Facelift and Necklift

Endoscopic browlift and endoscopic brow re-contouring.

This is a “functional” endoscopic browlift. Functional means that it physiologically and holistically re-balances the muscle activity around the brows, eyes, and forehead so that the final result is a natural eye-opening effect and a more youthful expression. This technique avoids “pulled” and “surprised” looks that often intimate prospective patients.

Dr. Anastasatos learned this operation form his mentor Dr. Luis O. Vasconez who is the original inventor of the endoscopic brow lift and endoscopy of the face.
Dr. Anastasatos has continued and evolved the original work of his mentor with endoscopic lifting of the forehead, brows and face.

The critical differences of how Dr. Anastasatos performs the endoscopic brow lift are:

1. Dr. Anasatsatos does not use permanent fixation screws because they are not indicated. Permanent fixation screws and devices are not needed because with his technique the brow lift is functional and physiologic. The brow lift is done by re-balancing the important muscles of the brows, eyes and forehead.

   Weakening of the brow depressor muscles allows the frontalis muscle to apply less tension to lift the brows and this allows the brows to naturally position themselves in a higher and more youthful position.

2. The other key technical element of this operation is that Dr. Anastasatos completely divides the orbital periosteum at the level of the brows. Division of the periosteum is a critical step that allows the brows to immediately elevate to a higher position.

The benefits of this endoscopic brow lift technique are:

1. The technique of Dr. Anastasatos does not produce a “surprised” look, or an un-natural “pulled” look. The brows are not pulled but instead are allowed to be naturally re-positioned to a more youthful position due to the peri-ocular and brow muscle rebalancing.
2. The endoscopic brow lift corrects upper eyelid hooding. Most patients with upper eyelid hooding require a brow lift to correct upper eyelid hooding and not necessarily an upper eyelid blepharoplasty. Some patients with significant upper eyelid hooding require both the endoscopic brow lift and an upper eyelid blepharoplasty simultaneously.
3. The endoscopic brow lift “opens up the eyes”.
4. The forehead becomes smoother.
5. The glabellar area also becomes smooth and any pre-existing vertical lines (11’s) or horizontal lines can go away.
6. It avoids the longer and more invasive scars created by coronal brow lifts and brow lifts with hairline scars.

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This patient had some additional procedures as well. Prior to having Dr. Anastasatos as her plastic surgeon, she had a previous deep plane facelift with fat transfer by another surgeon. The fat transfer was to treat the tear-trough area which was hollow. The problem that resulted was that the fat migrated inferiorly on to the cheek and created a protrusion or “pillow” appearance. This required Dr. Anastasatos to perform a lower eyelid surgery to remove that fat that had migrated and reconstruct the area.

At the same time, Dr. Anastasatos performed his MIMS procedure (Minimally Invasive Midface Suspension) to offer some midface elevation and also treat the tear trough area. A midface lift is something we use often in order to provide lower eyelid support. The malar fat pad which is what Dr. Anastasatos elevates with the MIMS procedure forms the lower margin of the orbital rim so it improves orbital aesthetics especially the tear-trough area.

This patient also had two rhinoplasties before meeting Dr. Anastasatos. Dr. Anastasatos also performed a finesse revision rhinoplasty on this patient.

Face lifting procedures
Midface lift with malar fat pad elevation – raising and suspending the malar fat pad to create cheek elevation and fullness and also correct his jowls. Raising the malar fat pad also raises the corner of the mouth and helps restore a clean jawline. Furthermore, raising the malar fat pad gives cheek fullness and zygomatic projection which is very attractive. Finally raising the malar fat pad which is the most important part of the midface improves the tear-trough area and also softens and effaces the naso-labial folds.

SMAS facelift with lateral SMAS-ectomy and plication (SMAS tightening)
The SMAS facelift helps with the jawline and jowls, the lower face and the neck. It does not help with the midface. This patient also had neck liposuction.

Facelift Scars
Notice how well the facelift scars have healed that allow him to have a bald look after surgery. His scars are imperceptible.

This patient had a deep plane SMAS facelift for the lower face and jawline and a midface lift with malar fat pad elevation for the midface. Her jowls were improved by both the midface lift with malar fat pad elevation and also the deep plane SMAS facelift.

She also had deep plane neck surgery with platysma plication and repair, corset platysmaplasty and also neck liposuction.

