Spring is that time when we like to freshen things up. The options to freshen our appearance seem endless and often confusing. Lasers, peels, fillers and other “non-surgical” choices often compete with the more traditional surgical procedures. However, just like an artist chooses the right colors for his canvas, the plastic surgeon must guide the patient to choose the right treatment for the desired effect.
The last decade has seen an explosion of fillers used to treat facial wrinkles. In addition, it seems every day we hear another slick “lift” procedure advertised that promises dramatic results with minimal down time. It is more important now than ever for patients to seek honest, competent advice from multiple practitioners versed in the whole array of treatment options.
I like to evaluate the facial rejuvenation patient by dividing the face into thirds. We start at the top by examining the forehead and eyebrows. If the brows are below the rim of the bone, or if the patient is bothered by significant forehead wrinkles, a forehead/brow lift procedure may be indicated. I have a high threshold for recommending this procedure however, since these patients can look overdone and surprised. Botox offers a simple alternative for forehead wrinkles. It works well but is temporary and expensive.
The middle third of the face are the eyelids. If the eyes are the windows of the soul, then the eyelids are the curtains that allow us enjoy the view. They are truly the most expressive part of the face and the first place we notice our age. Usually by age 40 most of us have aging changes around the eyes. The upper lids develop excess skin causing hooding. The puffy bags on the lower lids create a tired look.
The procedure of choice to correct tired eyelids is the eyelid tuck or blepharoplasty. It is a commonly performed surgery with a very high degree of patient satisfaction. It is one of my personal favorites to perform and is the most commonly performed aging procedure for men. The procedure takes 45 minutes and patients soon enjoy a refreshed and less tired look.
The lower third of the face includes the area of the cheeks, jawline and neck. As we age the skin and other tissues sag from the underlying bony structures. In addition, wrinkles in the skin, often affected by smoking and sun exposure, contribute to the facial aging changes. The two problems should be treated differently. Facial laxity is treated by surgical face and neck lift procedures, while skin changes are best addressed by injectable fillers or topical treatments such as peels and lasers.
Although highly advertised under many catchy terms, surgical facelift procedures generally fall into two categories, mini and full. A mini-facelift is best suited for patients in their 40’s or younger who just want to freshen the cheek and jawline. The advantage is that it is quick procedure with a rapid recovery. My preference for isolated mild neck fullness is a less invasive, unique ultrasonic liposuction tightening procedure.
The patient for traditional face and necklift is in her late 40’s and older with laxity of the jawline and neck, often with turkey-like banding. Combined with eyelid surgery, the procedure often produces dramatic results and can reduce the aging appearance by decades. It is another one of my favorite procedures to perform.
As with all procedures, an honest consultation with a reputable and experienced physician is the best place to customize an individual treatment plan.