In the Media

FACELIFT

By Steven Bloch, M.D.

Aging creeps up on all of us-from the shock of that first gray hair, crinkle around the eyes, or sagging of the jowl or cheek. Eventually, our reflection in the mirror begins to remind us of our parents. At first, we put if off to just being tired or overworked. At some point, we can't ignore it any longer, and either we must accept the inevitable or seek the help of a plastic surgeon.

The majority of patients that I have seen over the years regarding a facelift like who they are. They are successful, productive individuals who like their lives. They are optimistic about the future, and they wish to look as good as they feel. They are not ready to look like their parents, but they don't want to look like their children either. In general, I try to reassure them that the goal is to create an ageless look-to look as good as you can regardless of your age.

Facelifts have a lengthy history and have come a long way. Gone are the expressionless, wind-tunneled looks of the past. Today, we strive to recreate younger looking versions of our patients with the least telltale surgical signs as possible.

Every face ages differently. There are numerous conditions that develop with age and specific procedures for each of them. A facelift is rejuvenation surgery that goes beyond just tightening skin. A modern facelift goes beneath the skin to address the deeper structures-superficial musculoaponeurotic system (SMAS)-by repositioning underlying muscles and fat. The direction of tension should be vertical, which gives a more youthful expression and does not distort facial structures. A comprehensive facelift with the most natural outcome will reduce, redistribute, and in some cases add fat to the face.

As we age, fat loosens, descends, and sits lower on the face. The result is the face looks longer and more square in shape. Young faces tend to be more tapered and have more volume in the upper cheeks. Thus, the most important aspect of facelifts is to improve facial shape and restore a more youthful midface.

A facelift is meticulous complex surgery. Each feature of the face must be addressed both individually and as part of the whole. The surgeon must have VISION. This is not something that can be taught. The procedure is tailored to each patient's specific conditions and may include a brow lift, eyelid surgery, or laser resurfacing. In addition, cheek implants, chin implants, and fat grafting may be added to certain areas of the face to refine the results.

The mouth and lips should not be overlooked as this is one area that is critical in creating a youthful face. Volume should be restored when needed. The corners of the mouth may have to be lifted as they often descend with age. The skin texture must be smoothed out.

The final surgical component of a facelift addresses the neck. If the neck isn't right, the patient will not be happy. Through a small incision under the chin, the vertical bands are manipulated and smoothed out. Excess fat is removed and the excess skin is removed surgically with small incisions behind the ears or internally with lasers to promote skin tightening.

Results depend on the anatomy you start with as well as the surgeon. Terrific results depend on the artistic vision of the surgeon combined with technical skills and meticulous attention to details.