Facial Rejuvenation and Facelift

Our face is our calling card.

Nowhere does aging leave its imprint more noticeably than on the face. The appearance of aging does not always correlate with our own inner feelings and well being.

Many factors contribute to the aging face including heredity, stress, sun exposure, inadequate diet, alcohol consumption and smoking. Gravity and the unrelenting aging process add to those factors, sometimes dramatically. All of this results in loss of skin elasticity and relaxation of the of skin and soft tissues which are reflected in slack, sag, wrinkles and folds. This can change not only the way you look, but also the shape of your face. You start looking tired and older, despite the fact that you don’t feel old!!

Plastic surgery can “turn the clock back” by enhancing your facial appearance and creating a more fresh, youthful look.

Categories of Patients Seeking a Facelift

• Those that need lifting procedures for their sagging and excess skin.
• Those that only need nonsurgical treatments to address their skin quality with Skin Care, Peels or Microdermabrasion…or volume loss with non-invasive treatments such as Fat Transfer, Soft Tissue Fillers or Botox or other modalities such as external ultrasound or radiofrequency devices.
• Those that need both.

There are 3 elements that contribute to facial beauty: proportion, symmetry denoting good health and a pleasant expression.

Before and After Photos

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Areas of Facial Analysis

• Forehead and eyes
• Midface
• Neck
• Facial skin

Facial rejuvenation surgery may involve procedures to reduce signs of aging in the lower neck, the midface area, as well as the eyelids, eyebrow and forehead regions. Multiple facial procedures may be performed at the same time. The current trend is for a more natural look with “less equals more”. Therefore, the goal is to produce a more balanced, harmonious and natural appearing improvement.

The good news is that most of these procedures do not require general anesthesia and therefore can be performed under local anesthesia or under IV sedation resulting in less complications and problems.

Types of Procedures

Refreshing Techniques

These improve your facial appearance without the need of a total facelift. Early sagging in the neck can be improved with minimally invasive techniques such as Laser Liposuction or External Ultrasound-Assisted Liposuction or early platysma banding ( the two cords in the neck which are made by the platysma muscle) or sometimes with Botox injections (off-label). If the neck banding is more severe, a platysmaplasty may be necessary, which is a neck tightening procedure (the platysma muscle is fashioned into a corset) performed through a small incision hidden beneath the chin. Your skin quality and fine wrinkles can be helped with a skin care program specifically designed for you or with chemical peels in the case of very deep wrinkles. Nerium is a skin care cream that you can apply at night which can improve your deep wrinkles by 20-30% thereby avoiding the more aggressive peels. Nerium can be ordered via the internet by visiting our Nerium site.

One of the first signs of aging is observed in the eyes and in the latter case, eyelid surgery will be required to correct the bagginess and the excess skin. Eyelid surgery is performed under local anesthesia and has a shorter recuperation time than facelifts. Also fillers such as Restylane, Juvederm, Radiesse, etc. ( see “Soft Tissue Fillers” under Lasers and Other Treatments ) or better yet your own body Fat Injections can complement your result thus avoiding or at least postponing the need of more extensive surgical procedures. All these procedures including Botox will permit you to return to work the same day and resume all your regular activities. A word of caution to avoid any disappointments: do not fall for the advertisements of the so called “lifestyle lifts, weekend lifts, etc.” which are discussed below under endoscopic facelifts and are not definitely recommended.

Early Facelifting ( Short Scar Facelift )

The current trend is for a more natural look with limited pull and upward traction. The early facelift can help maintain that youthful and healthy look in your later years thereby prolonging the time for a second facelift. The reason is that in the early facelift the underlying tissues are somewhat more elastic, fuller and more pliable with a better surface skin tone. In selected patients a vertical suspension short scar facelift can be performed. This avoids the scars behind your ears thereby most people would not know you had a facelift and also permits you to wear your hair up off the face or in a ponytail. The advantages are obviously no more scars behind your ears, lesser discomfort, fewer complications and a more rapid recovery but sometimes you may have to accept a lesser improvement especially if you are 60 or older. The most important thing to know is that this procedure is usually performed under local anesthesia with IV sedation and you should not confuse it with all of those advertised procedures such as Thread Lift, Lifestyle Lift, Feather Lift, WeekenderLift, etc. The latter simply do not work and you would be unwisely spending your money. The short scar facelift is not unlike the classical facelift. When Dr. Hervé Gentile performs the short scar facelift he separates the skin and fat from the underlying muscles. He determines where fat can be trimmed in your neck and fat added to improve the contour of your face. Dr. Hervé Gentile then tightens the underlying muscles as a separate layer and pulls back and removes the excess skin. Recovery is much shorter since you are not put to sleep (it is done under local anesthesia with sedation) and generally you are presentable in a little more then one week.

The short scar facelift addresses only the sagginess of the skin and the deeper tissues but usually the other two components of aging also need attention,…the skin and the loss of fat and volume. Dr. Gentile’s treatment philosophy is to do fat transfer grafting in conjunction with your short scar facelift to restore the lost volume, thereby bringing back some of your youthfulness. Your results will be enhanced by this combo, especially after you have been started on skin care treatments to improve the quality of your skin and preserve your attained fresh and natural look. Afterwards, you will be started on skin care treatments to improve the quality of your skin and preserve your fresh and natural look.

