David W. Kim, MD, Facial Plastic Surgery

MORE ABOUT DR. KIM’S APPROACH TO FACE LIFTS AND NECK LIFTS

The goal of face lifts and neck lifts is to reposition sagging skin and tissue into a more elevated, youthful position. Incisions into the skin are made in areas which will be least noticeable: behind the ear, in the crease between the ear and face, and beneath the hair at the temple. The skin is then separated from the deeper tissue and freed from any attachments that tether it down.

Beneath the skin, another layer of tough, fibrous tissue covers the muscle and deeper structures in the face. This layer, called the SMASH (superficial musculo-aponeurotic system) is used to pull the facial tissue upward into the position it occupied in youth. Areas of the SMAS which are attached to the problems areas of the face and neck (jowls, cheek, and neck) are sutured tightly and suspended to deeper tissue. Since the face "lifting" is actually applied to the SMAS, the skin itself may not be under tension. This leads to a more natural appearance and minimizing scar formation.

Individualized Approach

Certain aspects of the face lift and neck lift surgery are modified depending on the patient’s problem areas and goals. For example, when needed, a small incision is placed under the chin to remove extra fat or tighten loose muscle in order to restore a youthful neck line. In patients with sagging tissue in the mid-face, a mid-face lift is performed at the time of lower face lift. This procedure entails elevation of fat pad in the mid-cheek and suspension to firmer deep tissue in the temple area. The mid-face lift is effective in restoring youthful volume in the cheek bone area and improving deep naso-labial folds.

For individuals with only mildly sagging facial and neck skin, a more limited mini-lift or mini-facelift may be performed. The S-lift or the MACS-lift are less invasive, less extensive versions of the facelift. Because the amount of elevation needed to correct milder problems is less, the amount of dissection, the degree of elevation, and the duration of surgery may be reduced. Patients with thinner skin, less facial and neck fat, and mild to moderate laxity respond best to these “mini” face lift and neck lift procedures.

Finally, for many individuals some replacement of lost facial volume is necessary in addition to face-lifting in order to fully treat the aging face. Facial structures not only descend with time, they also deflate. While surgery is effective in restoring a youthful position to face and neck skin, these lifting procedures do not replace lost volume.

Volume replacement may be performed at the time of surgery through structural fat grafting, during which fat is removed from another area in the body (typically abdomen, thigh, buttock or arms) and injected into volume-deficient areas, particularly in the mid-face. Alternatively, injectable fillers may be used after recovery in order to volume enhance these areas. A final option is the placement of solid implants to the cheek areas.
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