A facelift is what people think of first when they envision facial plastic surgery. It is the ultimate in surgical rejuvenation for a more youthful face. The true facelift addresses the lower two-thirds of the face. Some actually prefer to call this a "cheek-neck lift." More than any other procedure, it can restore a more youthful, refreshed face. A facelift is often combined with other procedures such as blepharoplasty and browlift for a "complete" look. Depending on your needs, younger patients may be candidates for the newer "short-flap" facelift. Older patients who require more facial suspension are better candidates for a deep plane or a bi-planar extended SMAS facelift.

Place your hands along the middle part of your jaw with your index fingers pointing upward and thumbs under the jaw and pull gently toward your ears.If you like the result, then you may be a candidate for a facelift.

facelift endoscopic browlift and blepharoplasty

As the facial muscles and skin weaken, facial tissue sags and jowls form along the mid-jaw. Skin may droop under the chin, creating a "turkey gobbler" deformity. (Believe it or not, this is actually the commonly-used term medical jargon!). The cheeks also descend causing deepened nasolabial folds (folds running from your nose around the mouth) and thinning of the mid- face. These conditions are all best corrected by a facelift.

facefront view

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What is the best age to have a facelift?

There is no "proper" age for a facelift. When performed at a younger age the results last longer because there is more elasticity in the tissue, but the time ultimately depends on when the patient is ready for the procedure. The operation is simpler and lasts longer on patients in their early 40s due to better elasticity but can be performed as late as the 70s. However, one should not wait too long to get a facelift. As the skin becomes less elastic and deeper lines form, it becomes harder to achieve a natural appearing looking result.

Facelift Procedures

There are a number of variations of the facelift:

	The newest technique is the “short flap” facelift. For younger patients, the lower face and jowls can be rejuvenated by an incision that begins just above the ear, goes inside the small rectangle called the “tragus,” and stops just behind and above the earlobe. This incision, once healed, is almost undetectable. The short flap facelift is best suited for younger patients with only a little excess neck skin.
	The midface lift, when performed alone, may accomplish cheek elevation when the neck and jowls do not need lifting.
	For patients who need elevation of the neck skin and heavy cheeks, one very reliable technique is the deep plane facelift. In this procedure, the incision begins either in the hair of the temple or behind the sideburn tuft. In front of the ear it is the same as in the short flap lift, but then continues, hidden in the hair behind the ear.
	Excess fat under the chin and thick muscle bands in the neck, when present, are approached through a small incision under the chin.
	After the skin is lifted, the underlying muscular/fibrous tissue called the SMAS (see below) is repositioned and tightened upward and backward. SMAS advancement is the maneuver that actually gives longevity to the facelift operation. The SMAS is pulled tightly to give a youthful face, allowing the skin to be gently “re-draped” without looking pulled.
	Discoloration may remain for two to three weeks. Most patients can resume normal activities as soon as two weeks following surgery. However, minor swelling may persist for a few months, especially with the deep plane facelift.
What is the SMAS? The SMAS (superficial musculoaponeurotic system) is a thin sheet of muscle and fibrous tissue (called fascia) that lies under the skin of the face. It continues into the neck as a muscle called the platysma. This strong layer separates the overlying skin from the delicate glands and structures of the face and neck. The SMAS can be elevated and pulled in different directions than the skin of the face for a natural post operative appearance.
A newer, even more dependable facelift technique is called the bi-planar, extended SMAS technique, where the SMAS muscle layer is elevated as far as the deep plane facelift. The difference here is that the skin is separated from the SMAS so it can be smoothed more naturally and gently, while the SMAS muscle beneath is pulled tightly to give a natural, longer lasting result.
What about this new “suture” or thread lift?
There is a new procedure that uses tiny sutures with barbs to lift the sagging skin of the face and neck. These procedures have been embraced by non-surgeons as a technique to perform almost surgical facial rejuvenation without making surgical incisions. However, if the sutures are placed too superficially, the barbs may become visible. If they are placed too deep, there can be effects on the nerves of the face.
Dr. Pearlman has reviewed this procedure and feels that the results are not yet consistent enough to use for his patients. Current publications and presentations rarely show patients more than two or three months after the procedure. Plus, those patients are selected by the presenters. We feel that before using this procedure on our patients, there should be a study showing consecutive patients at least a year later. So, if you really need improvement of your jowls and/or sagging neck skin, a facelift is currently still the best procedure.

Since there are a number of present day options for facelift techniques, results are more natural than ever before. The pulled or windblown look can be avoided by choosing the appropriate facelift approach for each individual patient.




Liposuction of the Neck


Liposuction of the neck is for patients with excess fat under the chin to produce a more sculpted, angular and youthful neck and jaw line. The best patients for this procedure have good skin tone. Neck liposuction does not tighten the skin, however in younger patients the skin adheres to the underlying neck following the procedure, which can improve loose skin.

neck liposuction

In most patients over 50 with loose skin - a facelift to tighten skin and underlying muscle may be a more appropriate procedure. Other procedures to enhance neck liposuction may include sub-mentoplasty to tighten the muscles. Better neck contour may also be obtained by chin augmentation to improve the profile.

Liposuction is performed under local tumescent anesthesia with sedation. One tiny incision is made under the chin and behind each earlobe. Fat is removed with small suction cannulas. A soft chin supporting garment is worn for 5 days following the procedure.

Otoplasty

Otoplasty is a surgical treatment for protruding ears. This is one of the few cosmetic procedures that can be performed on children. There are generally two problems with protruding ears: lack of formation of the "anti-helical fold", which is the upper arm of the "Y" on the top part of the ear. The other deformity is an excessively deep cup of the ear called the "conchal bowl". Otoplasty helps create or deepen the anti-helical fold. The conchal bowl can be made less shallow as well as the otoplasty is individualized for each patient. Otoplasty is accomplished through an incision that is hidden in the crease behind the ear.

Otoplasty can be performed on children as young as 6 years old. Their ears are 90% of the adult size by that age. They are also starting to socialize in school and may be subjected to teasing. By 6 years old, they are aware of the reasons for surgery and able to participate in that decision. For children, otoplasty is performed under general anesthesia. In adults, local anesthesia with sedation is used. Otoplasty is well received by patients. It's heart warming to see the look on a child's face when the bandages are removed 5 days following surgery and they no longer have "dumbo ears".

Another reconstructive procedure that Dr. Pearlman performs is auricular reconstruction for microtia. This is a creation of a "new ear" in a child born without one or both ears. Cartilage from their own rib or a synthetic framework is used in a series of operations.

Questions? Contact Dr. Pearlman about Facelift and Otoplasty Procedures.