Facelifts - Less is More

If your goal with a facelift is to end up looking like yourself, only younger and refreshed, then ‘less is more’ is a good guideline.

There are so many things being offered these days for facial rejuvenation, so you should be selective with your choices, both to remain a natural, non-plastic appearance, and to avoid unnecessary overspending. Just because it’s on the menu, doesn’t mean you need or should have it.

What is most beneficial? Everyone ages uniquely but most will develop laxity and sagging in their neck and jowls, contributing to a tired, less than fresh appearance, and at some point, insufficiently improved by non-surgical cosmetic treatments.

There are many confusing ‘descriptions’ for facelifts nowadays, so let’s simplify terminology: divide your face into an upper half (eyes and forehead) and lower half (cheeks/jowls and neck).

The ‘Lower Facelift’ targets the cheeks, jowls and neck and restores a clean jawline which is the principal sign of youth and beauty. It addresses both the deep (plane) and superficial layers of the face by tightening the deeper strength layer below and removing all slack skin above. The Lower Facelift, when expertly performed, is the one operation which produces the most, and natural looking, improvement in the majority of patients. Frequently, it is accompanied by an Upper Eyelid procedure (Blepharoplasty) to remove redundant skin arising around the same time as jowls and necks become a concern. The combo of the Lower Facelift and Upper Blepharoplasty effectively addresses the concerns of close to 90% of the patients I see.

Well selected patients might also benefit from a ‘Lateral Brow Lift’ to address sagging of the outer corner of the eyes, but many don’t need this since Botox may suffice here. Lifting the brows on a patient who doesn’t really need it only contributes to a surgical and surprised look. A full brow lift is very rarely indicated.

Lower eyelids are more sensitive than upper eyelids, and ‘Lower Blepharoplasty’ surgery thus riskier and more prone to complications such as a lower lid pull-down (ectropion) or other distortions. Fortunately, many patients don’t need this surgery as it only really benefits patients with obvious ‘bags’ below their eyes caused by protruding fat. Unfortunately, lower lid surgery does not effectively eliminate dark circles, nor does it erase the transition between the lower lid and the cheeks (the lid/cheek junction which is a reflection of the underlying eye socket). So, if there’s isn’t a significant cosmetic benefit, why add unnecessary risk and expense?

Fat grafting - is it worth it? It’s true that part of facial aging may include facial fat atrophy in some patients, though certainly not in all. But while it appears intuitively desirable, though overly simplistic, to just replace lost facial fat with fat from other areas, it just doesn’t pan out as hoped for, as much of the transferred fat ends up atrophying in unpredictable ways or potentially remain as unnatural areas of fullness or irregularity. Fat grafting is accompanied by increased swelling, bruising, a longer surgery time and downtime, at least if seriously performed. Beware that some surgeons will only spend minimal effort on this without really making any lasting difference, despite increasing your cost.

In our era of abundant facial filler options which allow for considerable precision in volume enhancement after the facelift has healed, fat grafting has lost much of its initial allure.

Lip lifts, an old procedure, have recently been resurrected on social media. Few patients really are good candidates. Risks include potentially visible scarring under your nose and possibly a snarled (rabbit) look. Certainly not an essential addition for most patients. So why add risk and expense?

An actual word of caution on another social media marketed procedure - reduction of your neck salivary glands. These glands produce saliva and are tacked away under the lower jaw. Cutting away part of these normal glands to obtain a ‘better’ jawline requires a substantially larger incision below the chin than usual, increases the length of surgery and significantly increases the risk for complications such as bleeding, saliva leakage and prolonged, annoying neck swelling. Also, the neck contour, once finally healed, may end up unnaturally sharp. It’s been called by experts ‘radical neck surgery’ and excessive for a cosmetic procedure. I agree.

In summary, when considering any item on the aesthetic ‘menu’, always think about your risk/benefit ratio. Only procedures with high benefit and low risk are desirable. Also, the more procedures you have, the potentially less natural you’ll end up looking. The goal of facial cosmetic surgery is to look good for your age. That entails realistic expectations. Nobody can make you look twenty again, no matter how much you cut, pull, or fill and if you try too hard it might just look desperate. You probably have seen some. Good facial surgery just looks good, not surgical or obvious, making others wonder why you look good but not being able to tell. Also, you do not want to lose your unique natural beauty! So think ‘less is more’.

As always, research carefully, choose wisely to end up safe, looking yourself, and not spending your money unwisely.