The corner of the mouth, the cheeks and the tear-trough areas were improved by the midface lift with malar fat pad elevation. No fat was added.

The most important goals in facial rejuvenation are the following: Jowl correction, marionette line correction, tear-trough correction, cheek elevation and fullness, raising the corner of the mouth, softening the naso-labial folds (laugh lines) and creating a clean jawline.

Face and Neck lifting procedures
This patient had a deep plane SMAS facelift for the lower face and jawline and a midface lift with malar fat pad elevation for the midface. Her jowls were improved by both the midface lift with malar fat pad elevation and also the deep plane SMAS facelift.

She also had deep plane neck surgery with platysma plication and repair, corset platysmaplasty and also neck liposuction.

The corner of the mouth, the cheeks and the tear-trough areas were improved by the midface lift with malar fat pad elevation. No fat was added.

The most important goals in facial rejuvenation are the following: Jowl correction, marionette line correction, tear-trough correction, cheek elevation and fullness, raising the corner of the mouth, softening the naso-labial folds (laugh lines) and creating a clean jawline.

Eyes and eyelid procedures
She then had bilateral upper blepharoplasties and also from the same upper eyelid incision she had bilateral upper eyelid ptosis repair with levator muscle advancement and repair. The lower eyelids were tightened by internal repair and tightening of the orbicularis muscle and a canthopexy.

This patient had prior facelifts in the past by other plastic surgeons. She was unhappy by her recurrent and saggy jowls. She told us that she had prior deep plane facelifts which by nature are not able or potent to raise the midface and malar fat pad and therefore correct the jowls. So often patients who have deep plane facelift alone or SMAS facelifts may soon experience residual jowls or recurrent jowls soon after their facelift. She also had a sad facial expression which is caused by her sagging jowls and by the droopy corner of the mouth. In order to correct those midface elevation is required. The most important part of the midface to be elevated is the malar fat Pad.

In addition to midface elevation and jawline correction she underwent the following
procedures at the same time.

Forehead and brows
Forehead lift and brow lift – mainly the outer part or lateral part. This is also called lateral brow lift or temporal brow lift.

Eyes
Bilateral upper blepharoplasties

Face lifting procedures
Midface lift with malar fat pad elevation – Raising and suspending the malar fat pad to create cheek elevation and fullness and also correct her jowls. Raising the malar fat pad also raises the corner of the mouth and helps restore a clean jawline. Furthermore, raising the malar fat pad gives cheek fullness and zygomatic projection which is very attractive. Finally raising the malar fat pad which is the most important part of the midface improves the tear-trough area and also softens and effaces the naso-labial folds.

Deep plane SMAS facelift
The Deep plane facelift in this patient and in general, helps with the jawline and jowls, the lower face and the neck. It does not help with the midface.

Upper lip lift
The upper lip lift increases red lip show and improves peri-oral proportions.

Fat harvesting and transfer to the lips for lip augmentation
Fat was taken from her abdomen and her neck by lipo-suction and then processed and transferred to her lips. Both micro-fat and nano-fat were used.

Neck
Platysma-plication (tightening) with corset platysma-plasty
Neck liposuction (minor)

This patient had a facelift, neck lift and an endoscopic brow lift.

The facelift was performed by elevation of the malar fat pad and also deep pane SMAS lift. Elevation of the malar fat pad achieves a midface lift. This can also improve the tear trough area and the lower eyelid region.

The necklift was performed by plication of the platysma in two locations: midline and laterally. The midline plication of the platysma is also called “corset platysma plasty”.

The endoscopic brow lift is the state of the art procedure to rejuvenate the upper third of the face. Think of it as a facelift of the upper third of the face. It opens up the eyes, raises the brows and can erase the deep frown lines or rhytids in the glabellar area

Notice how dramatic the result is yet at the same time very natural. Beautiful results when it comes to the face must always be natural.

This patient had a facelift, neck lift and an endoscopic brow lift. Notice once again the dramatic yet very natural looking result. Beautiful plastic surgery is natural looking. Notice also the improvement of the lower eyelids without surgically touching the eyes.

This pleasant lady was one of my first patients. She came to me for facial rejuvenation.

I performed an endoscopic forehead lift, a midface lift and a neck lift. Notice the results of the eyes. I did not perform blepaharoplasties on her (eyelid surgeries). The results of the eyes are purely due to the effects of the endoscopic forehead lift and the midface lift. The endoscopic brow lift, if properly done, truly and naturally opens up her eyes. Her look is relaxed, youthful and engaging after this surgery.

