Face Lift

Before & After

When the term face-lift is brought up, many people think of a skin tightening procedure. This, in fact, used to be true up until about 10 years ago. At that time plastic surgeons began serious evaluation of the causes of facial aging. What has been discovered is that skin stretching over time is only a small part of the aging process. Other factors have been found to be the major contributors. Facial rejuvenation requires that all the contributing factors be corrected in order to produce the most aesthetically pleasing, natural result. The fruit of this research is that face-lifting is much more predictable and effective at re-creating the youthful appearance we once had.

Dr. Cruise has been actively involved in investigating the causes of facial aging. It is not enough to just tighten skin. This can create an unnatural look and certainly does not re-create the full, glowing look of youth. The easiest way to describe this is to look at the cheeks of a baby. They are full of fat. In today's society fat is considered a bad thing but nothing could be further from the truth in regard to facial rejuvenation. In fact, it is the descent and/or loss of facial fat primarily and other factors secondarily that causes the characteristic look of facial aging. See the aging woman below.

Aging Face

If you look at any model, male or female, you will see high cheeks that are full of fat. Now, look at an older person. You will see that this facial fat has fallen from the cheek area and now is located in the fold above the upper lip and in the jowl area at, or even below, the mandibular border. The results of facial aging are quite predictable but only a small part of it is because of skin stretching.

Youthful Face. Cheek fat is just below the eyes.

Notice how cheek fat descends with age. This gives a gaunty look to the eyes. It also enlarges the naso labial folds just above the lips and creates jowls at the jawline. The once elegant triangular face has fallen creating an aged rectangular look.

Aging Face

It is a very exciting time in plastic surgery because we are just beginning to solve the puzzle of facial aging. Even though facial aging affects the entire face and neck, sometimes a patient is really only concerned with a particular area such as the neck. In this situation, only that area needs to be addressed. This is an excellent way to approach facial rejuvenation. You should only have corrected what really bothers you. You can always come back and have other things done.

Dr. Cruise's technique for face-lifting addresses ALL the causes of facial aging. It is not a skin pulling procedure that is commonly practiced. Primarily, it involves elevating the facial fat that has fallen into the upper lip/cheek fold and into the jowl area. This fat is then suspended back up to the cheek area where it should be. This has a three-fold effect. It helps to reduce the prominent upper lip/cheek fold and also re-creates a fuller cheek area similar to that of youth. In addition, elevating the fat from the jowls defines the mandibular border. This effectively widens the face at the cheek level and narrows it within the jaw area. By doing this, an elegant triangular shape is recreated. Look at an attractive young model and then at a person with obvious facial aging. The youthful model will have a triangular shape whereas the face of the older person will have a more rectangular shape. Dr. Cruise has developed sophisticated techniques to recreate this triangular shape without an operated look. This is done by re-suspending the cheek fat and muscles. Then redraping the skin gently so that it does not look tight or unnatural.

46 year old woman. Notice improvement of jowling, jawline, and neck.

As far as the neck is concerned, Dr. Cruise has developed a unique technique utilizing suture suspension to elevate the tissues of the neck. This dramatically tightens the hanging skin and eliminates the banding under the chin that is so common with aging. This creates a neck with a high, sharp angle above the Adams apple like that of youth. This is discussed in more detail within the neck-lifting section of this web site.

The results of face lifting and neck lifting are quite dramatic. They can easily take 10 to 20 years off of your apparent age. You must, however, understand that the aging process never stops. So, eventually the procedure may need to be repeated in 10 to 15 years. Some people say, Why bother? For them, it doesn't matter. But for most people, if they can turn the clock back 10 to 20 years, it has a huge impact on their state of mind and subsequently quality of life.

Dr. Cruise's philosophy regarding Face Lift

The world of face lifting has undergone dramatic improvement over the last ten years. In my hands, it has become more art and resuspension of fat and less skin tightening. After reading the above sections you already understand that facial aging is actually a very complex process. It involves primarily the descent of facial fat and muscles and secondarily stretching of the skin.

When you come in for consultation with me, you will have digital photographs taken of your face in five different directions. We will review the pictures together so that I have a clear understanding of what it is that you would like. I will go over the process of face lifting and what is and what is not possible.

The key to the way I do face lifting is to make sure that the facial fat that has descended over time is repositioned back to where it was during youth. The overview section outlines exquisitely how facial shape changes from an elegant triangular shape in youth to a more rectangular shape as we age. I strongly recommend that you read this section.

