Several things happen to the face during the aging process. The two most constant changes with most faces are DESCENT and DEFLATION. Descent refers to the descent of the facial tissues. This is most evident in the midface, or cheeks, where the fat pad descends downward and in the lower face and neck where the skin and underlying tissues descend downwards. Deflation refers to the loss of facial fat. This is evident in the midface, where some of the fat pad is lost, the temples and in the tear trough area. I believe that facelift operation should be comprehensive in nature and should try to correct or improve the face and neck as much as possible.
I begin my facelift operation by harvesting fat from the abdomen or flanks. I then process the fat by placing it in a centrifuge. This separates the fat and I then transfer the fat to the face using very small blunt needles. The fat is placed in the cheeks, tear troughs, nasolabial folds, marionette lines, and temples if needed.
The next step is the neck. I begin with a small incision underneath the chin. Conservative liposuction is performed. The incision is then made a little longer, about one inch. Through this incision, the neck muscles (platysma) are brought together and tightened. This creates a nice and tight neck. I believe that this is one of the most important steps to creating a pleasant neck.
I then move on to the right side. The incisions are made in key places and crevices in order to hide them well. The skin is then elevated from the soft tissues, or SMAS. I then enter what is called the “deep plane,” which is a dissection underneath the facial muscles. Why do I go underneath the muscles? Well, because it allows a strong pull on the facial tissues while maintain a very natural look without a “pulled” look. The muscles are then suspended using very strong sutures and the skin is then re-drape and trimmed. I am very careful not to remove too much skin and make it lays down in a natural fashion. I then close the incisions without placing any tension on the skin. This is important so that the incisions heal well and are imperceptible. I then go to the other side and do the exact same thing. The patient’s face is then cleaned and a dressing is placed. The patient is allowed to wake up and taken to the recovery room. The patient is allowed to go home several hours after they are awake. Most patients spend the rest of the day lying in bed. Most patients do not have any pain. They return to the office the next day, where the dressing is then removed. They are seen again on the fifth day, when the small stitches around the ear and chin are removed. They are seen again on the tenth day where the stitches behind the ear are removed. Most patients return to normal activity at fourteen days.