Rhytidectomy - Face Lift
Facial aging touches on two aspects of life; our longevity and our ability to compete in a world focused on vitality. A youthful face is assumed to be a reflection of our energy and health that provides us with a competitive advantage and gives us a sense of longevity.

As I analyze facial aging, I have come to conclude that aging occurs on three levels. At a deep level, there is a downward migration of the fat, formation of large skin folds and relaxation of neck muscles. At a medium depth, fine lines and fine wrinkles make their appearance (mainly around the eyes and mouth). At a more superficial level skin quality and texture is affected with dark patches, red spots, scaling, etc. If the aging is mainly at the medium or superficial level, please review the section on non-surgical facial rejuvenation.

I examine the patient in this framework and note at which level the aging process is primarily occurring. Accordingly, I choose the method of treatment that will give the most remarkable result.

Although facial rejuvenation is constantly being revisited and improved upon, there is some basic understanding that dictates my approach in performing a face lift. In order to simplify the discussion, I tend to divide the face into the upper face, the mid face, and the lower face. Discussion of the lower face is covered in the section on platysmaplasty (neck lift).

Plastic surgery literature has witnessed different approaches to the problem for the mid-face .There have been many changes in the recent past as to the way we understand the aging process. As we stand today, the most reliable and consistent understanding involves realizing that facial sagging develops in an up-down (vertical) direction not front to-back and, therefore, the correction of the mid-cheek needs to address that vertical descent. I sometimes use a combined approach through the mouth in order to allow for elevation of the tissues over the bones and suspension from an incision in the scalp above the ear level.

As far as the upper face, we will need to look at the forehead lines, the glabellar lines, the lateral aspect of the eyebrow and the eye, and then decide on how the correction will occur. We can perform a forehead lift and elevate the eyebrows, or lift the corner of the eyes. Depending on the anatomic circumstances and the concerns of the patient, a plan that addresses those needs is formulated.

I perform the surgery with general anesthesia or with intravenous sedation and local anesthesia. The patient goes home the same day of surgery with drains, which are typically removed the next day. Sutures are removed at one week, and the bruising is gone by ten days. The incisions are usually well hidden and allow a prompt return to normal life.

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       M. Vincent Makhlouf, M.D., F.A.C.S
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