This is a brief recap of an interesting conversation that I had with a co-passenger on my flight back from Izmir, Turkey to London.
I was happily working on a publication on my iPad regarding mastering facelift surgery, which was targeted towards senior trainee as well as experienced facial plastic surgeons. Intently watching was a gentleman, sitting next to me, smiled and said “I guess you are enjoying this work”? I replied yes, indeed, this is what drives me and keeps me going. I discussed a wide range of surgical and non-surgical procedures, that I perform in my clinic and we ended up having a detailed discussion regarding facial-lift surgery. His initial question was are facelifts only good for women? And what about men? Obviously, though in terms of sheer number, women make up for a higher proportion in facelift surgery. However, in my practice, approximately 15% of patients who have facelifts are indeed men. This is of course backed up by the figures of increasing facelift surgery in men published by American society of plastic surgeons: www.plasticsurgery.org/documents/news
He went on to ask questions such as, how old do I have to be before I can have a facelift? The answer to that question: anyone can have a facelift provided they have a realistic expectation and the risk/benefit ratio yields a significantly improved aesthetic benefit. Majority of facelift procedures are done in people between the ages of 40-55 years, however a number of my patients are in their 60’s, and slightly older.
It is also worth noting that jowling and sagging around the jawline and neck are NOT mainly related to skin excess, but to deeper structures, which include, ligaments, muscles, and fat. Therefore, one has to work on the underlying structures when performing surgery. This is achieved by releasing ligaments and lifting SMAS, a tough tissue that lies underneath the skin. Often, the hallmark of aging also is volume loss, which has to be addressed either by replacing volume with fat transfer or simply relocating the fat from other areas of the face to its original position.
We also went on to discuss the role of botulinum toxins (Botox) and fillers as well as other, the so called “non-surgical facelift” procedures. One has to be clear that botulinum toxin works extremely well in a select group of individuals and particularly in the upper third of the face which includes the forehead and the eye region. Generally speaking, the cheeks and deep furrows around the mouth do well with fillers and recently other procedures such as radio frequency, and injecting substances such as Sculptra (Poly L Lactic acid and PRP platelet rich plasma) all improve the overall aesthetics of the face. However, the gold standard facial rejuvenation procedure is still is a surgical facelift procedure.
During our conversation it was obvious that the biggest confusion was the type of facelift procedure, as my co-passenger had heard about the S-lift, French-lift, MACS lift, deep plane facelift as well as extended subplatysmal facelift.
One of the biggest concerns that was raised and discussed was the idea that facelift doesn’t leave scars. One should clearly understand that scaring is inevitable in any surgical procedure that is carried out. In facelift surgery the incisions are usually hidden and are inconspicuous. Of course, there are individuals who heal extremely well and these include the ones with little pigmentation, very fair skin that has not been sun exposed and non-smokers. As the skin colour gets darker, there is higher risk of scars showing. Smokers in particular perform badly and other risks factors such as high blood pressure have a high tendency of complications.
It is clear that one has to understand that a facelift is not a permanent procedure and the aging process will continue. Factors such as genetics, bony architecture, general habits such as diet, smoking, exercise, sun exposure etc. influence the final outcome. So in truth, facelift only improves the youthfulness but does not halt facial aging process.
Finally, there are a range of non-invasive facelift procedures such as thread lifts which in my experience, have very limited benefits. If one considers the expense versus the benefit, surgical facelift certainly provides the best outcome. So, in my opinion a facial rejuvenation procedure should provide a good result, with a natural, unoperated look with high safety profile, and facelift meets these criteria in good surgical hands.
As has been stated elsewhere, the holy grail of facial rejuvenation would be a device that allows a patient to get facelift results in the office with no downtime. In my experience having been in this field for over 20 years, we are far from this ideal situation.