If you need to only address the midface (the sagginess of your cheeks ) endoscopic techniques can be used resulting in very small and hidden incisions behind the hairline above your ears and sometimes in the gum-line inside the mouth.

Skin Rejuvenation

Your skin can be improved with a number of products such as Retin-A, Kinerase, Gentle Derm Care, Obagi and Obagi Nu-Derm skin creams and lotions and a variety of procedures such as superficial or deep Chemical Peels, Obagi Blue Peel and Microdermabrasion. Currently we only recommend Obagi and Obagi Nu- Derm as these products have demonstrated to offer better results. We do not recommend and we do not offer the Therma-Cool and other similar Light skin tightening procedures as recent studies have shown the results to be minimal or non-existing.
( see also Microdermabrasion, Facial Peels, Skin Care Treatments under Laser and Other Treatments)

Facelift ( Rhytidectomy )

When someone thinks of plastic surgery they think of a facelift. Unfortunately it is also thought of as unnatural, plastic and hollywoodian. There is nothing further from the truth, since not only it can turn your clock back between eight and twelve years without anyone knowing it (unless you tell them) but it provides you with a natural, refreshed and healthy look. The goal is to try and make you look as good as you used to.

The procedure usually takes about three hours and is performed in our own office surgical suite, preferably under local anesthesia with IV sedation. The facelift consists of removing fat from the neck and jowls, sometimes with ultrasound or laser assisted liposuction, tightening of the facial muscles and redraping the excess skin excised from the cheek and neck. It also can improve the sagging of the lateral corners of the mouth. A facelift will not remove the lines around the mouth, the permanent wrinkles in extensively sun damaged individuals who present a cobblestone-type skin appearance and will not address the wrinkles and looseness around the lower neck “the necklace area”. In the elderly patient the aging process has the combined problems of skin sagginess and wrinkling as well as thinning of the tissues including loss of fat and bone requiring a more comprehensive treatment involving a combination of procedures. Since every face is not alike, other asymmetries may need to be addressed at the time of your consultation.

A minimal-incision facelift ( the short scar facelift ) with the incision made in the front of the ear and temple can also be performed in selected patients, especially younger women and men. This avoids scarring behind the ears, which can be noticeable when the hair is pulled back and results in a more painful recovery. It is not the gold standard but the results can be as good as a regular facelift if there is not a lot of sagginess in the neck. The skin of your temple, cheek and neck will be separated from the sagging facial muscles, which will be tightened. All the excess skin and fat is removed and the resultant incisions are sutured under tension. Most of your scars will be hidden in the skin creases of your ear or in your hair. No hair is removed. Your tissues will resist their new location and therefore it is normal for you to experience a feeling of tightness. You will also experience swelling and bruising which subsides in 10-14 days, numbness especially in the ear which is usually temporary and some discomfort easily controlled by medication. A tight facial garment will be fitted to your face to reduce swelling complications. If you are a smoker it is imperative to stop smoking at least six weeks before the facelift and you must be honest about it, since complications develop more frequently in smokers. You will be provided with all the care possible to speed up your recovery, but remember that healing is slower than in other procedures. You can return to some of your activities in about 2 weeks.
You must have somebody with you the first night and if you are from out of town, we will provide your accommodations. To preserve your new look longer and healthier you will need to avoid the sun or limit its exposure using sunscreens and blocks and refrain from smoking.

Endoscopic Facelift

This procedure is ideal for carefully selected individuals who do not have a significant amount of skin sagging and desire to refresh their face. Usually a specially designed lighted instrument or an endoscope, which is a tiny tube with a camera attached, is passed through small incisions and is used to visualize the area to be treated. The involved muscles over your facial bones are then tightened and suspended resulting in a smoother overlying skin. It is indicated especially for midface rejuvenation ( midface lift ) and upper face rejuvenation (eyebrow/forehead lift ). The endoscopic midface lift should not be confused with the various publicized weekend facelifts “the thread lift, the feather lift, etc. ” which consist of suturing and suspending only your skin and advertised as producing minimal to no swelling. These weekend facelifts do not last at all, weeks to a few months in the best of cases, and in many instances there is no visible improvement at all since the skin will be pulled down by the muscle to which it is attached (see also FAQ).

Midface Lift

The midface lift corrects the sagginess and looseness of the lower eyelids and the falling off of the cheeks. It is specially designed for the younger patient seeking to address the earliest signs of aging which occur around the eyes and cheeks. The incisions are small and hidden in the hair above your ears (rarely a separate incision in the gum-line is required). The procedure takes about 2 hours and recuperation is similar to the classical facelift with most patients returning to work in 10-14 days. It is often combined with an eyebrow lift or a classical facelift.

