Facelift Beverly Hills
“Beauty is the best introduction” – Aristotle
The formal term for facelift surgery and necklift surgery as they usually go together is rhytidectomy surgery. Rhytidectomy is a compound term comes from the Greek word “rhytid” which means wrinkle and the word “ectomy” which means to remove. In its most simple term therefore facelift surgery entails the removal and effacement of wrinkles of the forehead, face and neck. To me though the art and mastery of facelift surgery should accomplish a lot more. It should make the face younger, it should beautify and it should brighten the patient’s aura. These are results that will last for decades. That is why I consider face-lifting the epitome of all cosmetic plastic surgery.
The successful outcome in the facelift and necklift begins with detailed, accurate and effective communication between the patient and the plastic surgeon. Communication is a critical step for the successful outcome in the facelift and any cosmetic plastic surgery. This is true for any cosmetic surgery operation but especially facelift surgery and face-lifting procedures.
What makes one plastic surgeon different than the others beyond proper training and skill? The answer is his or her own aesthetic ideals artistic creativity, and cultural foundation.
The facelift is the epitome of cosmetic plastic surgery because it affects the face. Therefore, the proper outcome does not alter or change an individual’s persona, identity, features and most of all personality. There is nothing more awful that a facelift result that looks fake and plastic. A wind-blown appearance, a surprised appearance, a fake look after a facelift is un-attractive and sadly can last for a lifetime. The facelift plastic surgeon operates on the individuality of his patients, hence the uniqueness of such procedure.
The best facelift is more than a lift, an anti-gravity procedure or extra tightening. It is facial architecture. It is the study of the deeper facial structures and the proper restoration of them in the aesthetically pleasing manner. And also a youthful manner.
I had the privilege and good fortune to learn face lifting procedures by Dr. Luis Vasconez. Dr. Vasconez is a one of history’s foremost plastic surgeons. One of qualities that set him apart from other established plastic surgeons was that he never stopped learning. He taught me to always challenge myself to continuously learn and perfect plastic surgery technique.
I owe him my great plastic surgery career and in particularly my understanding of the midface, the Malar Fat Pad, jowls, facial anatomy, neck anatomy and the endoscopic brow lift. He is the inventor and innovator of the endoscopic brow lift.
WHAT DO I TYPICALLY ADDRESS WITH MY FACELIFTS?
With age the distance between the hairline and the brows increases. Furthermore, both men and women may experience receding hairline and thinning hair. These events create the appearance of a longer forehead. A longer forehead is associated with advancing age.
The forehead lift or the brow lift elevates the forehead and shortens its length. The forehead lift can be open or closed. The closed forehead lift is done with the use of an endoscope and a camera. It’s done via three very small incisions in the hairy part of the head. These incisions are about 2 cm each. The endoscopic facelift is the sate of the art in forehead rejuvenation.
In cases where the forehead is too long it can get shortened via an open forehead lift. Open forehead lift means that a longer scalp incision is performed. This incision can be on the hairline or it can be in the hairy portion of the scalp.
In cases where the brows are uneven they can get fixed also with an open forehead lift. The incision of the open forehead lift can be in the hairline or in the hair itself.
The incision in the hairline heals very well especially in ages over 60. The incision in the hair has the advantage of being “hidden” however it may cause local alopecia i.e. hair loss.
The brows descend with age. In women they begin to slowly descent around the age of 28. In men they begin to descend around the age of 35.
Brow descent is best fixed with the endoscopic brow lift done at the same time as the forehead lift.
In different patients different parts of the brows need different degree of elevation.
In women the high point of the brow should correspond to the level of the mid pupil if they want the brows to have an ideal arch. The whole brow can be lifted symmetrically and equally along its whole length or different parts of the brow can be lifted differentially. Typically, women desire for the lateral sides or the sides to be lifted more.
In cases of brow asymmetry then an endoscopic and open forehead lift technique can be used in order to lift one brow more that the other and create symmetry of the brows.
- Glabellar area or the “frown lines”
These lines are caused by the muscles underneath. They are called Corrugator and Procerous muscles. They are vey strong that’s why when we frown the area becomes bulky.
During the endoscopic brow lift the surgeon can weaken the strength of those muscles. That accomplishes to make the skin in that area smooth and remove deep wrinkles that are vertical or horizontal.
The nose becomes longer with age and the skin thicker. The tip of the nose becomes droopier and bigger.
A nose lift can be done at the same time as the endoscopic brow lift without any visible scars because it is done from the forehead.
In addition, during facelift surgery the surgeon can do a tip rhinoplasty and fix the aging changes of the nose.
The peri-orbital area is the most critical area for a beautiful face. By peri-orbital area I mean the eyes, the eyelids, the brows, the soft tissue above and below the eyelid creases and the shape of the corner of the eyes.
Some patients are afraid that by a face lift or eyelid surgery the shape of the eyes will change. That is not true actually. The only way a surgeon will change the shape of the eyes is by doing a canthopexy. That means to sew the end of the upper and lower lids together. That is something not frequently done.
