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John M. Anastasatos

My facelift philosophy

The facelift is the most sophisticated, delicate, refined and creative combination of procedures performed together during one operation to reverse the visible signs of aging of the whole face and neck. The most beautiful successful facelifts address all the multiple anatomic parts of the aging face and neck simultaneously.

As a Beverly Hills plastic surgeon treating facial aging, it makes me very sad to see that the effect of aggressive marketing and commercialization of cosmetic facial procedures has led to the misleading perception that face-lifting success can be often created by minimal and simple non-invasive procedures.
For example terms like “one hour facelift, “mini-facelift”, “lunchtime facelift”, “non-surgical facelift”, “laser facelift”, “liquid facelift”, “vampire facelift”, “stem cell facelift”, serve to create the illusion that these procedures are by themselves adequate or equivalent to full facelifts in restoring the true causes of facial aging. They may create a fallacy that such facial procedures of lesser magnitude and efficacy could be equally as effective as the time-tested procedures that correct the multiple of causes of facial aging at the different anatomic layers of the face and neck.

Moreover we are often made to believe that non-invasive laser and injectable treatments can be alone “as good” in reversing the signs of aging and replace the value and need of a properly performed facelift. It may be true that in some young patents minimally-invasive anti-aging procedures can be enough to accomplish a more youthful image. I perform these procedures too and in the proper candidates-young candidates- they work well.

It is also true however that there is no short cut to success in life and this also applies to cosmetic medicine and surgery. The best face-lifting outcomes are the results of detailed facial analysis and synthetic multi-procedure approaches that address all the visible signs of aging on the face and neck. Facial aging needs to be corrected at the level of the skin and also at the deeper levels of the face including soft tissues, muscles, cartilages, ligaments and even bones. Successful facial rejuvenation addresses multiple anatomic areas of the face and neck in order to create a balanced outcome. Can you imagine for instance how un-balanced a face would look if the plastic surgeon only operated on the face and did not do the wrinkly neck at the same time?

Time is also an important parameter in determining the outcome and success of a facelift. The best facelifts take away many years off someone’s face and these results last for many years thereafter. A good facelift will add 9-10 of youthfulness to the patient’s age for life. This means that when someone who is 50 gets a facelift he/she may look 40. This also means that when the same person gets to be 70 she/he will not look that age but instead about 60 years of age.

The results of “mini lifts” do not hold up for a long time. Mini-lifts last a year or two and I personally consider them a disservice to patients. They are “cheap” in every meaning of the word alternatives to a proper facelift and necklift.

How about “thread-lifts”? The most important thing to know about them is that they are not facelifts. The are not designed to be able to lift the deeper tissues of the face hat have descended with time. They are not effective anti-gravity measures. What they do is simply provide the sensation of skin tightening in certain areas of the face.

So why are they so popular for decades especially in Europe and Asia? Scientific studies have shown that their result is causing some swelling after the procedure that lasts for about 6 months after. Patients like this swelling effect because this minimal facial swelling is volumizing to the face and also makes the facial skin look younger. Furthermore in Europe and Asia they employ threads made by materials such as silicone and nylon which can offer greater pull on the skin that are permanent but they also come with a higher rate of complications such as infection, palpable knots, extrusion and asymmetry.

At my plastic surgery clinic in Beverly Hills I pay particular focus and attention to face-lifting operations. Nothing is more rewarding and empowering than a skillfully performed elegant facelift. All cosmetic plastic surgery procedures have powerful effects because they change one’s self-image. Facelifts go a big step further. If I change one’s body I change their self-image and therefore I can change what is possible and available to them in this world. However If I change someone’s face I may do more; I change their lives. Patients become more powerful. This to me is the core and the beauty of well-performed plastic surgery. It is not just about physical alterations. It is about psychology and empowerment.

Our face is our personality. The facelift therefore is not a superficial operation.

My typical approach to rejuvenating the face includes the following procedures performed during the same operation:

  • Endoscopic brow lift
  • Midface lift
  • Eyelid tightening
  • Nose reshaping
  • Lip rejuvenation
  • Chin lift
  • Neck lift
  • Earlobe repair
  • Fat transfer to the face (optional)
  • Chemical peel to the face, neck and chest

Summary

The facelift is not one procedure. A facelift operation is the synthesis of multiple procedures performed by the plastic surgeon during the same operative time to improve the most visible and bothersome signs of aging of the face and neck. The main ones are listed below.

Forehead and upper third of the face:

  • Brow descend and ptosis
  • Forehead wrinkles
  • Glabellar wrinkles (also called “11’s)
  • Upper eyelid hooding
  • Long forehead

Face and Midface:

  • Loss of cheek projection and flatening of the face.
  • Prominent nasolabial folds
  • Jowls
  • Tear-trough deformities
  • Droopy corners of the mouth

Neck:

  • Double chin
  • Skin laxity
  • Muscle (platysma laxity)
  • Loss of youthful angle between the neck and jaw (loss of cervico mental angle)
  • “Turkey neck”

When all the visible signs of an aging face and neck can be corrected at the same time the aesthetic outcome is superior and profound. Good facelifts do not only improve the face but changes lives.

This article was written by facelift plastic surgeon Dr. John Anastasatos. Dr. Anastasatos is a Beverly Hills plastic surgeon with a particular interest in face-lifting procedures and treatments.

JOHN M. ANASTASATOS , M.D., FACS
Board Certified by the American Board of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery
Member, American Society of Plastic Surgeons
Former Assistant Professor in plastic surgery at The University of Alabama at Birmingham
Expert Reviewer for the Medical Board of California

Posted on behalf of Los Angeles Plastic Surgery

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