The face is one of the first areas to display noticeable signs of aging. Usually, patients start to notice displeasing creases and deepening wrinkles, i.e. nasolabial folds, early jowling, or marionette lines. Genetic factors along with stresses of daily life, including sun exposure, effects of gravity, facial animation, and lifestyle choices, all contribute to facial aging. In addition to skin excess and laxity, bony resorption occurs with fat descent and atrophy, further weakening the underlying foundation.
Facelift is an aesthetic surgery that reverses these signs of aging by correcting the underlying problems of muscle and skin laxity, skin excess, and volume loss. It is often performed with adjunct procedures such as brow lift, neck lift, and/or fat grafting. As everyone fears a windswept look, Dr. Lisa Hwang strives for a natural, understated appearance, restoring the younger you. Now you will look the way you feel!
In women, the brow ideally sits higher than the brow bone, while in men, the brow often sits at the level of the bone. A low-set, drooping brow can appear masculine or angry. It also contributes to hooding (heaviness) of the upper eyelids, triggering hyperactivity of the frontalis muscle in the forehead, which deepens forehead wrinkles.
AKA smile lines. People tend to become preoccupied with these lines, while they are only secondary to the underlying problems (bony resorption, soft tissue atrophy and descent, and skin laxity).
Jowl formation accentuates Marionette lines at the corners of the mouth and creates a pre-jowl sulcus. Jaw definition is gradually lost as the face becomes more rectangular and bottom-heavy.
The neck may show signs of aging even earlier than the face. Loose skin and fat are emphasized upon flexion of the neck. Platysmal bands may become more apparent as the muscle weakens and loses elasticity.
Brow lift establishes a more youthful brow shape and position while weakening muscles that contribute to brow furrowing and wrinkles. This surgery can be performed as an open or endoscopic procedure. Open incisions are hidden either within the hairline (coronal) or along the hairline (for people with high/larger foreheads). In the endoscopic approach, surgery is performed through tiny incisions within the hairline under visualization through a small camera.
Facelift corrects the underlying soft tissue problems of aging by tightening the underlying submuscular aponeurotic system (SMAS) and removing excess skin. Incisions are hidden within the hairline by the temples and continue down in front and around the ears, extending into the hairline behind the ears. The extent of the incisions depends on the amount of overall laxity in the individual. Reversing the soft tissue effects of aging enhances the contour of the mid and lower face.
Problems in the lower face and neck are usually not isolated problems, often extending from soft tissue laxity in the face. Thus, a neck lift alone usually will not fully address the problem; rather, it is often performed as an adjunct to a facelift. Platysmaplasty tightens the neck muscle through a small submental incision under the chin to correct banding. Liposuction or direct excision can be performed to remove excess fat. But moderate to severe skin excess will generally require a facelift to be fully corrected.
One of the main problems in aging is soft tissue and fat atrophy. Loss of plump, youthful volume results in an aged and exhausted appearance. Fat transfer utilizes the patient's own fat in other parts of the body to restore hollowed areas in the face, i.e. temples, cheeks, nasolabial folds, and the chin. Because only about 50% of fat survives long term, patients should beware that their immediate postoperative result may be more plump than ideal. Over the first 6 months, swelling improves.
Psychologically, face surgery is one of the most difficult to recover from, mainly because our faces are central to our identity, and while we are recovering in the isolation of our own homes, we are constantly reminded of the temporary disfigurement when we look at our reflection in the mirror.
Physically, patients generally experience minor discomfort—many actually report numbness in the affected areas. Patients can also expect swelling, bruising, and a sensation of tightness. Most signs and symptoms improve within 2 weeks. But it may take up to 3 to 6 months for swelling to completely resolve and for sensation to improve.
After facelift and neck lift, drains are placed on each side of the face to evacuate blood/bodily fluid and minimize swelling. Based on the output, they may be removed within the first couple days. Patients should sleep with their heads elevated while lying in bed. Cool compresses may be used, but direct application of ice should be avoided since the face is numb. Patients are encouraged to get out of bed and walk around periodically to avoid developing clots in their legs or lungs.
Risks & Complications.
Risks include bleeding, infection, delayed wound healing, asymmetry, contour deformity, and temporary or permanent numbness/paralysis. Smoking cessation is required, as it predisposes you to wound healing issues and skin necrosis.