The results of the facelift and the neck lift are obvious.

This lady was 69 years old when I operated on her. I think you would agree with me that after her surgery with she looks much younger and her result is very natural looking.

This lady had a facelift and an endoscopic brow lift and endoscopic forehead lift. The endoscopic brow lift is an impressive operation and one of the most recent contributions and innovations in cosmetic plastic surgery of the face.

The endoscopic brow lift opens up the eyes. This is the best way I can express it. It can be done most naturally and results to open up the eyes. The eyes is the most beautiful part of the face so this is a critical operation. The endoscopic brow lift can also raise the brows which begin to sag and descent after the age of 30 in most people.

The results that you see are only 3 months following the operation Thats why some areas of the face can be seen to be red still.

The close-ip before and after photos illustrate the finesses of the endoscopic brow lift.

I believe that cosmetic surgery of the face must be natural looking. A cosmetic plastic surgeon can do a facelift which can be natural looking. Fresh and natural looks is the goal.

Keywords: facelift, Necklift, Brow lift, Endoscopic brow lift, Endoscopic Forehead Lift, before and after pictures

This lady had a facelift, neck lift and lower eyelid cosmetic surgery. All these procedures where done together. Doing certain procedures together yields a more harmonious result.

With the facelift surgery I always do a midface suspension of the soft tissues under the skin. This is important because I do not rely on the skin tension for good results. This creates a very natural looking face.

At the neck level I did neck liposuction, and muscle tightening (platysma). Tightening the neck muscles is what creates the beautiful neck. Off course I do always remove the skin excess but that is a minor part of the cosmetic operation.

At the lower eyelid level I removed some fat and skin and re-positioned the rest of the fat of the orbit. I also tightened the eyelid muscles.

The result that you see is 6 months following the cosmetic operation (facelift and necklift).

This lady had a facelift and necklift at the same time. Although she was young at 39 she had some bad genetics that made her look older. Furthermore she wanted to be pro-active and help prevent additional signs of aging.

The main things that bothered her were her lack of definition of her neck, the presence of jowls and the presence of prominent nasolabial folds.

She wanted a very natural and refreshed look. The results that you see are 4 moths after her facelift surgery. On the sideview a skin fold is visible but that settles down as more time passes.

She was very happy as her whole face looks much younger and fresh but at the same time it looks natural.

This patient had a neck lift. In this surgery I performed plication (tightening) of the platysma muscle and re-created its shape. The patient also had liposuction of the neck.

Notice the dramatic result to her whole face and neck and also to her youthful look.

This young lady came to see me because she was unhappy with the look of her lower face and neck. Her underlying problems were a small and retruded chin- a pushed back chin- and an abnormal neck muscle (platysma) anatomy.

I performed a necklift and a plication (tightening) of the neck muscles and I also placed a small chin implant at the same time.

The aesthetic result is improved with a more proportional face and neck appearance.

This lady had a facelift and neck lift at the same time. I believe that in most patients there is an added advantage if the face and the neck are done together at the same time. I see the face and the neck as one entity. Facial rejuvenation therefore to me means rejuvenation of the neck as well for a more beautiful result. The result is obvious.

This patient was a beautiful 15 year old girl when she was in a horrific accident that resulted in an almost 90% total body surface area burn. As you can also see her face and neck were totally burned.

This is a cased I did when I was on the faculty of the University of Alabama in Birmingham. When a patient like that comes to the hospital the main focus is to provide life saving measures. After that was done by the brilliant and expert work of the burn team at UAB then I was asked to care for her face and neck burns as the plastic surgery expert.

The challenge was that she had no skin left due to her massive burns. In a first marathon operation that lasted about 11 hours I used skin form her scalp to reconstruct her face and neck.

She had one additional operation by me about a year later for placement of hair grafts and some minor wound revisions.

The result is obvious. She now has a normal life and she is happily married with children.

This has been one of the most gratifying operations and patients in my whole life.

Patient had the following procedures: upper eyelid surgery (blepharoplasty), upper eyelid ptosis correction, correction of upper eyelid levator dehiscence, correction and suspension of lacrimal glands through upper eyelids, upper lip lift, midface lift.