A Natural Appearing Facelift by Jesse Smith, MD

Dallas Fort Worth Facial Plastic Surgeon Dr. Jesse Smith shares with us insights on achieving natural results with a facelift. Read more below!

Have you ever looked in the mirror and used your fingers to elevate the skin and structures of your face? Did you like what you saw because it reminded you of a more youthful-looking you? If you answered yes, you may be a candidate for some type of facial rejuvenation. You may also be pleasantly surprised to find that you may not need surgery to look younger.

Navigating Options in Facial Rejuvenation

There are four components of the face that change with age: skin, muscle, bone, and fat. Skin looses elasticity and luster, bone loses volume, and muscles and facial ligaments become weak, contributing to sagging appearance. Every person has a different mix of these factors, and correcting them requires each one to be addressed in a special way. Gone are the days of a “wind-blown” facelift appearance where one surgery was used to correct each unique individual.

Within the central third of the face, we begin to lose bone volume from around the canine teeth, contributing to the parenthesis deformity and to jowls at the corners of the face and mouth. The cheeks also descend, further exacerbating end deepening lines. Many surgeons have attempted to alleviate these problems with a face-lift; however, the primary issue is volume loss that needs to be restored. There are a variety of products currently available for these deformities including: Fat Grafting, Sculptra, Juvederm, Radiesse, and Restylane. These are non-surgical options that can be done in the office. Correcting volume loss alone can take years off of a person’s appearance, and we commonly use these products in combination to produce the Liquid Facelift. The Liquid Facelift restores volume to hollows, while lifting the cheeks, jowls, temples, and forehead, thus, restoring a natural, youthful appearance to the face.

Older Facelift Techniques

Until recently, most face-lifting techniques consisted of extensions of skin only lifts, which resulted in a somewhat unnatural and un-refreshed appearance that seemed to be “pulled too much”. Beneath the surface of the skin runs a thin sheet of muscle called the superficial musculoaponeurotic system, or SMAS. This forms a critical support network for the face and actually stretches with time, leading to laxity of the overlying skin. We do not grow more skin over time. The effects of gravity result in drooping of the facial skin because of decreased elasticity and stretching of the underling SMAS. Surgeries with “SMAS plication” techniques (also known as “S” lift or “J” lift) yield somewhat better results than simple skin lifting in most individuals. The “S” and “J” lifts are performed in combination with a skin lift and add suture suspension of the underlying SMAS, leading to better support than a skin lift alone.

Type of Facelift With Most Natural Appearing Results

In most patients, “deep plane” face-lifts will provide the most natural appearing results. This surgery involves broadly elevating the muscle layer (SMAS) of the face and re-draping it at a higher area, where it was in more youthful times. Only a small amount of skin is excised during a deep plane face-lift, as opposed to skin-lifts where large amounts of skin are removed. Since most of the patient’s skin can be preserved with deep plane face-lifts, this minimizes the possibility for the “wind tunnel” look of older style facelifts, and minimizes scaring because there is less wound tension.

Deep Plane Face Lifting Technique

Deep plane face-lifting is more technically challenging and not all surgeons feel comfortable with this technique. The recovery time is also longer than with simple skin-only facelifts or their cousin, the mini-lift or lunchtime lift. The results, however, are more natural and long-lived. Recovery times range from a few days for mini-lifts, 1-2 weeks for extended skin lifts with SMAS placation, and slightly longer for deep plane face-lifts.

Recently, the use of small cameras, through camouflaged incisions within the hairline and inside the mouth, has allowed for effective, minimally-invasive facelifts to be performed. These allow for enhancement of the central face and cheeks, making it an ideal procedure for the patient in their 40’s and early 50’s. Endoscopic techniques are often combined with rejuvenation of the eyebrows.

A Tailored Approach For Every Patient

Often combinations of the above techniques are needed to turn back the clock in a natural, long-lasting manner making modern face-lifting techniques quite gratifying for the patient. A tailored approach must be made for each patient to offer the best possible results. There are so many reasons why people put off cosmetic improvement. Some worry about taking time away from their hectic schedules to undergo a surgical procedure. While time is a precious commodity for all of us these days, stop and think about how much your beauty and health are worth to you. Would you be able to accomplish more with a fresh perspective and younger feel? Would it be easier to succeed at work and at home when you’re feeling great about your appearance? Many patients say “absolutely” and wish they had done their surgeries sooner. Others worry about focusing on themselves. It is simply not self-centered or vain to take care of you or to want to feel youthful and self-confident. Having a positive self image certainly benefits you, but it can also improve your interactions with others.

Dr. Jesse Smith is a clinical assistant professor at the University of Texas Southwestern Medical Center in Dallas and a Director of The Center for Aesthetic Surgery in Colleyville. Dr. Smith may be reached at 817-503-2442.