Microscopic Facelift

There are literally over a hundred different way to perform a facelift. The reason for the many different methods is the comfort level of the surgeon and the difficulty in obtaining a beautiful, natural appearance. To get an overview of the standard face lift procedures, refer to asps site.

The goal of the face lift is to reposition the various structures to a more youthful location and tailor the surgery to the patient's needs. What makes facelift such a great surgery is that we have great control to truly make the face more youthful and attractive. However, to achieve this, paying attention to details is of utmost importance.

Face should be addressed with extreme care to achieve the most natural appearance. Too much of a pulled appearance makes face look sterile and expressionless. In contrast, tighter the neck is, the more beautiful it will look.

No matter what the method, I believe there is nothing important than a microspic, detail oriented approach to a facelift.

Surgery is performed either with general anesthesia or under iv sedation. Using a solution made up of local anesthesia and epinephrine, this is injected into the face to minimize bleeding. Incision is made starting inside the hair above the ear, in front of the ear, behind the cartilage of the ear, and around the ear to the hairline in the neck.

The skin is not lifted up much, but a layer of tissue called the SMAS/platysma is elevated extensively. This is used to re-elevate the facial structures and reposition the tissues to it/s more youthful location. This ensures more natural appearance.

Microscopic Facelift refers to numerous details of the surgery that ensures beauriful result:

• Incision has to be precisely perpendicular so that there is good approximation during closure. This ensures hardly noticeable scar.
• Near the cartilage portion of the ear, the skin has to be cut thin so that the area appears more natural.
• Skin undermining should be minimal to ensure smoothness and less disruption of blood vessels so that there is faster and better healing
• The SMAS/Platysma tissue should be extensively undermined to reposition tissues
• There are tissues called retaining ligament which prevents tension free tissue movement. These must all be completely released. They are located along the malar bone, cheeks, along the jawline and chin areas. By releasing these ligaments, we have the freedom to reposition many droopy tissue in more youthful location
• For people with wrinkles along the side of the eyes, the muscle can be transected to weaken the lines.
• For people with nasojugal groove-a line beneath the malar bone and the cheeks, the malar fat pad must be separately elevated and suspended.
• Patients with heavy nasolabial fold, should undergo careful liposuction over the malar fat pad.
• Patients with heavy jowls, should also undergo careful liposuction of the overlying fat. Also, the retaining ligaments of the jawline must all be released to the chin area.
• Patients with wide lower third of the face who wishes for a slimmer look can benefit from removal of the buccal fat pad.
• For some areas that are depressed, SMAS can be folded upon itself to augment certain areas such as submalar region.
• The corner of the mouth line can be treated by good elevation of the SMAS in a upper direction
• Corner of the mouth can be elevated to give patient a more fresher appearace.
• For people with heavy fat neck, the neck must be very aggressively treated. Not only is the Platysma/skin pulled from the sides, but also from the middle. A small incision is made in the natural crease under the chin. Through this area, the fat underneath the skin is removed. Also, there is a fat layer underneath the platysma muscle called the subplatysmal fat pad which should be removed. Then the platysma can be tightened both from the middle and sides.
• SMAS that is trimmed during surgery can be used to augment areas that are depressed. Some of the more common areas are submalar region, nasolabial fold, and lips.
• All of the pulling tension is placed on the SMAS layers. The skin is allowed to just redrape. This ensures smoothness of the face and good scar healing.
• Constant reference to the preoperative photographs to ensure accuracy and symmetry.

These are some of the examples that must be considered on all patients. This kind of approach to all facelift ensures not just better aesthetic results, but also more natural appearance of the face.

There are many new "technology" that claims to rejuvenate the face. There are some benefits and downside to all of these approaches. However, if a patient wishes for a more definitive and dramatic rejuvenate, none can match a beautifully performed facelift.