Lifting the Aging Face

By: Dr Barry Eppley

Facelifting is an inherent part of plastic surgery and one of the earliest cosmetic procedures performed. But yet to the general public, it still remains largely misunderstood.

The general public's perception of a facelift....based on TV shows and the internet...is someone after such surgery being bruised from their eyes to their neck and their face wrapped up in a big dressing...like they had been involved in a major accident. And that it will take weeks to even look good enough to go out in public. In fact, this belief is quite inaccurate.

Facelift as the name of the surgery is misleading. It does not really describe what the surgery actually does or what the objectives of the procedure are. More accurately, a facelift should be called a neck-jowl lift, for this is what it actually helps. It is ideal for tightening that neck and lifting those jowls. The original name for a facelift, rhytidectomy, should be more accurately described as a necklilft or cervicoplasty. (reshaping of the neck) However, the name facelift persists and always will as it is embedded in our plastic surgery nomenclature.

Therefore, when you realize that only the neck and jowl are affected by the procedure, many of its misconceptions fade away. In isolation as a stand-alone procedure (which half of my 'facelift' patients only have), a facelift causes no bruising or swelling from the nose up. While many facelift patients get their eyes, forehead, nose and other facial procedures done at the same time, this is not a requirement and is only done if one wants the 'total face' rejuvenated. I find that after an isolated facelift, one can look pretty good in about a week and can easily be out in public in a few days with a little make-up in the neck area. No swelling occurs around the eyes at all!

One of the great misconceptions about a facelift is what is actually done in the operation. A facelift operation is all about tissue layers and vectors of lifting. The lifting off of the skin from the underlying tissues over the side of the face (to the cheek area) and across the neck through incisions placed in and around the ears is obvious in any diagram of a facelift operation. And movement of loose skin pulled back and over the ears at about a 45 degree angle to the face probably accounts for about 80% - 90% of the result created by a facelift. And often this is the only tissue moved in a facelift. This is the simplest, quickest and safest approach. More recent facelift developments have been to lift up tissue layers deeper than the skin. These deep layer that can be moved independent of the skin, is a special layer of tissue over the muscle. This tissue, known as SMAS, is raised and sutured up in a more vertical direction compared to the direction of the skin pull, closer to 60 degrees usually. Erroneously, the public is under the impression that facial muscles are moved whichi can not be done. On top of the muscle sits the SMAS. There is considerable debate as to whether the 'deeper' versions of the facelift produce better long-term results than skin movement only.

The neck-jowl lift, known historically as a facelift, can lift two different layers of sagging facial tissues in two slightly different up and backward directions.

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