T oday I talk about one of my favorite procedures - facelift surgery. Many people have an idea of what they think a facelift will do, but there is a lot of confusion about exactly WHAT a facelift does. We clear that up here, and I discuss some alternative treatments for desired outcomes with other areas of the face. Everyone always has questions about the incisions used, so I explain those, as well as address the reality of the "mini" facelift.
I talk about facelift recovery time, putting volume back into the face, and the recently popular deep plane facelift.
Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I'm your host, Dr. Jason Hall.
Dr. Hall: Hey, this is Dr. Jason Hall, jhallmd.com. And I wanted to talk to you today about facelift surgery. Facelift surgery is one of my favorite operations. I do a bunch of it, and my patients really get a great benefit from having facelift surgery. When people come into the office to talk about facelift surgery, there are a lot of questions. Specifically, what kind of facelift are we doing and what are my results going to be?
People come in with very specific questions, things that they're looking to improve on, and the facelift is kind of the go-to answer on the internet for pretty much everything from here up. What we're going to talk about is what a facelift does, but really more importantly, what a facelift doesn't do, and what other treatments and procedures are out there to help with the areas that aren't addressed with a facelift. When patients come to see me in the office and we start talking about facial rejuvenation surgery, a lot of times, what they will do is put their hands on the side of their face and pull backwards, and say, "I really like the way this looks."" And in truth, there's no procedure that is going to reliably do that and make that look natural, or really make that possible. A reliable way to see what a facelift will actually look like is for you to either look in the mirror, put your fingers under your jaw line and gently pull backwards towards the bottoms of your ear, or to lay down, either on your chair—we do this in the office—and tip your chin back slightly and take a mirror and look in the mirror.
And those are both really good ways to get an idea of what a facelift by itself would accomplish. When we talk about facelift surgery, what a facelift does and where a facelift works is if you draw a line from your nostril to your ear, everything between that line and your collarbones is what a facelift is designed to improve. It works reliably on the jowls and on the neck. Anything that's above that line, cheeks, eyes, eyebrows, forehead, is going to have to be addressed with a separate procedure. Similarly, things in the center of the face, so between your pupils, nose, around the mouth, wrinkles around the mouth also are not going to be reliably and naturally changed with a facelift.
A lot of patients, when they put their hands on their face and pull backwards, see the skin of their cheeks around their mouth flattening out and smoothing out, and facelift surgery doesn't do that. We have to talk about things like chemical peels and lasers and skin treatments to affect wrinkles. Wrinkles are really skin quality problems that we don't address with facelift surgery. The egg is a very good analogy to a youthful face. You have a heart-shaped chin and you're wider at your cheeks than at your chin. With time, and one of the things that we talk about in facelift surgery is that egg flips over and so the widest part of that egg is at the bottom.
What that looks like in real life is, as gravity takes over, the skin starts to sag, volume is lost in the face, the muscles of the face start to sag your face tends to get heavier at the bottom around the jowls and gets more square shaped. What a facelift does is we try and establish that inverted egg shape of youth. Where patients can go astray—and this is where we see a lot of, sort of, unusual, unnatural looks with injectable fillers—is that injectors, who are a lot of them well-intentioned, will try and recreate that heart shape by filling up in the cheeks claiming that their filler is going to lift. And filler just—it drives me crazy; filler doesn't lift anything; it fills. And in the wrong patients, what happens then is you end up turning an egg shape into a square. You're not helping to reshape the lower part of the face and neck; you're just making the top part of the face wider and making a square shape, which is a very unnatural appearance.
In younger patients. A little bit of filler in the upper face and cheeks can work, especially if there's very mild or no jowling that's present, but once you start seeing heaviness around the jowls, you're not going to get a good result with filler. The other thing that I hear a lot of is people asking questions whether we're going to do a mini-facelift, whether we're going to do a partial facelift, whether we're going to do a full facelift. And where that got started is in the '70s and '80s, facelift surgery was incisions all the way around the ears, up over the top of the head. And facelift techniques have improved over time. We know more now about how to do more with less, and so that traditional big long incision over the top of the head isn't done much anymore.
Modern facelift techniques, the incisions—which we talk about in every consultation—are very well camouflaged. They fall in natural boundaries, so they're very, very hard to see. And really the incision for a facelift surgeon is your signature. These incisions are difficult to see at 3, 4, 5 weeks after surgery, and six months to a year later are—and should be—very very difficult to see. Incisions are typically hidden around the hairline, in the sideburn, follow very closely the contours of the ear, around the ear, back up, and then down in the hairline.
And a smaller incision underneath the chin is used to help tighten the platysma muscle, which is kind of an apron of muscle which goes from your lower jaw down to your collarbones and is responsible for this neck banding. It's very difficult or impossible to eliminate neck banding without doing a platysmaplasty, or tightening that neck muscle in the middle. So, that is also an important part of modern facelift techniques. Now, there's a lot of talk about mini facelifts and short facelifts you can do in an hour in the office with local anesthesia, and you're back at work the next day.
And can those be done? Yes. I don't do them, primarily because they're quick procedures that offer minimal recovery and really don't offer good long-term results. Within six months, things have started to sag already and you really don't get what you pay for. And so, for those patients, that's where we can talk about some non-surgical things.
A lot of the patients that would benefit from a mini facelift are the same patients that with good skin care and a little bit of filler or fat grafting can avoid having a facelift until it's a procedure that is really going to be beneficial. Another part of that is that in terms of recovery, you really get what you pay for. Typical facelift recovery so that you can be back to work and back out in public without looking like you've just had facelift surgery is about two weeks. And what I've found over time is that you really can't shortcut that recovery too much. There are things that we can do in surgery that can help minimize bruising and swelling, and we do those things, but I still advise patients to budget two weeks off for recovery from a facelift.
Another important part of facelift surgery is the addition of volume. We do lose volume as we age and that volume needs to be put back. And that was a shortcoming of old facelift techniques is that they would pull, they would stretch the skin and the muscles tight around the deflated face, and all you would see is a deflated face with tight skin which doesn't look natural, it doesn't look youthful, and most people see those results as the hallmark of bad facelift technique. And you can pick up any magazine at the supermarket and see evidence of that.
Going into a little bit more detail, I've talked in previous shows about how facelift surgery is really muscle surgery more than anything. And there are a lot of different ways to manage the muscle, to tighten the jawline, to tighten the neck—and we talked about platysmaplasty just a minute ago—the SMAS is the muscle layer of the face and that's really what we tighten during a facelift, and there are lots of different ways that we can go about tightening that muscle. Right now, it's summer of 2022, and the deep plane facelift is all the rage. And the deep plane facelifting is an arrow in many of our facelift surgeons' quivers, so to speak.
The deep plane facelift, though, has been around since the '90s, when Dr. Sam Hamra first described the composite technique, and so the deep plane is not something new; it's been something that's kind of been rediscovered and perfected since Dr. Hamra's first description. A couple of years ago, there was an article in [unintelligible 00:10:30] Journal—which is, kind of, the plastic surgery medical journal—where four surgeons who were all very experienced did facelifts on different patients, and everybody got to rate each person's results. And the interesting thing was that the results were all great, and all four surgeons used different facelift techniques. And so, the takeaway to that is that it's really more about the surgeon than it is about the technique.
Dr. Hall: Thanks for listening. If you're looking for great content like that, please subscribe to the channel and leave us a review so that you can get updates on all of the podcast episodes that are produced. We're always looking for topic suggestions, so send me an email email@example.com, and we'll put out episodes that directly answer your questions. Thanks, and we'll see you next time.
Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at @jhallmd on Instagram and Twitter and @DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.
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