By Dr. Mark E. Richard

Direct inquiries to: ageless@attractive.com

www.drrichards.md

As people age, the effects of gravity, exposure to the sun, and stresses of daily life can be seen in their faces. The face undergoes changes in its deep structures. There is a downward descent of the facial fat and skin, which creates a "fallen" look. As this fat slides, it comes to rest at natural roadblocks in the face, such as the creases by the nose and mouth, along the jaw line, and in the neck. The result is a deepening of the lines by the nose and mouth, a flattening of the cheeks, and the formation of jowls (the deposits of fat that appear along the jaw line). Changes in the neck and eyes also occur, including the accumulation of fat and loose skin, as well as a loss of crisp facial angles. Muscles weaken, contributing to an aged, tired appearance. Since the signs of aging are caused by changes in the deep structures of the face, reversing those changes should be the surgeon's priority in restoring a more youthful look. By repairing muscles and restoring the underlying structures that give each face its unique identity, patients can achieve a refreshed look without exaggerated skin tightness.

Contrary to popular belief, a facelift does not get rid of skin wrinkles. The skin of the face is separate from its structure. While the facial skin is re-draped and tightened during a facelift, the procedure cannot eliminate skin imperfections. Tight pulling of the skin will not smooth out acne scars, wrinkles or hollows. It will only place undue tension on the skin and distort facial features. Skin treatments such as microdermabrasion or laser resurfacing improve skin quality and can be performed before or after a facelift.

Nor does a facelift correct aging of the entire face. Each plastic surgery procedure only addresses a single area of the face. Surgeons naturally divide the face into 3 zones for evaluation purposes. The forehead, eyebrows and upper eyelids comprise the upper face, The lower eyelids and cheeks are labeled the mid-face. And the lower face begins at the mouth and includes the jaw and neck. A facelift will only correct aging changes in the lower 1/3 of the face. Additional procedures, such as a cheeklift, blepharoplasties or browlift, are required to refresh the remaining areas of the face.

There are also many other misconceptions about facelifts, which are due to outdated techniques, poor surgical planning or poor surgical execution. People are afraid of conspicuous scars, baldness, altered hairlines, distorted features, nerve damage, and a mask-like appearance. With careful surgical planning, good communication and careful surgeon selection, these pitfalls can usually be avoided. Most patients can achieve their goal of looking better without betraying that surgery was performed. The goal of facial surgery should be to restore the facial structures to a desirable position and offer a more youthful look with artificiality. A patient should look refreshed, not altered, and with no traces that a surgeon was at work.

Careful placement of incisions is critical. Many surgeons place noticeable incisions on the face and unnaturally raise the hairline high into the scalp to perform a facelift. A more discrete placement of incisions eliminates this concern. Incisions can follow the sideburns and hairline so that there is no hair loss and no need to change your hairstyle to disguise surgical incisions. And, instead of straight line incisions on the cheek in front of the ear, incisions should follow the natural curves of the ear. Such incisions heal well, blend easily and do not attract visual attention.

In a well executed facelift, the majority of work is performed on the structures beneath the skin. There are many layers beneath the skin which give the face its unique look and personality. Each layer must be adjusted appropriately and in relation to its neighboring structures to provide a pleasing result. By repositioning these structures in their proper position, the architecture, natural shape and the curves of the face are restored. Then, the excess stretched skin is removed and the skin is gently redraped over the face. Many patients confuse this comprehensive structural facelift with a "skin-only" facelift. When the skin is pulled to "refresh" the face, none of the underlying structures have been adjusted. Distortion of facial features and a pulled, mask-like appearance are the hallmarks of such a quick-fix facelift. Through exaggerated skin tightening, the face is flattened but not rejuvenated. And, since the skin will always stretch again, these "skin-only" facelifts are of very short duration. Since there are many different types of facelifts, make sure you understand what your surgeon is planning in order to refresh your face.