Forehead / Browlift

The forehead lift corrects and improves the deep wrinkles in your upper third of the face and the horizontal and vertical frown lines in the middle between your eyebrows. Consequently it eliminates the sagging and drooping eyebrows giving you that tired and sad look and the heavy excess skin of the upper lids since a forehead lift always incorporates an eyebrow lift. The procedure is performed in our office surgical suite under local with IV sedation or general anesthesia and the incisions are usually placed and hidden behind the hairline. Botox is usually injected 10 days before to prevent the brow from contracting downwards. We use the new COAPT system for fixation of the brow in lieu of the old fashioned metal screw. If you have very thin skin you may actually feel the Coapt implant underneath, but, since it is self absorbable, it will disappear in approximately 8-12 months. This operation takes about 2 hours and addresses both the skin and the underlying muscle.

While a browlift is a more limited procedure since it elevates only the brows it is the one most frequently performed. In a Forehead lift intervention on the deep muscles is performed in different ways to weaken and eradicate the frown lines and wrinkles. Then both the skin and muscle are lifted and tightened. This can help provide a more lasting result and it can prevent frown and worry lines from coming back. Your sad and tired appearance may disappear and your face will look brighter and refreshed, but remember, the results last an average of five to twelve years. The procedure is most of the times performed endoscopically (Endoscopic Forehead Lift or Endoscopic BrowLift ) through multiple smaller incisions and it is otherwise similar except that less excess skin can be removed. After surgery you will experience bruising, swelling and discomfort for about a week and numbness in the scalp which is almost always temporary. You may wash your hair the day after surgery and usually you can return to work after the first week.

However, with the advent of Botox, both the browlift and forehead lift are not performed as frequently as in the past.

Total Facial Rejuvenation

Total facial rejuvenation is a combination of multiple procedures that permit you to achieve that natural and youthful look you want. It consists of eyelid tucks and facelift sometimes in combination with lip lift, fat injections, cheek/chin augmentation and brow/forehead lift addressing all of your facial features and structures together in one setting. After you are started on a skin care regimen or a peel is performed later to balance your new appearance. This creates a more harmonious look by giving you a smoother, fresher and a better tone skin.

Secondary Lift

These procedures are designed to restore your natural facial harmony after your first lift. This results in a more youthful you.

Ancillary Procedures

Lip Lift/Augmentation, Facial Fat Injections/Grafting, Cheek/Chin Augmentation, and Nose Reshaping (Rhinoplasty) all help redefine and can be considered complimentary to the facial rejuvenation procedures. Chemical Peels, Skin Care and Microdermabrasion also complement your results. Please check them out under Facial Redefinition and Lasers and Other Treatments.

Lasers for the Face

Laser surgery is one of the most exciting and requested cosmetic procedures because lasers have many applications today. But one of the fallacies about lasers is that they can do everything with less bruising and swelling. They can be used to tighten your neck, remove unwanted hair and treat spider veins in the face and legs as well as other pigmented lesions. The laser is an extremely precise surgical tool in which a beam of light is generated to vaporize the surface of the skin or shoot a light beam through the skin without affecting it to treat spider veins and unwanted hair. For example the goal of skin resurfacing ( Erbium, Fraxel, etc.) is to soften or eliminate wrinkles and possibly rejuvenate the skin but since the light energy is converted to heat it can produce some unwanted effects. There are other modalities which offer much better results and are less expensive than skin resurfacing and therefore Dr. Hervé Gentile does not recommend Lasers on the face. Lasers has also been used to treat hypertrophic scars and acne but again despite the media hype they offer minimal improvement.

Dr. Hervé Gentile recommends laser hair and spider vein removal and in selected patients laser liposuction of the neck as this results in tightening of the skin and the underlying soft tissues. Although this modality is available for men and women of all ages, the ideal candidate for laser hair has fair skin and for laser liposuction of the neck some fat in addition to the minimal skin looseness. All people, both with fair and darker skins, are candidates for Microdermabrasion, Obagi Blue Peel and Obagi Skin Care for their skin treatment. For severe wrinkles of the face and specially around the mouth a deep Facial Peel sometimes in combination with a facelift will offer the most improvement at a lesser cost even compared to the results using the newer skin resurfacing and radiofrequency machines. Remember that if you need skin retightening or correction of significant neck sagginess laser face is not for you. No Laser can perform a Facelift.

Non-Surgical Procedures such as External Ultrasound and other Devices

These procedures are designed to tighten the soft tissues of the neck without surgery. We offer the external ultrasound treatments which are performed without any incisions and you can return to work the next day. The ultrasound has a very low risk of burn since it works on the deeper tissues without affecting the skin. The newer transcutaneous radiofrequency devices use lower energy and therefore require multiple passes and treatments. They also offer very little clinical change, are somewhat disconfortable and are very costly. In my experience patients who need it the least do the best. With ultrasound treatments you may get 10-15% improvement and that is the reason why we do not perform many. But, for the right person who is not a surgical candidate for a facelift, at least the ultrasound will offer some benefit.

Photographs

For your convenience you may view a few selected cases in our Facelift Before & After photo gallery. To see our extensive photographic catalogues of pre-operative and post-operative photographs please contact our office and schedule a complimentary consultation.