Rhytidectomy – Facelift Surgery
Facial aging touches on two aspects of life; the longevity and ability to compete in a world focused on the best vitality. A youthful face is assumed to be a reflection of energy and health that provides a competitive advantage and gives a sense of longevity.
As Dr. Makhlouf analyzed facial aging, he came to a conclusion that aging occurs on three levels. At a deep level, there is a downward migration of the fat, formation of large skin folds and relaxation of neck muscles. At a medium depth, fine lines and fine wrinkles make their appearance (mainly around the eyes and mouth). At a more superficial level skin quality and texture is affected with dark patches, red spots, scaling, etc. If the aging is mainly at best, the medium or superficial level, please review the section on non-surgical facial rejuvenation. Dr. Makhlouf examines the patient in this framework and notes at which level the aging process is primarily occurring. Accordingly, he chooses the method of treatment that will give the most remarkable result.
Although facial rejuvenation is constantly being revisited and improved upon by plastic surgeons, there is some basic understanding that dictates Dr. Makhlouf’s approach in performing a face lift. In order to simplify the discussion, he tends to divide the face into the upper face, the mid face, and the lower face. Discussion of the lower face is covered in the section on neck lift.
The best plastic surgery literature has witnessed different approaches to the problem for the mid-face. There have been many changes in the recent past as to the way the aging process is understood. As of today, the most reliable and consistent understanding involves realizing that facial sagging develops in an up-down (vertical) direction, not front to-back. Therefore, the correction of the mid-cheek needs to address that vertical descent. Dr. Makhlouf frequently uses a combined approach through the mouth in order to allow for elevation of the tissues over the bones and suspension from an incision in the scalp above the ear level.
As far as the upper face, there is a need to look at the forehead lines, glabellar lines, the lateral aspect of the eyebrow and the eye, and then decide how the correction will occur. A forehead lift can be performed to elevate the eyebrows, or lift the corners of the eyes. Depending on the anatomic circumstances and the concerns of the patient, a plan that addresses those needs is formulated.
Dr. Makhlouf performs the surgery with general anesthesia or with intravenous sedation and local anesthesia. The patient goes home the same day of surgery with drains, which are typically removed the next day. Sutures are removed at one week, and the bruising is gone by ten days. The incisions are usually well hidden.