Facelift

It is rare that a week passes without a prominent newspaper column, magazine article, or TV program extolling the virtues (and sometimes the downside) of cosmetic surgery. The search for longevity and youth pervades our society. We all protest the reminder of the passage of time that we see in the mirror each morning. Most of us age 40 or above have stretched our face and neck skin back with our hands to note what it would look like after a facelift. The following will introduce the reader to the fundamental operation available for rejuvenation of the neck and face commonly known as the facelift or rhytidectomy (face and neck lift).

This patient has also had a browlift and lower eyelid tuck.

BASIC ANATOMY

The facial skeleton determines the basic shape of the face. The shape of your nose, the prominence of your chin and cheekbones, and the height and width of your face are deter­mined by the anatomy of the facial bones. Aside from changes in the teeth, very few of the changes we see in the aging face are due to skeletal changes. The soft tissues overlying this bony framework exist basically in three layers, each of which contributes to aging changes in the face.

The deepest layer consists of the muscles of facial expression. These muscles are arranged around the forehead, eyes, ears, nose, mouth, and neck. All of the movements of the face are due to contraction of these muscles. Stretching and losing tone in these muscles results in sagging of the face. The most important of these is the platysma muscle, which is a thin sheet‑like muscle that extends from the lower neck up to the lower face. In youth, these muscles are tight and give the throat and neck a clean and sculpted look. With the passage of time this muscle loosens and the area under the chin becomes loose and folds appear. These folds are sometimes referred to as the "turkey gobbler" effect. The prominent bands that often exist on each side in the upper front of the neck are actually the front edges of the platysma muscle.

The outermost layer is the skin. As we age the facial skin becomes looser and more wrinkled. This process is promoted by excessive sun exposure and smoking. Your choice of parents is also important because youthful skin definitely is inherited. With time, the elasticity of the skin decreases and becomes looser, just like the elastic in old socks stretches out and actually seems bigger than when the elastic was new and tight. As the skin becomes looser, creases and wrinkles form at the areas of greatest mobility. The areas of the face with the most movement (the eyes, mouth and forehead) show the greatest changes.

The fatty middle layer, lies between the muscular layer below, and the skin above. In youth, the fat was evenly distrib­uted throughout the face. With the passage of time, the fat responds to gravity and is pulled downwards, accumulating in the jowl area and the area under the chin. The fat usually decreases in the cheek area giving a hollow look to the cheeks.

GENERAL FACTS

There is no "best time" for a facelift. In certain individuals with premature aging changes, a facelift may be indicated at age 35. Most patients are in the 40 to 65 age group. However, assuming good health, there is no upward age limit. Although a greater percentage of facelift patients are women, men have become more and more comfort­able with facial aesthetic surgery and are undergoing this procedure. Regardless of gender, the ideal facelift candidate is a healthy patient of normal body weight, with skin laxity of the jowl area and neck. This procedure will help to recap­ture a more youthful appearance. Expectations must be realistic. Facial cosmetic surgery will not make you young again, will not necessarily improve your personal relationships, or your position at work.

Patients who use tobacco products, drink excessive alcoholic beverages, or have had excessive sun exposure in their lifetime have higher rates of complications and may not achieve optimum results.

We are excited to help you through your upcoming surgery. Do not hesitate to ask questions of our staff about any details that are unclear to you. We want this process to be as pleasant and relaxing as possible.