Facelift Mountain View
Individuals interested in facial rejuvenation may be candidates for facelift surgery. At his practice serving Palo Alto, San Jose, and surrounding communities, Dr. Robert Lowen can help patients understand facelift surgery and other options so they can make educated choices about their care. The links below include Dr. Lowen’s personal philosophy on facelift surgery and information on the goals of facial rejuvenation. Patients can also contact our plastic surgery center to learn more.
For those patients who wish to begin the surgical rejuvenation process in their 30′s, there is now a reasonable, effective approach which does not leave visible external scars and has a short recovery time. This involves non-invasive methods such as skin tightening with LUX IR (infrared) skin tightening, LUX 1540 fractional erbium skin rejuvenation through collagen remodeling, dermal fillers such as Restylane, Juvederm and Radiesse, IPL ( intense pulsed light) for pigmentation and blood vessels, and a medical skin health program such as ZO.
Patients in their 40’s use all of the above modalities and can add Botox to smooth wrinkles forming around the eyes. Facial rejuvenation surgery provides excellent results in the 40’s because the skin retains much of its youthful elasticity and the fat volume of the cheeks has not decreased. These are the factors that contribute to the look of youth.
Re-volumization with fillers or fat grafting plays a major role in maintaining this look from the 40’s on. Filler use is extremely common as an easy office visit solution at this age. With a little local anesthetic and a syringe or two of a filler, five years of aging can be removed at practically any time. Combined with a little Botox at the central and lateral brow, and a non-surgical browlift can give a relaxed look and make you feel that your eyes and brow are less tired feeling.
Surgical treatment is done with a limited-incision face lift or short-scar facelift technique at this age. My preference is for a vertical anterior subcutaneous lift. We can get a nice jowl and corner of the mouth lift with this technique. If possible we try to avoid an incision under the chin and surgery on the neck, because more irregularities of the neck skin and a longer healing period occur. These can require several months or more to resolve.
If there is significant banding of the platysma muscle that does require treatment, then surgery on the neck as well as the face is required. This can usually be done without a submental incision.
For patients whose main complaint is a fatty appearance of the neck, plus perhaps some laxity, Precision TX liposuction is done to remove the fat and tighten the skin, which is possible due to the ability of the laser to heat the skin of the neck in a controlled fashion from within, and thus induce tightening.
When incisions in front of and around the ears are done in a rapid, unartistic fashion, the resulting scars and distortion of the delicate anatomy around the ear canal and ear lobe are clearly visible from a social distance and can be a great source of disappointment to patients. When done precisely and with good artistic planning, and care to minimize skin tension on the suture line, the facelift scars can be almost non-detectable. Dr. Lowen takes these extra steps to maximize his patients’ outcomes.
The eyes are treated with fat transfer to the cheek and suborbital area, with muscle tightening and skin excision as needed.
Removing bulging lower lid fat bags causes the eyeball to sink downward and inward. This fat normally supports the globe like a mattress. When fat removal is combined with upper and lower lid skin and muscle removal, a woman often looks like she has smaller eyes, and an abnormally smooth, flat lower lid. This is an unnatural, operated look. When fat is added to the cheek and tear trough, and supported by the cheek, oribital fat bulging and is usually decreased to the point that no removal is needed. The eye is held up and out and the surgical repositioning of the brow and midface/cheek cause the frame of the eye to look youthful. The size of the eye looks the same or larger, and the appearance is pleasing.
If lifting the cheek brings additional skin up into the lower lid, causing increased fullness or wrinkling, skin alone is removed in a conservative manner, or a light laser resurfacing is done. By removing only skin from the lower lid, the function of the specialized blink muscle is preserved. This strip of muscle along the front of the lower lid will be separated from its nerve supply when incisions are made across the lower lid through both skin and muscle to remove lower lid fat. As we get older, the tone of the lower lid becomes less and the lower lid is more subject to being pulled down after facelift surgery.
