volume to the cheeks and around the eyes. This is the deep plane lift. The deep plane lift is a longer-lasting rejuvenation with rapid recovery as short as a couple of weeks. Our technique has been honed over time and provides patients a safe approach to creating a more youthful appearance. 

Approaches & Techniques


Facelift

The facelift procedure pulls the jowl up to its youthful location in the cheek and better defines the jawline. This elevation also carries along the skin of the neck, which improves the neckline. The procedure removes excess skin and soft tissue around the ears, which is key to a lasting improvement. Noninvasive technologies work by shrinking tissue, but only to a limited extent, which is why a surgical lift is still the gold standard for lifting tissue. For some, the idea of a facelift conjures an image of a pulled or windswept appearance. This does not happen when the procedure is done correctly. A modern understanding of the progression of aging and the deep plane technique allow a natural-appearing lift.

Mini Facelift

The mini lift procedure is a smaller version of the face and neck lift intended for the patient who has early jowls and neck laxity. It is not intended for the patient with a heavy jowls, a double chin, or sagging neck bands. This procedure may refine both the jawline and the neckline through similar, but shorter, incisions as the face and neck lift. It also has a shorter recovery, making it ideal mostly for patients in their 40s and 50s with mild facial laxity. This is a procedure may be performed in the office under local anesthesia.

 Neck Lift (Submentoplasty)

The neck lift, or platysmaplasty, is a procedure is designed to tighten the neck through an incision just behind the chin. It is best for patients with neck laxity without jowling and may be coupled with neck liposuction. The procedure does not actually remove excess skin, and so it works best in patients who retain some elasticity in the neck skin (ideally patients in their 30s or 40s). It may be performed in the office under local anesthesia.

Neck or Chin Liposuction

The neck or chin liposuction procedure uses a suction device placed through small incisions to remove fat from the neck. It is the procedure of choice for patients with a double chin. Good candidates have fat below the chin and in the neck without too much skin laxity. In patients with laxity, excess skin may need to be removed with a lift. The procedure may create jawline and neckline definition even in patients who have never had it previously. This may be performed in the office under local anesthesia.

Planning Your Procedure


The Consultation

During the consultation, we really want to get to know you and understand what makes you tick. we will review with you the changes you would like to make and their potential impact on your life. We will also review your medical history and the history of your current concerns. We will examine your face/neck and determine the optimal direction of pull. We will look at other factors such as you your earlobes, lip/cheek volume, and nasolabial folds to determine if you would benefit from complementary procedures for a more balanced rejuvenation.

After the consultation there is a second visit prior to surgery called a "preop". At this visit we will go into much greater detail about how to best prepare for the coming surgery. We offer a wealth of information about optimizing your recovery, ensuring proper healing, resuming normal activities, and avoiding complications.

Duration of Surgery & 
Anesthesia Options

A traditional facelift takes about 4 hours, must be performed in a surgery center, and includes an overnight stay in the hospital. Having a nurse take care of you allows total rest during the first 24 hours after surgery. 

The mini facelift, neck lift, and neck liposuction range from 1 to 3 hours and may be performed with local anesthesia in the office. They may also be performed with general anesthesia at the surgery center, if preferred.

Incisions

Why do we need incisions at all? Years of age-related sagging has created a lot of excess skin. If you have ever pulled your face upward (to simulate a facelift) you will notice that extra skin bunches up above your fingers. This extra skin must be removed, and this may only be achieved at the site of incisions placed around the ears and sideburn. For those tempted to pursue nonsurgical options for lifting tissue, remember that without removing excess skin, one will have to settle for a lesser result. Another reason for incisions: we need to access the deeper tissues because they take on the force of the lift (see How It's Done below). 

The incision starts either along the sideburn hairline or within the sideburn depending on the patient’s anatomy. When a large amount of skin requires removal and/or the patient has a high sideburn, we generally make the incision along the hairline so as to not displace the sideburn upward. In this case, we make the incision at an angle so that the sideburn hair may grow through and help conceal the incision. When less skin requires removal and/or the patient has a low sideburn, we generally carry the incision up into the sideburn hair. In this case, we bevel the incision at an angle that minimizes hair damage, and we maintain the sideburn at a normal position. The incision then continues around the natural curve of the ear before traveling along the edge of the tragus (this is the cartilage above the earlobe that extends backward toward the ear canal). We have found the most natural result comes from an incision placed at the edge of the tragus. Placing the incision deeper into the ear canal will bring unnaturally thick skin over the tragus and placing the incision in front of the tragus risks a visible scar. After traveling down the tragus, the incision wraps around the earlobe at its attachment point to the face. It then travels upward in the crease behind the ear. This portion of the incision is completely concealed. After the incision nearly reaches the top of the ear, it is either carried back into the hair or it follows the hairline downward for a short distance. Similar to the sideburn region, the choice depends upon the amount of skin that will need to be removed and all hairline continuity is maintained. In patients with heavy or more advanced aged necks, we also use a small incision placed in a crease just behind the chin. This incision allows more direct access to neck regions that require liposuction or treatment of prominent neck bands. Poorly placed incisions or displacement of hair will make the best lift look terrible. Our intention is for patients to be able to wear their hair up and not worry about visible incision lines or irregular hairlines. We have many methods to achieve this goal.

