Surgical Facial Rejuvenation

Facelift/Necklift
You telegraph your identity primarily with your face – its structure and lines, texture and color, overall appearance and expressions.  Your face sends messages regarding your emotions, health, vitality and age.  What are you telling people about you?

Time and age-related changes can alter the appearance of your face and perhaps make you feel as if your identity has changed over time. You feel you look tired, angry, sad or older than you are.

Your face is composed of layers of skin, muscle and fat lying above the facial bones. Like a stretched rubber band, the tissues within your face weaken over time, become less resilient and lose the ability to maintain youthful firmness. With sun damage and other factors, your skin's collagen and elastin break down and skin loses structure and elasticity. Facial muscles weaken and stretch, and fat deposits, which normally give the face a soft, rounded appearance, migrate downward, creating hollow areas. These changes create deep wrinkles, jowls, and loose skin in the lower face.

Has your face aged?
Consider these factors.

• Your face houses the stress and tension of your life.
• Your face is exposed to harsh environmental conditions – sun, wind, excessive heat and cold, chemical and biological pollution.
• Your face is impacted by hormonal changes, depleted collagen production, thinning due to free-radical damage.
• Gravity and time takes a toll, resulting in slacked facial ligaments.
• Genetics, smoking and/or poor diet and skin regimens can produce wrinkles, sagging, discolored and dull skin.

Facelift
A facelift is the cornerstone of surgical facial rejuvenation. Designed to remove excess sagging skin and to tighten the underlying facial muscles that become lax over time, a facelift restores a youthful shape and appearance.  After a facelift, the skin of the cheeks and neck is tighter, jowling is decreased, the jaw line is sharper and more defined, and lines on the front of the neck that are due to muscle separation and laxity are smoothed.

Facelifts are frequently combined with an eyelid lift  (blepharoplasty) and browlift  for a more complete rejuvenation of the face. In order to reveal dewy, fresh skin after a facelift, laser resurfacing or chemical peels can minimize fine lines that cannot be eliminated with a facelift. Dr. Wells carefully assesses  every patient to create a customized approach to address their particular problem areas and achieve their specific desires.

There are several  types of facelifts – each specialized to treat different regions of the face.

Lower Facelift
The lower facelift is performed to rejuvenate the lower portion of the face.

During a lower facelift, the underlying connective and muscle tissues known as the SMAS is lifted, facial skin is tightened, and excess skin is removed. A lower facelift cannot correct signs of aging in the forehead or around your eyes, or address fine lines or uneven skin tone and texture.

Age-related changes in the upper and middle region of the face are usually corrected with a mid facelift and/or browlift.

Mid Facelift
Changes to the middle region of the face, such as like loss of volume and sagging of the cheeks, deep wrinkles and hollow areas below the lower eyelids,  often occur earlier than changes to the lower face. A mid facelift is often appropriate for individuals who have not yet experienced sagging in the lower face, reducing these specific signs of aging and restoring a firmer, more youthful appearance.

Dr. Wells will help you determine which procedure is best for you, and whether an additional procedure such as eyelid lift, necklift  or browlift would benefit you as well.

Are you a candidate for a facelift?
The best facelift candidates are patients whose skin appears lax or sagging.  Patients in their 40s, 50s, and 60s are the most common facelift patients, but others in their 70s and 80s have successful surgeries as well.  In a personal consultation, you and Dr. Wells will determine the best options for you.

Incisions
The incision is strategically placed so that it is maximally camouflaged within or along the hairline of the temple, following the curve of the ear, behind the earlobe, and back along the hairline behind the ear.  An additional small incision is usually placed under the chin to address fatty deposits and muscle separation in the front of the neck.

Necklift
The neck reflects aging signs for many reasons - time and gravity, certainly, and significant weight changes.  If you have lost weight, one side effect may be leftover, loose-hanging skin that has lost its elasticity. Whether it is band lines, excess skin, or fat, a necklift can bring your neck back into shape.  A neck-lift may also be part of a combination treatment plan in conjunction with a browlift, facelift or eyelid surgery.

Are you a candidate for a necklift?
There is no ideal age for necklift surgery. In fact, candidates may range from early adulthood to octogenarians. People who suffer from certain diseases may be excluded from treatment. Dr. Wells will consult with you about your goals and expectations and medical history to determine if you are a good candidate.

Necklift  Procedures
Typically, a neck-lift includes liposuction to remove fat.  Cervicoplasty may be included to remove excess skin, and platysmaplasty to remove or tighten neck muscles: a process that gets rid of unwanted band lines.

