FACELIFT (RHYTIDECTOMY) NEW JERSEY
Introduction To Facelift
"There is no garden variety facelift technique that applies to everybody."
A facelift is a surgical operation for the purpose of rejuvenation of the face and neck contours. Skin type and tone, degree of skin laxity, and basic bone structure all factor into your options for facial rejuvenation and contribute to your outcome. We look at each person on an individual basis to customize a surgical plan that meets your needs and desires.
In years past, large incisions were made and the skin alone was tightened. Nowadays, smaller incisions can be used and the skin and muscle layer (SMAS) are tightened, which results in very little tension on the skin and ultimately, improved scarring. To keep your facelift un-extreme, we reshape the skin and underlying tissues by removing, repositioning, and adding soft tissue rather than merely pulling the skin tight. Adding volume back to the face instead of just removing loose skin, is another very important aspect of a rejuvenated, more youthful look.
Facelifts mainly address the lower two thirds of the face and the neck, but do little to improve the eye and brow area unless the operation is specifically designed to address aging changes on your upper face. Unfortunately, facelifts do not address overall skin texture, skin thickness, or the presence of fine wrinkling and deeper creases near the nose and around the mouth. Consequently, we often do facelifts along with other procedures such as eyelid lifts or browlifts. It is also very common to add non-surgical treatments to a facelift including injections with botulinum toxin or filler substances, and resurfacing techniques (laser peels or chemical peels) to give the best result possible.
A facelift is not a specific procedure anymore. It has become a more generic term, as newer methods continue to evolve. Facelift techniques are usually categorized by the tissue level where the work is being done. For example, a SMAS lift is a more superficial technique in which we are working with the skin and the underlying muscle layer while a subperiosteal lift indicates that we are working at a deep level, just above the bone.
Different Facelift Techniques
"The universal concept in facelifts is to correct loose skin, tighten stretched out muscles and reposition fatty tissue."
We are continually devising new facelift techniques, with smaller incisions, and building upon older methods. No one technique works for every patient so we have to customize our approach for each person taking into account age, gender, skin type, and bone structure. The universal concept, however, is that loose skin, weakened muscles and drooping fat, like in the cheek or jowl area, must all be corrected to fully rejuvenate the face.
This type of facelift not only repositions and removes excess skin, but also isolates and tightens the thin but strong underlying connective tissue layer know as the SMAS (superficial musculoaponeurotic system). As a result of tightening the foundation beneath, the skin over the cheeks, jawline and neck are more easily redraped to give smooth and improved contours without visible tension. An extended SMAS lift includes more extensive isolation of the connective tissue layer to take up the additional skin laxity in people who have deeper folds between the nose and corners of the mouth.
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A subperiosteal type of facelift liberates and releases tissues off the bony layer and is sometimes done endoscopically. This technique is performed to get a more thorough release of the facial tissues. It usually causes significantly more swelling and takes longer to recover, but some surgeons feel the lifting effect is longer lasting. We do not believe, however, that the subperiosteal approach adds any additional advantage over the SMAS technique, which has become the gold standard in facelift surgery today. The bottom line is that everyone now recognizes that reshaping, elevating and fixing the underlying structures is crucial for achieving natural, lasting, and satisfying results over skin lifting alone.
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Deep Plane Facelift
This technique is used to reshape the entire face - including the upper and lower eyelids, the brow, and the neck - by lifting the facial tissues, fat, muscles, and skin in one continuous section. It is more invasive than other methods, and may require longer recovery. This technique is used infrequently as most people are well served by the less invasive techniques.
"Everyone now recognizes that reshaping, elevating and fixing the underlying structures is crucial for achieving natural, lasting and satisfying results over skin tightening alone."
Traditionally, an incision is made that starts two to three inches above the ear in the hairline behind temple which extends down in front of the ear for two to three inches and around the ear lobe, and then into the crease behind the ear with an extension into the hair behind the ear. Modified techniques are becoming popular which reduce the length of the incision behind the ear and into the scalp. We prefer to use the modified facelift approach, also known as the "minimal" facelift, "mini" facelift or the "S-Lift", on younger patients who generally have less skin laxity to correct and are thus able to have a shorter scar. In another modified approach, the incision stops short of the hairline and extends around and in front of the sideburn area to minimize the alteration of the sideburn or temporal hairline location. This technique also works well for men who may not have thick enough hair to cover scars.
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Signs of aging along the middle section of your face include increased definition between the lower lid and cheek area. It is here, where the hollow of the eye begins to appear more defined and the natural smooth transition between the cheek and the area below the eyelid now becomes very distinct. In addition, the deep folds which extend from the sides of your nostrils down to the corner of your mouth (nasolabial folds) become heavier as the cheek tissues descend. The mid face-lift or "Cheek Lift," improves loose or hanging skin and soft tissue along the middle of your face but does not improve the contours of your forehead, jawline or neck.
Mid-face lifting has taken on a new focus in the past several years. As the triangle between the lower eyelid and nasolabial folds begins to age, the cheek begins to descend. Plastic surgeons began to notice that despite all efforts at traditional face lifting and correction of the jawline, neck, and side of the face, the mid-face area just to the side of nose and below the eye was not greatly improved by a facelift alone. Detecting the presence of aging signs in the mid-portion of the face and making a plan to correct the problem is more important than which fixation technique is ultimately chosen. When this area is overlooked by you and/or your surgeon and not properly addressed, a satisfying rejuvenation may not be achieved.
Several access points can be used to perform mid-face lifting. Traditionally, a midface lift is performed through incisions along the lower eyelids and is often carried out in combination with an eyelid lift and/or facelift. During a traditional face lift, an additional incision can also be made inside your mouth to help to release the mid-face tissues. The tissues are then suspended by use of sutures or dissolvable devices. The Endotine® is an example of one of these dissolvable devices and is made of an absorbable material that acts like a carpet tack in holding up the elevated tissues and then dissolves over the next few months.
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