Facial aging touches on two core aspects of our life; longevity and the ability to compete in a world focused on vitality. A youthful face is assumed to be a reflection of energy and health. It provides a competitive advantage and gives a sense of longevity. We all want to have our external appearance match what we fell inside.
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.
In reality we all age at the three levels and many times correction is needed at all levels. Pulling the skin, eliminating deep wrinkles and re-positioning the fat but not addressing dark spots in the face is similar to ironing a stained bed sheet. The result is incomplete.
However, if your changes are primarily in the medium or superficial level it is best to treat it non-surgically or with minimally invasive interventions.
If you are interested in exploring your options, 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. His recommendations are based on his experience and many times may recommend a simpler solution. Dr Makhlouf strives for natural results; he firmly believes that the treatment should be proportionate to the amount of aging present. Accordingly, he chooses the method of treatment that will give the most remarkable result with the least intervention.
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.
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, correction of the mid-cheek needs to address that vertical descent. This is not however an isolated event as we realize the neck upper attachment is the cheek, and correcting the mid-face will go a long way to improve the neck itself
At this stage some surface anatomy is indicated:
- The lower anterior part of the side burn is one reference point.
- The attachment of the earlobe to the check is another.
- The attachment of the upper ear to the skull is a third one.
By feeling the tissues and looking at a tentative pull, one can identify the points on the face and cheeks that should meet these non-moving reference points.
This gives the surface plan; the fat repositioning represents the plan for the deeper tissues.
There is a small variation in the incisions made for men and women. Essentially the incision has to start at the junction of the hair and temporal area or within the scalp above the ear, it the moves in front of the ear, but Dr Makhlouf prefers hiding part of it at the entrance of the ear canal. After it passes in front of the earlobe and then turns behind it. At that point it has to go across towards the hair bearing scalp. That turning point it behind the upper part of the ears because the scar is hidden while it heals. Later it becomes invisible. Excess skin is taken out throughout all the incision lines, the amount depending on the laxity of the skin and the pull.
Not uncommonly adjunctive procedures are done at the same time. Blepharoplasty (eyelid tuck) being the most frequent, but lip lift, per-oral dermabrasion, chemical peel along with fillers, among other interventions, are done as well.
Dr. Makhlouf performs the surgery with general anesthesia or with intravenous sedation and local anesthesia. The patient goes home the same day of the surgery with drains, which are typically removed the next day. Sutures are removed after one week, and the bruising is gone by ten days. The incisions are usually well hidden. Generally patients can go in public at one week, and be comfortable to go out for dinner in 3 weeks with minimal make up.
For more information about this procedure and others, please contact our office at 847-297-8001. In the meantime, you can see the results of some of Dr. Makhlouf’s facelift surgeries in the photos section.