In closing, I would like to stress three critical points that you should understand before undergoing face lifting. One: Make sure you go to a board certified plastic surgeon that does at least 20 face lifts a year at a minimum. Two: Be realistic. A good face lift can dramatically improve your appearance but it will not make you someone you are not. Three: Be prepared for significant swelling especially for the first 2-3 weeks. It takes at least 6 weeks for the majority of the swelling to go away.

Benefits

The benefits of face lifting are numerous. As mentioned above, the effect of 'turning back the clock' is profound in terms of state of mind and quality of life. The results can be summarized as follows.

• Elevates fat that has fallen down to the fold above the upper lip and back into the cheek area.
• Elevates fat in the jowl area and also back into the cheek area.
• Markedly reduces facial wrinkles and excess skin.
• Markedly improves the fold above the upper lip known as the nasal labial fold.
• Markedly reduces jowling or the hanging skin at the jaw line.
• Creates a youthful, triangular facial shape.
• Can address neck without touching the face or vice versa to accomplish the desired results.

Possible complications

The most common complication after face lifting is inadequate resuspension of the facial tissues. The cause of this is usually because the facial fat has faded away with time so that it is not available for resuspension. In this case, it may be beneficial to transplant fat into the areas where it no longer exists. This is rarely necessary. Other risks include asymmetry, nerve injury, infection, blood and fluid collection, and unfavorable scarring. A list of possible complications is provided by the American Society of Plastic Surgery and this will be discussed and given to you during your consultation.

Are you a good candidate?

No one is immune to facial aging. It is true, some ethnicities tend to age slower, but the descent of facial fat and muscles, as well as the stretching of skin, occurs in everyone. If it bothers you, you should have something done. If you look at your face and think that you look older than you feel, this may actually make you feel older somewhat like a self-fulfilling prophecy. Good candidates include those with the following.

• Jowling or fat accumulation along the jaw line.
• Markedly pronounced fold above the upper lip otherwise known as nasal labial fold.
• Saggy facial skin.
• Deep facial wrinkles.
• Deep circles underneath the eyes.
• Loss of cheek fat.
• Loss of youthful look.
• Corners of mouth have fallen down.

The candidates for neck lifting are referred to the neck lift section.

It should be mentioned that face lifting does not improve the texture of the skin. This is best managed with chemical peeling or laser skin resurfacing which would be done separately from the face lift.

Prior to surgery

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask Dr. Cruise for something to help you sleep.

• Smoking. It is imperative that you do not smoke within 3 weeks before and after any surgery but especially so for face lifting. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood for infection, wound healing problems, and scar formation. It also affects your airway, therefore, making anesthesia much more difficult.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. Please discuss all medications with Dr. Cruise and the anesthesiologist.

• Washing. It is important to thoroughly wash your face and scalp the morning of surgery. Do not forget to wash inside your ears just like your mother told you. After washing your hair, comb it straight back or straight down. Do not apply any clips or rubber bands. Do not apply any make up or hair spray.

• Arrival. It is best to arrival on time so things go smoothly. Please be sure to have someone else drive you.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly anxious. Excessive worrying can actually be detrimental and you should discuss this with Dr. Cruise prior to surgery so that something can be prescribed to make sure you remain calm

Consultation

• Temple: Crow's feet, droopy skin
• Cheeks: Loose/hanging skin, loss of cheek fullness, large nasolabial folds
• Jaw line: Jowling, loss of jaw line definition.

Common Complaints with the Aging Face.

Ideal Facial Shape

• Temple
  • Smooth without a hollow
  • No wrinkles when not smiling
• Cheek
  • Full with the most prominent point just under the lateral eye
  • No nasolabial fold when not smiling
  • Smooth when not smilin
• Jaw Line
  • Border should be clearly visible without jowling
  • Triangular in shape

• Temple

With aging, facial fat either descends or goes away, or a combination of both. In the temple region this causes a sunken area characteristic of aging droopy skin also is a result. Crow's feet with smiling are not uncommon and are acceptable as long as they are minimal. Permanent wrinkles and/or deep lines during smiling give an aged appearance. A face lift will elevate some of the descended temple fat as well as smooth out the wrinkles. Wrinkles with smiling will not be eliminated but should be improved. Concurrent brow lift and/or lower blepharoplasty may be necessary to treat significant crow's feet.

