Plastic Surgery FAQ
Frequently Asked Questions
- Are there alternative treatments to facelifts?
- Does experience “count” in facelifting?
- What Kind of Facelift Do You Do?
- How can I tell which lift is right for me?
- Is imaging helpful to understand how I might look?
- What is a “Deep Plane” Facelift? What are the advantages?
- What is a SMAS and High SMAS Lift?
- What is your usual “Masterlift”?
- What is a “Mini-Lift”?
- How long is the recovery period? Is it different for different facelift techniques?
- Where are the incisions? Will anyone see them?
- What is meant by “Gravitational Descent” and “Volume Loss”
- How can I tell if I have volume loss or gravitational descent?
- How does our face age?
Yes, modern skin tightening devices (RF, lasers, ulthera, etc.), fillers, and suture techniques often can “put off” a facelift for a number of years. We have more of the modern equipment than anyone on the West Coast, and can match your treatment to your needs. For most people, the inevitable cannot be avoided forever, and aging often occurs suddenly, particularly for women, around age 45-60 years old.
Facelifting is one of the areas where experience counts the most. Faces have hundreds of variations and many different skills (hair transplantation, anatomy knowledge, surgical breadth, etc) are involved. This is a technique where the surgeon with a little age and more experience “shines”. Both the volume of cases that a surgeon performs and the number that he has performed over the years add up to a “practice”. Long term follow-up of a surgeon’s results give he or she the ability to use techniques which yield the highest success rates with the lowest number of problems.
While we have branded our facelifts with “Masterlift” (our complete facelift), “96 Hour” (a minimally invasive cheeklift), “Minilift” and the like, I feel that these brands need more explanation. In fact, we do not use one type of facelift to achieve our characteristic “natural, effective, and long-lasting results”.
We have many different techniques and incisions, which we individualize for each patient. This allows us to obtain a natural, effective facelift that, with a high degree of safety and speed of recuperation is among the best in the industry. To describe all of these would take a textbook, as it reflects our 35 years of experience, teaching fellows as a professor at UCLA, and editing textbooks and journals. Still, it is worthwhile to present several common alternatives.
Contact our office and we will set aside time to discuss your particular interests and situation. If you are from a distance from our Santa Barbara or UCLA offices, we may be able to review your pictures and give you an idea of what might be possible to achieve (though personal consultations will be required prior to surgery).
Imaging is “art”, and is a form of communication. The end results may not be what the image portrays, but it helps to define goals. We have a licensed PA (physician’s assistant) on staff who has 30 years of plastic surgery experience, and is also a professional photographer. He can help you explore the goals that you would like to achieve.
A deep plane facelift lifts the skin and underlying muscle structures in one layer. Because the skin and muscle are not lifted in separate layers, the end result is usually more even, without “swoop lines” and “ripples”.
There are no long-term, randomized studies of significant numbers comparing facelift techniques. Still, many, if not most, experienced surgeons feel that a deep plane facelift corrects folds and wrinkles better and lasts longer.
In fact, most of our facelift patients achieve extremely long-lasting results. Because collagen tissue is formed in deeper layers, and ligaments that hold up facial structures are re-positioned, a more stable, natural result is, in our opinion, obtained.
This facelift is more difficult to perform, especially for the inexperienced or low volume surgeon. Our safety record and outcomes result with the deep plane facelift is among the best in the industry for any type of facelift (including mini-lifts). Because it is “routine” for us, we consider it to be “another day at the office”. We utilize advanced technology to diminish your recuperation time.
The SMAS is the underlying muscle structure of the face. This type of facelift moves the skin and muscle in separate layers. The elevated skin is, therefore, not as robust as with the deep plane lift and can lead to a greater incidence of “scar formation. The “high SMAS lift” provides a more secure stabilization of the muscle layer and a more vertical, upward lift than the “low SMAS lift”.
Often our Masterlift is a “deep plane lift” combined with a “high SMAS” technique to achieve a more vertical lift and stabilization than the usual deep plane lift. We have evolved this technique over years. The Masterlift may also re-position cheek and neck structures (see Necklift and Mid-face/Cheeklift sections of our website) in several different layer.
A “mini-lift” describes a lift that involves less undermining of the skin and muscle than a more extensive facelift that lifts the skin and muscle. Often the incisions in the back of the ear are omitted. “S-lifts”, “MACS lifts”, “Vertical lifts”, “Quick Lifts”, “Lifestyle Lifts” and many other branded facelift techniques fall into this category. Most of these techniques evolved generations of surgeons ago, and the “branding” falls into the category of marketing.