The rejuvenation of the eyes and peri-orbital area requires not only eyelid surgery but also a brow and forehead lift. The brow lift is the prime and critical operation that “Opens Up” the eyes.
- Corner of eyes or “crow’s feet”
It is very important to prevent wrinkles from happening there. This area is very prone to wrinkles because the skin is very thin and subject to repeat and frequent muscle action.
Botox or Dysport should be done there every 3-4 months to prevent muscle action and further development of wrinkles there or smile lines.
There are significant changes with time that occur around the mouth and on the mouth:
- The length of the upper lip (white lip) lengthens.
- The red lips become smaller and lose volume with age.
- The corners of the mouth get a downward orientation and need to be lifted superiorly.
- Ears (lift, shorten, trim earlobe, fix earlobe)
The ears become longer with age and descent. Ina addition the earlobes become bigger and longer with age. In those women who were heavy earnings for many years. That chronic pull makes the earlobes drop more. In many facelifts I reduce the earlobes as well and suspend the ears in a slightly higher position.
CONSIDERATIONS AND COMMON PATIENT QUESTIONS
- Facelift scars and necklift scars.
Facelift scars is a topic that worries almost every patient who is interested in facelift surgery or rhytidectomy surgery. People are concerned about visible and noticeable scars on the face and rightly so. I spend a lot of time discussing facelift incisions types, location and variations.
An important biological fact about facelift scars is that scars on the face and neck heal much better than the rest of the body in the same person. Why is that? We believe it is because the scalp, face and neck areas have much better and more abundant blood supply than the rest of the body. Better circulation and blood supply translate into better healing. Consider the scars of eyelid surgery. Skillfully performed these scars are in most patients almost “invisible” once they heal. The same is true when someone has thyroid surgery and get a transverse scar at the inferior part of the neck. If the thyroid surgeon performs an elegant plastic surgery closure and respects the tissue then those scars heal amazingly well.
The same principles apply to the rest of the face. Proper plastic surgery technique and very gentle tissue manipulation and management will result in scars that will be almost invisible around and behind the ears.
Facelift incisions and facelift incision final wound closure are critical parts of the surgery. I spend a considerable amount of time to discuss incision options with my patients before the operation. There are some classic “standard” type facelift incisions that most plastic surgeons utilize and then are variations. My principles are that the sideburn of the patient should not be altered or changed. That is why at the temple area I place the incision along the hairline. The ear incision can be well concealed by placing the scar in natural ear creases and behind the tragus. Behind the ear I place the incision along the posterior ear crease or the pot-auricular ear sulcus. It is this portion of the incision that extends behind the ear that is utilized for the necklift surgery. If I have to extend the incision behind the ear considerably-like in a patient with a “turkey neck” then I follow the hairline of the occipital scalp. It is my philosophy not to distort the hairline with facelift and necklift surgery. Preserving the natural hairline orientation and shape creates a natural outcome.
If a plastic surgeon distorts the hairline during a facelift or rhytidectomy surgery then that cannot be fixed. A good example is when plastic surgeons place the superior portion of the facelift scar – the one above the ear- in the hairy part of the scalp in the Temporal area. This has the potential to often the distort the natural sideburn. It can elevate it or even efface it which simply does not look “right”. Furthermore scars placed in the hair can cause local hair loss and a bald spot that can be aggravating and can only be fixed with hair transplant or excision of the bald spot.
There is some good news for patients over 55 years of age getting facelift surgery. They heal better. They make better scars. The reason for this biological fact is that as we all age we do not form as much and as strong scar tissue during wound healing. That translates in better looking and less prominent scars.
- How about facelift scars on men and on male facelifts?
The critical factor in men and male facelifts is that men have a beard bearing region on the cheeks which is separated from the ears with an area of non-hair bearing skin. During facelift surgery the cheek skin is pulled upward and sideways. In women that is not an issue because their skin is non hair-bearing. But in men the hair bearing skin that forms the beard can end up on the ear and the tragus of the ear. That is not aesthetically pleasing. Furthermore, it can complicate and aggravate the daily ritual of shaving for most men. There are ways to mitigate and perhaps avoid these issues and this is something I discuss in the pre-operative consultation with all my male patients. As a general principle respecting the sideburn orientation and lifting in a vertical vector -instead of lateral toward the ear- avoids problems, creates better scars and better outcomes.
- Will I lose hair with a facelift?
This is a common concern as well. As I described above if the scars are carefully and thoughtfully placed then no hair will be lost and no bald spots will be created.
- Revision facelifts, Secondary and Tertiary Facelifts
The revision facelift can be the second or third facelift. It is not necessarily more dangerous. It does not take longer to heal. The actual operation can take longer in order to brake or remove prior scar formation.
The main thing to pay attention with a secondary facelift or a third facelift is not to distort the hairline. Many plastic surgeons do not realize how even the slightest hair distortion can be troublesome to many women and men who get a facelift.
