I prefer the term 'facial rejuvenation' over the more antiquated term 'facelift', as many patients that I see who seek a more youthful and refreshed facial appearance undergo a set of surgical procedures very different from what would have been considered a 'facelift' twenty-five years ago.
The word 'rejuvenation' means, literally, 'to make young again'. In each individual, different facial changes occur with age. One person may be unhappy with 'baggy eyelids', while another has 'droopy eyebrows'. One person may be troubled by 'jowls' in the lower face, while another would like an improvement in their 'floppy neck'.
Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.
Plastic Surgery of the Face in the 21st Century
The specialty of Plastic Surgery has been undergoing a 'paradigm shift' in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older 'subtractive' techniques to newer 'restorative' techniques.
Surgery which consists mainly of removing (subtracting) skin and fat and pulling tissues tight will lead, in many instances, to a 'skeletonized' and therefore more aged (or "done") appearance. Facial soft tissues (and even the facial bones) actually lose volume and projection with age, and it is thus inevitable that surgery which focuses only on removing tissue will in some fashion 'age' the face.
The contemporary approach to surgical rejuvenation of the face consists more and more of an attempt to restore facial volume and contour, in an attempt to emulate youthful facial features. My personal approach to facial rejuvenation is to first maximize repositioning and recontouring of facial aesthetic areas, and to remove only as much tissue as is necessary.
I also find that structural fat grafting, using a patient's own fat from the abdomen or hips, is an extremely effective means to help restore the facial volume associated with a youthful appearance. The importance of restoring facial volume is readily apparent when I review with a patient a number of photographs from their twenties and thirties. The meticulous addition of soft tissue volume by means of fat grafting is one of the most powerful means now available for 'turning the clock back.'
Below is a list of facial aesthetic areas and the corresponding surgical procedures that I perform to enhance each specific area. Most patients that have what is commonly referred to as a 'facelift' are undergoing some combination of the procedures listed below based on their own individual needs and goals. For that reason I prefer the term 'facial rejuvenation' over the term 'facelift'. Each of these topics is discussed on the following pages.