Mini-lifts allow the surgeon to complete the process in less time. A lesser surgical skill level is required, so the low volume or inexperienced surgeon will often use one of these techniques, which are often taught at weekend courses.
The underlying muscle is usually sutured up, rather than lifted. In some instances, a piece of the muscle is scraped away. Many experienced surgeons feel that these lifts may not “hold up” as long. Still, for the right patient, Mini-lifts, performed in a skillful manner, may represent a reasonable option, and we use them for younger patients, and to revise or tuck up previous facelifts.
While recuperation is reported to be quicker with mini-lifts than with more extensive lifts, we have found, observing our results and those of other surgeons, that there is only a small difference in recuperation time. Recuperation speed seems to relate more to the individual patient and their healing abilities, rather than the type of lift performed.
Certain technologies can help to speed recovery. By using these, we find that most patients can appear in public within ten days to two weeks, and will be functional in a couple of days. Some patients require a longer recovery and some will be “ready to go” in a couple of days. Ask yourself: Do I bruise and swell easily?, and likely you will get an idea of your recovery time.
We use many types of incisions based on hair patterns and type of facelift that we perform. The goal is to make the incisions as invisible as possible. Generally, a woman can wear her hair up after complete healing is over. Men, who are almost 1/3 of our face rejuvenation practice, can grow a beard until the incisions are healed.
Our facial structures “fall” with gravity and the loosening of ligaments that fix these structures upward to the underlying bone and muscles. The skin looses its elasticity and collagen that, like a loosened rubber band, stretches out. The resultant facial “falling” is called “gravitational descent”.
“Volume loss” describes changes of aging where our facial bones shrinks and resorbs, and the tissues of the face loose some of the fat and volume of their youth. The volume loss also can accentuate the facial “falling” as the “mask” of skin and muscle re-drapes over less facial volume.
Our emphasis is on repositioning the fallen facial structures, rather than pulling skin and its underlying muscle excessively tight. Reversing the “gravitational descent” of the fallen facial structures and correcting skin and muscle looseness is the usual problem. While loss of our bony and soft tissue volume definitely occurs, it is only a minor factor for most patients (though, for some, correction of volume loss is extremely important).
Adding volume such as commercially available fillers (such as restylane and the like), fat, platelet rich plasma (the so-called “vampire lift”) can camouflage some sinking (like “blowing up a balloon” to diminish the wrinkles), particularly in a younger patient. In fact, the use of non-invasive skin tightening, Thermi, and fillers has pushed the facelift age to 8-10 years later in life and can forestall a facelift (see our sections on these techniques).
Also, for someone who has always had a thin, slender, or long face, volume replacement can be extremely important, as age accentuates the problem. In these cases (genetic facial thinness), a cheek, or chin implant, may be beneficial.
Still, at some point, adding volume can be overdone, and the blown up “puffer fish” look of adding too much volume can produce an odd, un-natural appearance. Also, adding injectables to the upper or mid-face, can cause the rare, but severe complication of blindness (though platelet rich plasma does not have this complication).
Smile! If your cheek volume is restored, odds are that the problem is gravitational descent. The cheek fat that has fallen is lifted over the fallen mid-face.
To obtain both a “natural” and an “effective” result that restores a youthful face, a surgeon must understand how the face ages and how to correct the aging process.
As we age, our face experiences a “gravitational descent”. Our skin loses its elasticity and the structures of our face fall downwards. Some of the causes of aging are “intrinsic” causes, our natural genetic programming. Other causes of aging are “extrinsic”, the environmental causes such as sun exposure, smoking, stress, and the like.
The outward signs of this are a fallen face with sagging of the eyelids and bulging of the eyelid fat pads, sagging cheeks that fall over the folds that extend from the nose to the mouth (nasolabial folds), jowl fat that sags over the jawbone (jowls), drooping of the eyelids (hound dog eyes), sagging of the eyebrows, and fallen neck tissues.
As the fat of the face falls, certain areas become hollow and “lose volume”, such as the middle face under the eyes. Other areas of the face protrude, and “gain volume”, such as the neck (waddle).
The signs of aging make us look “tired”, “mad”, and/or “sad”, and depict as as less vital, awake, and alert. Artists use the structural signs of our aging to depict emotion and age and are well aware of them.
Artists such as DaVinci and Michaelangelo studied the anatomy of aging. During the renaissance, these and other artist depicted the aging changes that depict the different stages of life, and emotions with great understanding and detail.