In revision facelifts or secondary or tertiary facelifts the main problem is not typically skin laxity. The problem residual or recurrent jowl formation. This results from the fact that most SMAS techniques are not effective to lift and support the malar fat pad and the midface. As a result, the midface continues to descend at a much-accelerated rate as opposed to the lateral face which appears more firm following a facelift. This is the definition of “lateral sweep” which is un-attractive and a tell-tell sign of a facelift. Ideally nobody should be able to tell that a patient had a facelift.
Malar Fat Pad elevation and midface elevation or rejuvenation is a critical part of any facelift and especially a secondary facelift.
- Volume augmentation and fat transfer to the face
As we get older the skin of the face becomes more loose and lax due to the realization of collagen and elastin fibers. We also lose volume of the soft tissues.
It is important therefore not to remove volume form the face but sometimes to add volume. This is often done with fat of hyaluronic acid. Recently stem cells in the face seem to have a role.
- Adjunctive procedures during the facelift surgery
Chemical peels to the face, neck, chest and décolletage area.
- Care of the skin before and after facelift surgery
Many times patients ask me how to prepare their body and their skin before a facelift for optimal results. Even though I discuss these topics extensively in person I am happy to share some useful points on this section.
I advise a normal and diverse diet that does not deviate from pre-surgery standards. The diet should be of high nutritional value. I recommend the avoidance of Vitamin E before surgery. High levels of Vitamin E can make certain patients bleed after surgery. On the other hand, I do recommend Vitamin A and C because they promote healing.
I do not recommend any procedure such as a chemical peel or a laser treatment on the facial skin before surgery because they may injure the skin. During facelift surgery I rely on optimal skin durability for proper healing.
- Care of the skin after surgery
I get asked more often about proper aftercare for the skin following facelift surgery. I model and prepare certain skin care regimens (creams) that promote moisturization and healing. The principles for ideal management of the skin after a facelift rely on abundant moisturization and limitation of inflammation. These creams are potent and prepared by me with a prescription at a compounding pharmacy.
The timing for any other treatments to the skin such as a chemical peel or a laser treatment following facelift surgery are generally allowed after 3-6 months.
One of the most detailed facial cosmetic plastic surgery procedures is also one of the most requested. The facelift is what our founder, Dr. John Anastasatos, calls the “Rolls Royce” of plastic surgery, and one he has expertise in. When performed correctly, a facelift can erase 10-15 years from the face, restoring a naturally youthful appearance. Dr. Anastasatos and our team offer exceptional options in facelifts at Los Angeles Plastic Surgery, with outstanding, natural results.
Your face expresses your personality. It is how you view the world and how the world sees you. Every detail on the face is significant. Therefore, when properly done, a facelift is really the synthesis of many meticulous details that are accounted for and addressed with surgical precision and an artful aesthetic.
Dr. Anastasatos understands that a good facelift is a natural one. If you can spot men and women who had a facelift from a glance, then the procedure was not performed correctly. A beautiful face is warm, expressive, soft, tight and youthful. A great facelift accomplishes that, which is what Dr. Anastasatos offers at our facilities.
Correcting the Signs of Aging
As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth, the jawline grows slack and jowly and folds and fat deposits appear around the neck.
A facelift (technically known as rhytidectomy) can’t stop this aging process. What it can do is “set back the clock,” improving the most visible signs of aging by removing excess fat, tightening underlying muscles and re-draping the skin of your face and neck. A facelift can be done alone or in conjunction with other procedures such as a forehead lift, eyelid surgery or nose reshaping.
During a facelift procedure, Dr. Anastasatos address several major signs of aging in the face, including:
- Descent of the malar fat pad or descent of the cheek
- Nasolabial folds (smile lines)
- Jowl formation
- Nasojugal folds (folds and lines under the eyes)
To accomplish changes on these areas of the face, an incision is placed in the hair near the ear and partly in front of the ear to expose the midface. The whole midface superior is elevated where it used to be, creating a natural midface lift. Proper elevation of the midface creates cheek fullness and enhances the cheeks. Proper midface lifting also removes the sagging jowls and improves the nasojugal folds and the nasolabial folds. This can be accentuated with an eyelid surgery, which can be done at the same time for a harmonious appearance.
Types of Facelift Procedures
There is more than one type of facelift. Our patients are unique, and so are the procedures they require to look their best at any age. Our facelift options include:
The type of facelift required depends on the extent of the sagging and deterioration of the skin and tissue. Our younger patients may begin with a thread, liquid or mini facelift in their late thirties or early forties, graduating to other versions in their fifties and beyond.
With the right plastic surgeon, a facelift can look completely natural and enhance all the nuances of your face. View the before-and-after photos from our gallery to see the incredible results Dr. Anastasatos has created for our patients. To receive a personalized facelift consultation with Dr. Anastasatos, contact us at Los Angeles Plastic Surgery in Beverly Hills, and we also have a location in Athens, Greece.