Facelifting examples
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Repositioning of the sunken structures
In experienced hands, modern techniques allow for targeted correction of problem areas which achieve very natural results. The dreaded loss of facial expressions and contorted mouth, with proper implementation, are no longer an issue these days.
As age relaxes the tissue structures, the face starts to sag due to gravity. Furthermore, relaxation of the skin folds and reduction of the subcutaneous fat causes the face to lose volume.
Cosmetic facial surgery must address these three aspects:
According to plastic surgery, the face is divided into four regions:
Each of these four regions ages differently in each individual. We all know that hamster cheeks differ strongly in people of the same age, similarly in one and the same face we can see very different degrees of aging in different regions. There may be a clear double chin, while in the cheek area are no wrinkles. This shows the importance of accurate analysis of the problem when planning a facelift.
All four face regions must be regarded as distinct and separate parts of the face to be corrected. For each of these regions there are many techniques which differ in efficiency and extent.
The forehead lift is used to remove wrinkles on the forehead and raise the eyebrows. It is an effective method to eliminate the “sad” expression. In particular the position of the eyebrows strongly influences the facial expression.
A successful forehead lift can achieve as much as a successful cheek lift. The height of the forehead is essential in the choice of the forehead lift method.
Three methods are available:
If you are interested in a forehead lift and have a low forehead, the coronal forehead lift would be suitable. In this method, the incision is curved within the scalp. In addition to the elimination of forehead wrinkles and raising the eyebrows, this intervention leads to an increase in the (forehead) hairline.
If you have a high forehead, the pretrichial forehead lift would be suitable. In this method, the incision is made along the frontal hair line. In addition to the elimination of forehead wrinkles and raising the eyebrows, this intervention leads to a lower hairline (forehead).
During an endoscopic forehead lift, no excess skin is removed thus resulting in almost no scarring. However it is significantly less efficient than the coronal or subcutaneous forehead lift.
The mid-face lift is used to correct the region that extends from the lower margin of the eye socket to the sides of the mouth. This area often ages faster than other facial regions. Due to volume loss and the relaxation of the tissue in the mid-face region, the formation of dark circles occurs which leads to a flattening of the zygomatic region and an emphasis on the nasolabial folds.
The mid-face lift is therefore threefold:
There are three ways:
Let us not discourage the use of technical terms. The choice of technique depends on the anatomical conditions, i.e. which of the three problem areas (dark circles, malar region (cheek), nasolabial folds) is in the foreground.
If there are marked dark circles present, the upper layer of tissue needs to be raised. This works best with the MACS technique. Simultaneously, the nasolabial folds can be effectively corrected.
If the zygomatic region is flattened, volume must be added. In this case, the subperiosteal technique is appropriate. For the correction of nasolabial folds, this method is less suitable.
The third technique is not an independent method and can only be used as a complement to a cheek lift. If, in addition to a sunken mid-face, chubby cheeks and wrinkles are present in the cheek area, by extending the technology used here (SMAS-flap) this can also be corrected with the mid-face lift.
The cheek lift is frequently carried out on all cosmetic surgery of the face and has the largest range of different techniques.
The cheek lift can correct chubby cheeks and add fullness to a laterally flattened malar region, but cannot correct nasal folds nor dark circles and puffiness.
The classic of the available methods is the cheek lifting with the SMAS flap. At the same time this is also the most effective technique to correct chubby cheeks and wrinkles in the long term. It is a two-layer method in which one tightens the SMAS, the cheek skin is then softly and gently stretched out after removal of the excess skin. This dreaded unnaturalness is avoided.
In addition to this method, there are a whole range of techniques that require less effort, but which are also far less effective. These include so-called “modern” methods, which are often advertised in newspapers and magazines and imply the supposed advantage of faster healing and less recovery time. These types of interventions are more appropriate for relatively young patients with relatively little need. To offer a mini-lifting to a 60 year-old patient with age related problem zones is not only unreasonable but also irresponsible.
The cheek lift can be extended with little effort to a limited neck-lift.
The tightening of the neck is combined in most cases with a cheek lift, but can also be done alone.
There are three ways:
The neck-lift by only removing the skin behind the ear is outdated and of limited effectiveness. The standard method is to streamline the platysmas sideways with the SMAS technique. The platysma is a superficial, straight neck muscle, which merges into the side of the SMAS and causes the relaxation and the formation of a double chin.
The most effective method by far is the corset-operation by Feldman. By unifying the two Platysma halves, a new ribbon-like anatomical structure is created with which the neck can be moved inward and upward. As can be seen in the profile, the neck is again smooth and firm.
BEFORE & AFTER PHOTOS FACELIFTING
Dr. Edvin Turkof
Specialist Professor of Plastic, Reconstructive and Aesthetic Surgery
Court-Appointed Expert Witness