Excessive skin removal plus poor lid tone plus a non-functioning lower lid muscle can lead to the following problems after facelift surgery: rounding of the corner of the eye, eversion or pull down of the lower lid, and problems with tear film function, dry eyes, or watery eyes. To minimize the chance of these undesirable side effects of lower lid surgery, Dr. Lowen currently removes only skin from the lower lid without cutting through the muscle. Suspension of the lower lid is individualized depending on the degree of pre-existing laxity. Options include suture suspension to the orbital rim of the relaxed lateral eyelid ligament and suspension of the lower eyelid muscle to the orbital rim.
In patients with significant excess of bulging lower lid fat, the fat is conservatively removed, smoothing out the bulge and maintaining a natural appearance. In younger patients who have a congenital excess of fat in the lower lid, it is reasonable to remove some of it. This is done through the conjunctiva or inner lid, and avoids the anterior skin and muscle layers completely.
Patients, particularly those in their late 40′s or 50′s, who retain a few wrinkles around their lower lids, yet have a natural, youthful look are usually not concerned by these few wrinkles. A few character wrinkles look normal while a smooth, flat lid and a small eye do not.
Face lift surgery involves swelling for seven to ten days after facelift surgery that precludes return to work for most people, although some have returned to work on day eight. After that, although facial swelling persists in a gradually decreasing manner, it does not detract from one’s appearance in most cases, since the effect of soft-tissue swelling is to mimic the more youthful face which usually has more fat. The use of small suction drains for two days after surgery reduces the duration of swelling and minimizes bruising. Patients must avoid aspirin-containing products, non-steroidal medications such as Motrin®, Advil®, Aleve®, large doses of Vitamin E, and any herbal products containing St. John’s wort, echinacea, ginseng, and gingko biloba, for two weeks before and after surgery. Tylenol® can be substituted.
The risks involved in a neck lift and a face liftare related to potential injury to motor and sensory nerves, unevenness of contour, asymmetry, excess or insufficient fat removal in the neck or jowl area, bleeding, infection, skin loss, loss of fixation of repositioned tissues, and excess or insufficient tension on repositioned tissues.
Eyelid surgery carries a small risk of eyelid malposition, with lower lids being pulled down, rounded at the lateral aspect or frankly everted. Final appearance can be altered in a pleasing way or can be undesirably distorted with excess lateral tension, excess elevation of the corner of the eye, or narrowing of the lid opening. Some techniques can cause irregularities of the lid margin at the corner of the eye, and scars may or may not heal well. They can also be too visible lateral to the corner of the eye, or placed too low on the lid. There is a very rare risk of blindness with eyelid surgery, but this would be even less likely when no surgery is done on the orbital fat.
Elevation of tissues is done in the fatty layer above the SMAS, decreasing the risk of injury to any branches of the facial nerve.
Lateral incision approaches to the mid-face that are done in the deep-plane or SMAS, dissect directly over the facial nerve. Great care is needed to avoid injury to these branches. Good plastic surgeons pride themselves on their ability to perform these facelift procedures without facial nerve injury. Nevertheless, the risk of facial nerve injury is inherently greater. A series of published facelift reports found facial nerve injuries in the one to two percent range, with less than one percent being permanent.
With regard to skin loss, it is known that the traditional face liftis a risky operation for smokers. Some surgeons will not do a facelift on a smoker.
In summary, good facelift surgery takes time, attention to detail, and appreciation of what looks younger and natural. We want minimal scar visibility, preservation of the normal delicate anatomy and position of the ear, and the ability to wear short hair.
New techniques, incorporating fat grafting, and vertical subcutaneous anterior lifting, avoid the swept back look of standard lateral approach facelift techniques, making a natural appearance after surgery a realistic possibility.
For more information on face lift techniques, contact our plastic surgery center. Dr. Lowen helps patients from across Northern California understand the many variables that need to be considered to maximize the results of their facial rejuvenation procedure.