Face Lift surgery is the crown jewel of plastic surgery, consisting of procedures that require extensive experience, artistic vision and planning, and meticulous attention to detail. There are numerous tip-offs to face lift surgery, including but not restricted to, the obvious pulled “too tight” and “scary” appearance. After a properly performed face lift, a person should be able to sit comfortably next to someone with no discernable clue that surgery has been performed. Other tip-offs are avoidable alterations in the hairline, distortions of normal anatomy of the ear, and a “wind-swept” appearance to the cheeks. Current up-to-date face lift techniques no longer rely upon simply pulling the skin to achieve marvelous results, though many surgeons still use dated face lift techniques because they are quicker and easier to perform, but in my opinion, yield unsatisfactory results.
You should hold your surgeon to the highest standard to spend the necessary time and effort with attention to detail to give you the best and most natural result possible.
To evaluate face lifts, one must understand unaltered facial anatomy. The first photograph is of a woman’s unaltered ear. Notice the subtle curves of the ear cartilage, the natural depression in front of the tragus and subsequent shadow, and the shape and angle of the earlobe. Also notice the position of the temporal hairline in front of the ear and the post-auricular hairline behind the ear.
Poor surgical results
Poor planning and execution of face lift surgery often distorts normal anatomy leaving patients self-conscious and sorry about their choice in surgeons. Commonly visible scars, pulled earlobes, altered hairlines, and visibly unnatural directions of pull can be avoided with careful planning and execution in the operating room with strict utilization of techniques that avoid excessive tension on the skin. I think it is of critical importance to be extremely precise and focused with regards to the details of face lift surgery, and subsequent results should speak for themselves. The photograph on the left labeled “Poor Surgical Result”, is of a patient referred to me after previous face lift surgery with many of the stigmata of poorly planned and performed face lift surgery.
Bad surgical results
The photograph on the left is of another face lift patient that was referred to me for evaluation after having face lift surgery in another state. She was unhappy with her result, and very self-concious about the appearance of her ears. She had to change her hairstyle to accommodate the shifts in her hairline, and constantly monitored social situations to avoid embarrassment. These post operative changes are the result of poorly designed and executed face lift techniques that rely upon undue tension on the skin and produce unsatisfactory results. Although it saves time for the surgeon, it is difficult to conceal these errors, leading to anxiety and humiliation for the patient.
Bad results normal hair line
With the ear pulled slightly forward, the same patient illustrates the loss of posterior hairline and very visible scars. Such results are due to a lack of meticulous detail that is mandatory in face lift surgery. Incisions should always be planned with a consideration of hairstyles and patient lifestyle in mind. The direction of incision placement should respect hair follicle growth. Dated techniques that rely solely upon pulling the skin to produce a surgical result will consistently produce inadequate surgical scars. These factors should be kept in mind when evaluating surgeons to perform your face lift surgery.
The photograph on the left is of a woman who was referred to me for evaluation a few years after a very disappointing experience with a surgeon who performed a “conservative” face lift. She was told that the surgery would be comprehensive and performed rapidly, and that she would look younger and more attractive. She liked her appearance initially after surgery, but found as the swelling resolved over the next three to six months, that her eyes looked sad and hollow, and that her jowls and poorly defined jawline had already begun to return. These changes seemed to be accentuated by the strange vertical lines of pull of her neck that were more obvious when she tilted her head down. Now conscious of these changes, she noticed that some of her friends had the same characteristics in their face lifts. Distressed, she asked me why she looked the way she did after so little time from her original face lift surgery. I answered that an outdated “conservative” face lift technique was the source of her dissatsfaction.
The photograph on the left is the same patient after I performed revisional face lift surgery. Her previous face lift surgeon simply took out fat where “needed” as in the eyes and possibly the jowls and neck, and pulled her skin to achieve a “tight” result. This technique, though still common, is simply outdated and achieves suboptimal results. The face lift that I subsequently performed elevated crucial facial fat to its intended position (to provide the voluptuousness of a youthful face), and kept it there by using the facial SMAS (the layer with the facial muscles and fat) for suspension. No tension was applied to the facial skin for tightness, hence these results are long lasting, and in fact, look softer and more natural over time. By me doing more at the time of surgery, my patients look very natural, and much less like they have had surgery in the first place. This, to me, is the magic of face lift surgery. This patient was delighted with her results.
The photograph on the left is of a patient who I performed face lift surgery on approximately 10 months previously. She was very concerned before her surgery about being able to continue short hairstyles, and did not want family or friends to be aware, in any way, that she had undergone facial cosmetic surgery. The surgery still remains her secret.
This final photograph is of my surgical nurse Pat. She had undergone face lift surgery performed by me, and continues to be able to wear any hairstyle, with the confidence that no one can decipher that facial surgery has been performed. She travels throughout the country serving as an instructor in advanced injection techniques. Others assume that she is 15 years younger than her true age, and I believe this has given her a competitive advantage in that her youthful enthusiasm and disposition is matched by her external appearance. I believe that this confluence of youthfulness, beauty, maturity, and wisdom is the wonder of modern plastic surgery.