It was just under a century ago that a few maverick surgeons in Europe performed the first facelift procedures. These pioneering operations consisted of little more than making an incision around the ear and removing a strip of skin. Facelifts have come a long way since then.
What is a state-of-the-art facelift in the twenty-first century? How has the procedure evolved? A brief review of the history of facial rejuvenation surgery will help us understand the advances that patients benefit from today.
For the first fifty years of its history, the facelift hardly progressed at all. Improvements in anesthesia allowed surgeons to remove more skin around the incision and pull the rest of the skin tighter, but that was about it. Then, in the 1960s and 1970s, surgeons began to realize how limited these primitive techniques were for correcting all but the earliest signs of aging. The skin is an elastic structure. When pulled tight it stretches, but only to a point. After that, it loses its elasticity and droops, leaving unsightly folds and stretchmarks. Any improvement in appearance from those early facelifts was short-lived.
Another serious problem confronted surgeons when they tried to correct advanced signs of aging. Lifting the face required rotating and repositioning the skin to such an extent that it distorted the facial features and displaced the hairline. The resulting mask-like, "overdone" look was a dead giveaway. Unattractive and unnatural-looking, facelifts were easily spotted for what they were.
Surgeons had to look deeper for a solution. They began to explore safe ways to repair the deeper, inelastic foundations of the face--the underlying muscle, fat, and connective tissue. Once this foundation was restored, they discovered, the skin would redrape naturally, without any rotating or pulling. The result was a longer-lasting, more natural-looking lift.
That brings us to the present. What are the key factors that characterize a state-of-the-art, "totally natural" facelift?
The surgery is extremely safe, without risk of nerve damage, skin loss, or more severe consequences to the patient's health.
For this, the skill and the judgment of the surgeon are paramount. A prospective patient should select a plastic surgeon with the same diligence and care used in choosing a brain or heart surgeon. [Click here to read “How to Choose a Plastic Surgeon or Dermatologist.”] The surgeon, in turn, must carefully assess the patient’s goals and expectations; in other words, their suitability for the surgery.
Advanced anesthesia practices have made facial surgery one of the safest procedures in medicine. Many of these operations are now done on an outpatient basis, under "twilight" sedation [Click here to read “Anesthesia and You.”] Having a highly skilled surgeon-anesthesiologist, a certified facility, and a healthy patient lowers the risk of serious complications to nearly zero.
New surgical techniques and the advent of high-tech suture materials like Gore-Tex, the gold standard for vascular surgery, have revolutionized the process of tightening the deep facial foundation. It is no longer necessary to cut under the facial muscles near the nerves to restore this critically important layer. This new, soft-suture technology allows plastic surgeons to achieve long-lasting results while protecting the motor nerves that control facial expression. The incisions are almost invisible and the result so natural that the patient looks ten or more years younger, without it being obvious that surgery has been done.
The "short-scar" facelift has all but eliminated skin loss and visible scars. This technique preserves a great deal of the blood supply to the skin, greatly reducing post-operative swelling and bruising, and shortening the recovery time. The short-scar approach hides the lateral temple- and brow-lift incision in the hairline. Unlike a traditional facelift, it does not extend the incision around the ear into the hair behind it. This allows the surgeon to avoid the important blood supply in that area and makes it possible for the patient to wear her hair pulled back in a ponytail, without a visible scar.
One way the surgeon hides the incisions is by making sure that the skin is never pulled, rotated, or sutured under tension, and that only the excess skin is carefully trimmed. Short, cleverly concealed incisions closed with no tension seldom result in scarring. Since the lifting work is done under the skin, in the deep foundation layers, there is no distortion of the facial features.
All aspects of the aging process are corrected to the greatest degree possible, from the surface appearance of the skin to the deepest aging changes, and from the brow to the collarbone.
The third principle is that of total correction--addressing every aspect of the aging face, from the fine lines, wrinkles, and discoloration on the superficial layer to loss of volume and looseness of the skin and deeper layers. To accomplish this, plastic surgeons have adapted many techniques that evolved in other surgical specialties. The endoscope, a tiny magnifying device commonly used in laparoscopic procedures like gall bladder removal and microscopic knee surgery, allows the surgeon to lift the brow and tighten "neck bands"--folds in the skin of the neck--through very small incisions that heal rapidly and produce long-lasting results.
Another tool plastic surgeons have adopted is the carbon dioxide (CO2) laser, widely used in gynecology and in ear, nose, and throat (ENT) surgery for areas in which making incisions with a scalpel would be difficult. Dermatologists found that by defocusing and pulsing the laser beam, the CO2 laser could be used to resurface the skin. The laser removes fine lines, sun spots, and capillaries that cannot be addressed by facial tightening alone, and the new collagen produced after treatment is as youthful as that of an adolescent's. Laser resurfacing also offers a non-surgical way to refresh a facelift years after the original procedure, with exceptional results.
Facelifts today are far more enduring than those achieved by simply pulling the skin, and the recovery period is short and comfortable.
The key words in twenty-first century facelift surgery are "simplified," "rapid recovery," and "long-lasting." Though the repairs are better than ever, surgeons can make them with the least amount of trauma to the anatomy. This translates to more effective work in less time, with minimal risks.
Less invasive surgery also means that recovery time is shorter. Younger people can now enjoy the benefits of rejuvenation without a significant interruption of their lives. Even when advanced aging requires extensive correction, the patient often can return to an active social life in ten days to two weeks.
But do these state-of-the-art facelifts last? The answer is yes. Despite the fact that the surgery is shorter, safer, and less invasive, the results are far more natural and enduring. How long a facelift lasts varies with the individual, but if the rejuvenation procedure is done when aging changes are evident, but not pronounced, the result may last as long as ten years--or even longer in some younger patients. Traditional lifts didn't come close to this. Better understanding of the aging process, coupled with micro-technology and hidden incisions, mean that it's possible to address problems when they first become apparent and to target specific areas like the upper or lower eyelids, or the neck. Making these corrections early, with inconspicuous incisions, serves multiple goals: It restores youthful facial harmony, postpones or eliminates the need for more comprehensive facelift surgery, and allows patients to return to active life after less than a week.
Today, we no longer need to postpone procedures that will make us look younger longer. "Sequential correction" serves as an effective maintenance program, allowing surgeons to make natural-looking improvements that earn patients compliments on how youthful and vital they look. In the new millennium, the term "middle age" is rapidly becoming obsolete. We're productive longer and, thanks to state-of-the-art procedures, we can look our best "naturally," whatever our age. |