How It's Done

Any lift that relies on skin tension is doomed to fail because skin stretches. In contrast, the deeper tissue that holds the lift stretches very little over time. Once we have freed the deeper tissues, we place strong sutures between the loose tissue in the lower cheek and the firm tissue around the ear. This has the effect of pulling everything up. The direction of pull is mostly up and somewhat backward. The tissue is then lifted and suspended in a direction opposite to the pull of gravity, and excess skin is removed around the ears. A proper lift will elevate the jowls, redefine the jawline, and restore a sharp neck line. This procedure is tailored to the patient and may include liposuction in the neck, earlobe reduction, and tissue grafts to the deep smile lines and/or lips.

Recovery

For a traditional facelift, typical at-home recovery time is 10-14 days. For the mini facelift, neck lift, and neck liposuction, typical at-home recovery time is 7 days. Immediately after surgery, the patient wears a compressive dressing for a couple of days. For the following one to two weeks, a chin strap is worn at all times. The sling gives a sense of security by protecting the incision sites and resisting the ever-present pull of gravity until the neck tissues heal and become stronger. Sutures in particular locations are removed at specific times to ensure proper healing. By 7-14 days, all sutures are out and bruising has generally disappeared. Makeup may be applied. Most patients feel comfortable being out in public at this point.

Pain

The first night after surgery, you will feel a dull ache around your ears and tightness around the jaw and neck. Everyday thereafter, any discomfort will reduce significantly. It is normal to take opiate medication as needed up to a week after surgery, but most transition to regular Tylenol within the first week. The feeling of tightness will decrease over the course of weeks.

Swelling & Bruising

Swelling and bruising are normal and expected. Most of it subsides in the two weeks. Most bruising may be concealed with cover-up as it gradually fades. On average, 90% of the swelling subsides by 6 weeks after surgery, and the remaining 10% slowly diminishes over the following months. Eventually all swelling and bruising will go away.

Special Topics


Mechanism of Aging

Genetics, sun damage, and other environmental exposures all lead to progression of fine and deep wrinkles and loss of skin tightness. A natural result from aging face surgery only comes from a deep understanding of how aging occurs and how to properly reverse it. Overall, we all go through a similar aging process that involves volume loss and tissue laxity. Years of facial movement wear down the underlying bone: the jawline thins, the cheekbones flatten, and the eye-sockets deepen. At the same time, our tissue loses its elasticity and various muscles and fat pads begin to sag. Cheek volume descends downward contributing to dark under-eye circles, jowls, and deepening of the folds around the mouth. Lax tissue gathers below the chin, concealing the natural neckline.

The Deep Plane Lift

The deep plane lift is the most recently evolved method of face and neck lifting which involves releasing deeper tissue “ligaments” before lifting tissue. With this technique, we are able move areas of the upper cheek, lower face, and neck tissues as one complete unit in an anti-gravity direction for a more natural result.

The technique relies on an anatomic understanding of a tissue layer of the face called the superficial muscular aponeurotic system (SMAS) and its continuity with the neck muscle called the platysma. Laxity in the platysma muscle contributes to the sagging of soft tissues under the chin.

By releasing deeper layers of tissue and directly suspending them to a higher position, we also minimize tension on the skin. Tension is what makes incisional scars spread apart and become more visible. Tension on the deep layers allows skin incisions to heal better.

Large Earlobes

An often overlooked, tell-tale sign of aging are large, sagging earlobes. Not addressing this will make a lift look incomplete. To reduce the size of the earlobe, a wedge of tissue is removed with the incision concealed in a natural transition point. Also, the attachment point of the earlobe to the face may be modified.

Jowls

Jowls are the lower parts of the cheek that droop below the jawline and deepen the marionette lines. They change the shape of the face from one that is round with an angular jawline to one that is square. This can give the appearance of aging and increased weight. The jowl use to lie higher up in the cheek and the goal of the lift is to put them back there. 

Hollow Cheeks

Hollowing in the cheeks can create a gaunt, aged appearance. Flatness or indention of the cheek takes away from a youthful appearance. With the facelift, we are able to lift the cheek fat pad in a mostly upward but also slightly backward direction to restore its youthful location in the upper cheek. For most patients, this is enough. For others with more significant volume loss, we may also restore bony volume with the use of silicone implants. These implants work perfectly because they are contoured to sit flush with the facial bone – once implanted it is difficult to distinguish implant from bone. The implants are placed through incisions inside the mouth or on the inside of the lower eyelid. These pre-formed implants do not react with tissue and do not change over time. Therefore, in contrast to injectable treatments, they are more permanent, symmetric, and consistent over time.

Loose Neck Skin

Loose neck tissue may conceal the natural neckline. This may look lumpy, hang more to one side, or even tighten with effort. This is often cause by both loose skin and muscle. For some we are able to tighten this with the facelift alone and in others we also perform the neck lift (submentoplasty).

Double Chin

The double chin refers to fat that protrudes from under the chin and looks like a second chin. It often wraps from one ear to the other and completely takes away from the natural neckline. Here, we perform liposuction to achieve a smooth and flat neckline. Small cannulas are passed back-and-forth under the neck skin to pull out fat in a uniform manner. This requires a small incision placed in a crease behind the chin.

Deep Smile Lines & Thin Lips

Deepening smile lines and thinning of the lips is a common feature of facial aging. The lift helps with smile lines to a limited degree by elevating cheek fat directly away from them. Some patients benefit from augmentation of these areas with tissue grafts that act like longer lasting dermal fillers. These tissue grafts are harvested from the areas around the ears that we have exposed for the lift procedure. The tissue grafts are placed into small tunnels created in the body of the lip or under the smile lines. Soft silicone implants are a more permanent option.
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