Expanding Horizons Symposium – Part 1 of 3 (Face)

This is one of a three-part blog on the highlights of the meeting.

Part 1 of 3, FACE

Facelift and Necklift surgery are performed by many techniques with excellent results. One technique is not necessarily better than the other. Most plastic surgeons are performing “minifacelift” techniques with less aggressive dissections in the right candidates. Patients with moderate to excessive neck skin or muscle banding (platysma banding) in the neck do need full neck and lower face undermining with both skin and muscle work (a “full face or full necklift”). Endoscopic Brow lifting continues to be a workhorse for enhancing the upper third of the face. Blepharoplasty or eyelid surgery needs to be done more conservatively, avoiding excessive skin and fat take-out to avoid a hollow, skeletonized look. It is important to maintain some fullness around the eyes for a youthful look.

Fat injections or volume enhancement with injectables is an important adjunct to skin tightening procedures in facial rejuvenation. It works best with surgery in patients with good skin tone or in patients who have had previous facelifts. It should be done conservatively to enhance the cheek, lower lids, temples, perioral area, and jawline. Overcorrection with fat is a tragic mistake. Fat injections to the face can be unpredictable and require a patient to be at a very stable weight to avoid appearance changes. Many different techniques are used to harvest and inject or transfer fat. Not one technique is necessarily more successful than the other. The fat needs to be injected meticulously and therefore takes extra time in the operating room, which leads to increased costs and potential for much more bruising, swelling, and down time. Expect 50% of the fat graft to reabsorb in the best conditions. Fat transfer to the eyelids is much more risky for uncorrectable lumpy bumpy irregularities and should be done with extreme caution. Hyaluronic acid products such as Restylane, Juvederm, or Belotero are much more forgiving in this delicate area. Patients with a history of Sculptra or Radiesse to the face may not be as good candidates for fat grafting to the face because of the inflammatory and stimulatory nature of these products and the unreliability of fat grafting in these conditions.

Many patients are concerned about the neck. Isolated neck lifts can be performed but results are generally disappointing as the whole point in rejuvenating the neck is to improve the jawline and jowl. Neck lifts alone fall short here. The amount of work and dissection can be the same as a facelift, so patients are probably better off getting the benefits of a lower facelift along with their neck lift. Small access neck lifts with suspension sutures do not work well nor last. Direct excisions of skin under the neck have the potential for visible scars in this conspicuous area. Non-invasive modalities for neck skin tightening such as Ulthera, Thermage, Radiofrequency, and other lasers can offer a 20% improvement in neck skin looseness after multiple treatments with results lasting up to 1.5 years. Future neck tightening surgery can be more difficult in these patients because of the possibility of deeper tissue scarring or inflammation that may affect the ease of the surgical dissection and the mobility of the skin.

How long do Facelift results last?

The majority of patients surveyed nationwide report a high rate of satisfaction with their procedure. The average age of patients undergoing facelift surgery is 57 years. Longevity is reported at 9-10 years. 80% of patients also say they would consider a secondary facelift. The longevity of facelift surgery is quite variable and a result of many factors. Patients who have their surgery at an earlier age have better skin tone and therefore have longer lasting results. However, patients who are older with severe aging may perceive longer lasting results because of their initial dramatic results. Other factors that affect the longevity of the results are environment, lifestyle, restful sleep, weight and weight fluctuations, looseness or laxity of skin, actinic skin damage, medical problems and stress.

Dr. Hayley Brown MD, FACS
Board Certified Plastic Surgeon
Desert Hills Plastic Surgery Center serving Henderson and Las Vegas, Nevada

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