Facial aging touches on two core aspects of our life; longevity and the ability to compete in a world focused on vitality. A youthful face is assumed to be a reflection of energy and health. It provides a competitive advantage and gives a sense of youth. We all want to have our external appearance match what we feel inside.
As Dr. Makhlouf analyzed facial aging, he came to the conclusion that aging occurs on three levels:
- Deep level: there is a downward migration of the fat, formation of large skin folds, and relaxation of neck muscles.
- Intermediate level: fine lines and fine wrinkles are visible (mainly around the eyes and mouth).
- Superficial level: skin quality and texture are affected by dark patches, red spots, scaling, etc.
In reality, we all age at the three levels and many times correction is needed at all levels. Pulling the skin, eliminating deep wrinkles and re-positioning the fat but not addressing dark spots in the face is similar to ironing a stained bedsheet. The result is incomplete.
However, if your changes are primarily in the medium or superficial level it is best to treat it non-surgically or with minimally invasive interventions.
If you are interested in exploring your nonsurgical options, please review the sections on chemical peel and injectables (fillers and neuromodulators).
Dr. Makhlouf examines patients with these three levels in mind and notes at which level the aging process is primarily occurring. His recommendations are based on his experience and many times may recommend a simpler solution. Dr. Makhlouf strives for natural results and he firmly believes that the treatment should be proportionate to the amount of aging present. Consequently, he chooses the method of treatment that will give the most remarkable result with the least intervention.
Although facial rejuvenation is constantly being revisited and improved upon by plastic surgeons, there is some basic understanding that dictates Dr. Makhlouf’s approach in performing a facelift. To simplify the discussion, he tends to divide the face into the upper-face, the mid-face, and the neck.
For the upper-face, nonsurgical intervention results are very successful and accordingly surgical intervention for the upper face is steadily decreasing.
The best plastic surgery literature has witnessed different approaches to the problem for the mid-face. There have been many changes to how the mid-face is addressed recently due to our changing understanding of how the aging process is occurring. As of today, the best understanding we have is that that facial sagging develops in an up-down (vertical) direction, not front to back. Therefore, the correction of the mid-cheek needs to address that vertical descent. This is not, however, an isolated event as we realize the neck upper is attached to the cheek, which means that correcting the mid-face will help improve the look of the neck as well.
In summary, the surgery involves two steps: skin lifting with resection and fat repositioning.
In planning the skin readjustment, there are fixed reference points on the face that should not be modified:
- The lower anterior part of the sideburn (point A)
- The attachment of the upper ear to the skull (point B)
- The attachment of the earlobe (point C)
By feeling the tissues and looking at a tentative pull, one can identify the points on the face and cheeks that should meet these non-moving reference points.
This gives the surface plan; the fat repositioning represents the plan for the deeper tissues.
There is a small variation in the incisions made for men and women. Essentially the incision has to start at the junction of the hair and temporal area or within the scalp above the ear, it then moves in front of the ear. Dr Makhlouf prefers hiding part of it at the entrance of the ear canal. In heavy bearded men the incision goes at the junction of the hairless skin with the hair-bearing skin of the check. After that it passes in front of the earlobe and then turns behind it. At that point it has to go across towards the hair bearing scalp. That turning point it behind the upper part of the ears because the scar is hidden while it heals. Later it becomes invisible. Excess skin is taken out throughout all the incision lines, the amount depending on the laxity of the skin and the pull.
Not uncommonly adjunctive procedures are done at the same time. Blepharoplasty (eyelid tuck) being the most frequent, but lip lift, per-oral dermabrasion, chemical peel along with fillers, among other interventions, are done as well.
Dr. Makhlouf performs the surgery with general anesthesia or with intravenous sedation and local anesthesia. The patient goes home the same day of the surgery with drains, which are typically removed the next day. Sutures are removed after one week, and the bruising is gone by ten days. The incisions are usually well hidden. Generally patients can go in public at one week, and be comfortable to go out for dinner in 3 weeks with minimal make up.
Fountain of youth is real, A 69-year-old woman with a desire to improve the appearance of the lower part of her face, her neck, and the upper eyelids. This lovely lady underwent a rhytidectomy (face lift) and blepharoplasty (Upper Eyelid). With only two months after surgery, the patient loves her new appearance and she found the fountain of youth.
55-year-old female did not like the neck redundancy and the jowling of her cheeks. Note the firmness achieved in her post-op photos.
53 year old patient from Chicago with significant facial laxity, small mandible and thinned lips underwent a rhytidectomy with lip lift, and chin implant. A year later she exudes a natural look as shown in her before and after photos.