Many times when I talk to patients about a facelift, I see this look come over their eyes signifying dread and fear – fear that they will look unnatural or freakish after the surgery. All of them have seen the unnatural appearance of some high profile people, particularly those in the entertainment industry, who have had facelifts or other operations. And there is no doubt that their results can give facelifts a bad rap.
But, I would contend that, for each of these, there are many more men and women who have had facelifts that look so natural that no one is really aware that they have had surgery. (The only way to figure this out is to compare photographs.) So what’s the difference in achieving these natural-looking results? Glad you asked.
You’ve Come a Long Way, Baby
Facelifting is an operation that has evolved over the last several decades. There have been many different approaches that have been tried and the ones that look the best, and the most natural, are the techniques which focus on putting things back where they used to be, thus recreating the natural appearance at a younger age.
As we age, the tissues of our faces relax, and the fat that makes up the normal contours of our faces moves south. This is most seen along the jawline as jowls, and along the inner aspect of our face, the nasolabial folds. This process can be sped up in people who smoke or people who have had a lot of sun exposure. The goal of most successful facelifts is to move this fat back to its proper position.
In the late 1960’s a Swedish surgeon named Tord Skoog identified a layer of tissue in the face below the skin known as the SMAS (subcutaneous musculo-aponeurotic system – big word, I know. We all just say SMAS). When you release and move this layer vertically upward, the facial fat moves up as well and this restores the younger appearance. Most of the advances in facelifting have been the refinement of this technique. Before, the efforts had been in just lifting or moving the skin. And these are some of the results that can really look distorted.
When you move the SMAS upward in a vertical direction, you are undoing what aging and gravity have done, by putting things back in their natural place. If you simply pull the skin sideways in an attempt to tighten the skin, you distort the natural features of the face and create an unnatural look. And more tension on the skin is not necessarily good. It can distort the mouth and make the face just look too tight. When you rely on the SMAS elevation to do the lifting, the tension is on this layer and not on the skin. So the skin and facial features look more natural and the scars heal better. Parenthetically I would mention that a well-done facelift also improves the appearance of the neck. And many people are as delighted with this as they are with the changes in the face.
Try This On For Size
Here’s an exercise you can do. Look at yourself in the mirror. Put two fingers just below you cheekbone and push the skin directly upward. Look at the change in your jaw line and along the nasolabial folds. Then, put your fingers in front of your ears and pull them sideways towards your ears. Look at yourself again. Which looks more natural? Right, moving things upward. I rest my case.
Advice for a Successful Facelift
So, if a facelift is somewhere in your future, understand that there are ways to do this to make sure that you look like yourself. Discuss with your board-certified or board-eligible plastic surgeon what his or her plans are and how they are going to achieve them. And don’t be put off if a facelift is suggested when you thought that something simpler would work. In another blog I will discuss why “mini” lifts and the like may not work.
And, ask to see some before and after pictures. If the pictures are like Picasso’s, keep looking until you find some Michelangelo’s or Da Vinci’s!
All the best,
David B. Reath, MDPlastic Surgery
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