Facelift surgery is a very large part of Dr. Romy's practice. Facial aging is the results of two factors, gravity acting on the facial muscles and loss of volume and thickness of the facial skin and soft tissues. These changes create folds, depressions and shadows in the face that make us look tired, stressed and simply older.
The Goals of a Facelift
Facelift surgery is not meant to change the appearance of your face, but to improve the signs of aging and restore a more refreshed and youthful facial appearance. Patients often feel we have turned the clock back by 10 years or more. When performed correctly by a properly trained and experienced board certified plastic surgeon like Dr. Romy, the procedure achieves a natural, beautifully revitalized version of yourself.
The Facelift Procedure
Dr. Romy performs facelift procedures using local anesthesia and intravenous sedation, or under general anesthesia. Incisions are usually made around the ears in well-hidden creases, and extend into the hairline. Deep tissues of the lower face are lifted, tightened and sculpted to produce a naturally younger-looking appearance with firmer and smoother skin (see SMAS and deep plane facelift ).
Optional Add-ons
Many of our facelift patients also choose to rejuvenate the eye area with a blepharoplasty when they have their other facial surgery, or they add on fat grafting to bring back the youthful appearance that can be lost as fat atrophies and drops on the face.
Early Recovery
Facelift patients typically stay overnight in hospital before going home. You should expect to see some swelling and bruising, which can appear quite dramatic but is expected and temporary.
At Home Recovery
We recommend that patients have 2 weeks set aside from regular work and activities so they can relax and recover in comfort at home. After this time, the majority of swelling and bruising will have resolved.
You'll see Dr. Romy again within the first week of your recovery for follow up assessment.
Mini Lift
A mini face lift, or short scar facelift, is a surgical procedure that Dr. Romy performs on patients who are looking to rejuvenate primarily the lower face, and jowls. This procedure can also be used to create smoothing of loose skin around the neck. Many women choose this procedure if they want specific more limited results while keeping the ability to wear their hair back in a ponytail without anyone seeing scars. For this reason, it is also sometimes referred to as an S-lift or even more colloquially as a ponytail facelift.
The Mini Lift Procedure
Dr. Romy performs the mini facelift procedure by repositioning all portions of the lower and central face that are showing signs of aging. The main difference between this type of facial rejuvenation and a full facelift surgery is the length of the incision. The mini facelift involves elevating the overlying skin, tightening and restoring the muscle layer and contouring and removing excess skin. The mini facelift scar is half the size of the incision normally seen in front of the ear. It also does not require most of the incisions behind the ears so those are eliminated.
The mini facelift achieves natural and impressive results, but is best suited for women in their forties and fifties. In the sixties and seventies there is greater amounts of skin that requires removal, and a longer incision is required to achieve the desired results.
Deep Plane Facelift
The deep plane facelift avoids the problem of the too-tight look of older facelift techniques, which resulted from pulling back the skin. With a deep plane approach, the muscle layer is released from the underlying tissues and repositioned in a natural fashion so as to avoid a too-tight or “pulled back” look.
The “deep plane” is the anatomic area that exists between the SMAS complex (which is muscle and fascia) and the underlying soft tissues of the face. The deep plane facelift focuses on the release and movement of this muscle layer and repositioning of fat pads.
Here, Dr. Romy elevates the superficial skin layer for a short distance then goes below the superficial muscular aponeurotic layer at the level of the mid-face, and below the platysma muscle at the neck. The structures of the mid-face are lifted vertically, while the deep neck is lifted posteriorly. This separation allows for a natural vector of pull in each desired direction. Excess skin is removed as contour is achieved.
SMAS Plication Lift
For some patients, a SMAS plication lift is ideal. The superficial muscular aponeurotic system (SMAS) is a layer of fibrous tissues and muscle that begins just in front of and below the ear and extends down to the neck. With age, the SMAS becomes loose and redundant. Drooping of the SMAS creates laxity of the skin along the lower face and jawline leading to jowls, marionette lines, and nasolabial folds.
Traditional facelift techniques generally lift the skin of the face, which can create a tight and unnatural appearance. SMAS facelift involves tightening the muscle layer and allowing the skin to drape naturally on the muscle. This creates much more natural results that still appear smooth and youthful. Most people considering a facelift want to look younger and refreshed, but not like they have had a facelift. The tight unnatural appearance can be avoided with the SMAS facelift technique.
Candidates for SMAS Plication Lift
Men and women who are showing the signs of aging with droopy, sagging facial skin are typically good candidates for the SMAS Facelift procedure. It is best that candidates are in good health, do not smoke, and don't have medical conditions that impair the healing process.
The SMAS Plication Lift Procedure
A SMAS facelift begins with Dr. Romy releasing the skin from the underlying attachments. Here, at a level above the muscle, the SMAS layer is identified and plicated. This allows for reconstitution of the muscle layer while allowing the skin layer to follow a very natural contour as the excess skin is removed.
Revision Facelift
Revision facelifts are procedures done after a person has already had a facelift elsewhere. Dr. Romy has extensive experience in revision and corrective facelifts.
Patients who come in for revision facelifts with Dr. Romy have different issues than patients who have not had prior facial surgery. A revision requires special techniques and care because of previous surgical manipulations to the underlying anatomic layers.
Most people seeking a revision facelift had a good result with a previous facelift, however the skin has continued to naturally age over time and a repeat lift is required to maintain the youthful appearance. Although individual factors such as skin elasticity do factor in, most well performed face lifts can last a good ten years.
Less often, a person had a facelift and felt the result was not acceptable because some areas were under treated. Some common concerns are ongoing jowls or continued neck laxity after surgery.
Patients who are overdone with a too-tight or “pulled back” appearance tend to be dissatisfied and often will seek facelift revision procedures as well. If their initial facelift technique placed excessive tightness on the skin, this can lead to unacceptable scars and distortions around the ears.
In a revision facelift, Dr. Romy begins by identifying the techniques used in the initial procedure. This is one of the reasons why its important to seek out a board-certified plastic surgeon with experience in all facelift techniques as well as revision surgeries. Dr. Romy concentrates on the sagging deep tissue that remains after the original superficial facelift. Here, often a deep plane approach is best as it does not over tighten or over pull the skin but can still correct residual jowling, cheek drooping and nasolabial folds in one procedure.
In the case of unacceptable scars, Dr. Romy will assess whether a scar revision can be done or if it will produce greater tension on the new scar and not heal well. In these cases, Dr. Romy will often revise the facelift with an approach that supports the deeper layers of the face (fascia and muscle) to take the tension off the skin so that the incision can heal with a thin and more acceptable scar.
Male Facelift
Facelift surgery in men has become increasingly popular and represents a large portion of the facelifts Dr. Romy performs. A male facelift can improve jowling, neck sagging, and restore a natural fullness to the face while maintaining a masculine jawline and minimizing scars for men with short hair.
The Goals of the Male Facelift
Like most facelift patients, men considering facelift usually want to look naturally youthful and rejuvenated. Men often request help with jowling and neck laxity, and seek a more defined and masculine jawline. Dr. Romy is proficient in techniques that minimize scarring even for men with short haircuts.
An Individualized Approach
Depending on your area of concern, an isolated neck lift, submental (under chin) liposuction, or mid-face lift may be appropriate for you. The techniques for facelift surgery in men are quite different than those in women. The presence of the beard, choice of incisions, direction of pull, and addressing fat loss are all critically different in the male facelift.
Above all else, a natural look is critical as it avoids facial feminization. A SMAS or deep plane approach is often appropriate for men as they focus on improving laxity in the muscles and fascia of the face while not pulling at the skin which gives an unnatural appearance.