When I was a younger man, and in training to be a plastic surgeon, I was taught how to do a facelift. If a patient came into the office, and complained about looking too old there was essentially only one treatment that patient would be offered: a facelift. The only question would be:are we going to lift the brow too, and do we need to treat the eyelids with an “eye-tuck” (blepharoplasty), and are we going to add some treatment to make the skin itself look younger (chemical peel, laser). The basic treatment however was the facelift.
In the earlier days of plastic surgery the thought was that people looked old because they had too much loose skin, so the early facelift was about tightening the skin. By and by, plastic surgeons came to understand that the more important issue was what had happened underneath the skin to make the face look old. We saw that the soft tissue under the skin appeared to have slipped down on the face, as if gravity had pulled things down on the face. In the 1970s plastic surgeons started lifting up the soft tissues under the skin to make the face younger. Over the years, this technique was modified in several ways that particular surgeons thought might make for a more durable result. These operations are still very popular, but in the last few years there has been a huge revolution in how we make faces look younger.
Before I explain to you how we make faces look younger, you have to understand why faces look older. To help you understand this, we will look at two photos of me, taken about 35 years apart.
Besides the utterly depressing loss of hair, I want you to notice several things:
1- Look at the general shape of my face. When I was 24 years old, my face was oval shaped, being very much narrower at the bottom, and fuller at the top. At 59 years old, my face is rounder, being fuller at the bottom and down onto my neck.
2- Notice how I have shadows under my lower eyelids that look like bags, and how the shadow extends across my right cheek, whereas when I was younger,my cheek was entirely smooth from just below my eyelashes right out onto the cheek.
3- Notice the deep lines that extend from the base of my nose, past the corner of my mouth, and down onto my jaw.
4- Notice how the line of my jaw that used to be so visible is now blurred by the fullness in my lower face.
All four of these changes are caused by the same events that accompany aging, namely that some of the fat cells in my face have completely shut down and have virtually disappeared, while others have awakened and become chubby. The fat cells in the upper half of my face have largely disappeared, while the ones along my jaw and down in my neck have plumped up. This is why oval has become round, why my jaw has jowls, why my eyes look tired, and why my mouth looks like a marionette. Think of the cheek as a balloon that has deflated and is now hanging limp across the corner of my mouth.
We call that the “deflation wave”. It is kind of like “the wave” at a football game, when people stand up and sit down as the wave goes along. In this case the fat cells at the top have permanently sat down, and the ones on my jaw and neck have stood up.
Notice how my description of aging has said nothing about “too much skin”. It is all about fat in the wrong place.
Now let’s look at a “No Incision Facelift”. In this nice lady I used laser liposuction to remove the fat from her jaw and neck, and then I used a sophisticated fat grafting technique (using her own fat) to restore the fat to her upper face. No incision, just little punctures hidden under her chin and in the normal creases of her face.
The wonderful thing about this advanced approach is that I do the whole thing in one visit to my office, under local anaesthesia with a very mild sedation, and there is really no recuperation, just one week of being careful about how you sleep, what you eat, and how much you talk.
A very wise surgeon once told me, “Patrick, just because you own a hammer doesn’t mean everything is a nail”. Just because I know how to do a good facelift doesn’t mean everyone needs a facelift. Now I also do minimally invasive techniques that are the perfect approach for many of my patients who neither need, nor want a facelift.*
-Patrick W. Lappert, MD
*Remember that individual results of surgery and other procedures varies.