Browlift/Eyelift

Browlift
Aging changes often first start to occur in the brow, or forehead region, which include the formation of forehead lines and drooping of the brow itself. A forehead lift, or browlift, can help to lift the brow line to a higher position and reduce the appearance of lines and wrinkles, restoring a firmer, more youthful appearance to the upper portion of the face. A browlift re-positions the eyebrows higher in order to lighten and open up the eyes.  The goal is to lift the eyebrows into a youthful, gentle arc. With a browlift, the forehead becomes more taut, yet still allows natural expression.

Repetitive muscle movement creates different wrinkles in various forehead muscles. A variety of techniques can correct these signs of aging by carefully modifying all of the different muscles (or a subset of them) to disrupt normal muscle activity without compromising proper muscle function. As a result, lines and wrinkles will diminish and your muscles will still function to create natural facial expressions.

In addition to disrupting muscle activity in the brow region, the brow is lifted to a higher position. Small implants can be inserted between the tissue and bone which adhere to the bone and small teeth fix the tissues in a higher position. Or, sutures can be used to pull the brow upward to give a smoother, more youthful appearance.

Are you a candidate for a browlift?
As we age, layers of muscle weaken and fat deposits, which normally act as a cushion between skin and underlying bone, are depleted. The eyebrows and forehead descend and can result in a tired or angry appearance, along with a heaviness of upper eyelids. Lines and wrinkles in the brow region become increasingly apparent. A forehead lift can reduce the appearance of these lines as well as lift the brow, often achieving results that can make you look as much as ten years younger.

Please note that individuals who are bald, have receding or high hair lines, or have had upper eyelid surgery may not be optimal candidates for a browlift. 

Endoscopic Incisions
An endoscopic browlift is performed through small incisions behind the hairline of the scalp. The tissues of the forehead are lifted up using narrow instruments and a small camera placed inside, and then secured in the uplifted position with absorbable fixation tacks.  As the incisions are relatively small, the resulting scars will be well hidden within the hairline.  

Coronal Incisions
A coronal browlift is performed by making an incision that extends from ear to ear, over the top of the head, which lies approximately six to eight centimeters behind the natural hairline.

Dr. Wells will determine in your private consultation which procedure is best for you.

Eyelift 
Frequently, a browlift is performed along with eyelid lifts to maximally reduce the heavy and sagging appearance of the upper eyelids, as well as drooping eyelashes that impair vision. As you age, excess skin forms in the eye area and the skin loses elasticity. Fatty tissue can accumulate under the skin and eyes appear tired, wrinkled or puffy and you look older – even with a good skin care regimen. Genetic factors and body chemistry can cause these aging effects in younger people. Eyelift surgery may restore a youthful and refreshed appearance to your eyes.

To rejuvenate the eye area, upper and lower eyelid lifts (blepharoplasty) are performed to remove excess skin, fat, or muscle from the upper and lower eyelids.  Blepharoplasty surgery improves baggy above and below the eyes, and also reduces puffiness of the eyelids.  Puffiness of the upper and lower eyelids is often the result of bulging fatty deposits around the eye. 

However, blepharoplasty cannot correct drooping eyebrows or wrinkles, so this procedure is often performed with another surgery such as a browlift or facelift to improve droopy eyebrows, crow's feet, and facial sagging.   Sometimes fine wrinkling of the lower eyelid can be addressed by laser treatments or chemical peels. Eyelid surgery with these options can successfully restore a youthful, revitalized appearance to your eyes for years to come.

Are you a candidate for an eyelift?
Excess skin can be recognized as the thin, crepey skin that forms folds at the outside corners of the eyes, obscuring visualization of the main part of the eyelid just behind the lashline. This extra skin, can hinder makeup application. Do you have to hold and stretch the excess skin in order to evenly apply your eye shadow?  You and Dr. Wells can discuss your problem eye area and what options will work best for you. 

Incisions
The incision for upper lid blepharoplasty is placed so that it falls naturally in the crease. The incision for the lower lid blepharoplasty is placed close to the lashline, along the fold of the lower eyelid to ensure that the resulting scar is hidden in the natural contours of your face.  Both types of incision heal very well and are usually almost imperceptible. 

At Valley Plastic Surgery, we welcome all of your questions.  It is natural to feel some anxiety, whether excitement over the anticipated outcome or preoperative stress. Dr. Wells understands the gamut of emotions and experienced and welcomes the opportunity to answer your questions fully and alleviate any concerns.