Droopy Temporal Region. This is not corrected by face lift alone. This patient had temporal brow lift and lower blepharoplasty.

• Cheek

Similarly, facial fat in the cheek descends or goes away. As it falls it bunches up just above the nasolabial crease giving the typical fallen face appearance. During your consultation, your plastic surgeon will pinch this area and elevate the fat upward, thus, simulating a face lift. During a face lift, the surgeon will reposition this upward by 1 of 3 methods.

Before and After Facelift. Notice cheek elevation and improvement of cheek folds above the lips.

The Three Most Common Face Lift Methods

1. Subcutaneous Face Lift. The skin is undermined to an appropriate level determined during the physical exam. The skin is then advanced laterally and slightly upward to put it back where it was during youth. This effectively tightens the skin and smoothes out the facial contour. Care is taken to put all the skin tension above and behind the ear so that there is minimal tension in front of the ear itself. This avoids an operated look.

2. Subcutaneous Face Lift with Fat Suspension. This is a Subcutaneous Face Lift but in addition the descended fat is elevated back into position with sutures.

3. SAMS Face Lift. SMAS is an acronym for Superficial Musculo-Aponeurotic System. It is a fibrous/muscular layer under the skin. Above it lies the cheek fat. Below it sit the facial muscles that animate the face. A SMAS face lift will elevate the SMAS and thus, concomitantly, elevate the facial fat and muscles.

Like the cheek, your plastic surgeon will evaluate your jaw line by pinching the soft tissue on top of it and elevating it to see what is the best treatment. Jowls are a combination of fat and SMAS that have descended with age. During a face lift this tissue is re-suspended back into the cheek area where it belongs.

Before and After Facelift. Notice elimination of jowls and jaw line definition.

 

Typical Face Lift Incisions

Typical face lift incision.

Variations in Front of the Ear

Variations Behind Ear

No Posterior Ear Incision. Dr. Cruise utilizes this so that hair can be worn up and no incision can be seen at all behind the ear.

Dr. Cruise's Normal Incision

Dr. Cruise utilizes the above incision. Above the ear, the incision is within the hairline, it then goes retro-tragal. Dr. Cruise is usually able to avoid a posterior ear incision so that hair can be worn up without any visible scar.

Anesthesia

ICRS uses only board certified anesthesiologists to make sure you have the best anesthesia possible. The anesthesiologist will discuss with you what type of anesthesia is best for you. He/she will take into consideration your medical history, the procedure, and your personal wishes.

General anesthesia is usually the best type of anesthesia for face lifting.

After the procedure

The procedure itself will take about 3 to 4 hours but may take longer if other procedures are also being done.

Immediately. Right after the operation you will be watched for 1 or 2 hours and encouraged to walk around. Dr. Cruise is a strong advocate of good pain relief so you will be given as much pain medication as necessary both immediately after the operation and for the postoperative period. Of course, there will be swelling and bruising but there is surprisingly little pain. You will have a big head dressing on as well as ice packs to help keep the swelling down. You must not lay with your head down for the first week so that your face does not swell.

That evening. It is recommended that you take it easy. You can walk around, eat, but not too much more. You must sit and lay with your head up on at least 3 pillows. You should take as much pain medication as necessary and try to go to sleep early. Apply ice packs every 2 hours for the first 24 hours. You will be given medication to help keep the swelling down as well as to prevent infection.

First 48 hours. You can take a cool shower the next day. Just be gentle. Let the cool water run over your scalp. It is important to have someone help you shower. Your hair will be a disheveled with possibly some blood in it. Apply a generous amount of conditioner first to untangle your hair and then wash your hair gently. Reapply a generous amount of conditioner and then comb your hair straight back. Be careful as the comb may get caught up in the sutures or staples. The incisions will continue to ooze for about about 3 days.

Beyond. Swelling will not completely resolve for about 6 months but, as mentioned above, the majority of it will be gone by 3 weeks. Skin contraction will not start until about 4 weeks after the procedure and will continue to contract until about 6 months. The final result will not be evident until 6 months when all the swelling has resolved and skin contraction is complete but you will certainly notice a significant improvement right away. It is critical to understand that face lifting will have significant swelling for the first 3 weeks. Do not get frustrated with the swelling as it just takes time to go away.

Recovery time

The majority of the swelling and bruising will resolve in about 3 weeks. Complete resolution of the swelling takes about 6-8 weeks. Most people return to work in about 3-4 weeks.