Dr. Bader is not currently
performing facelifts or Minilifts at this time.
before necklift
after necklift
FACELIFT: TABLE OF CONTENTS
What is a facelift?
Will the facelift help smooth out fine
wrinkles?
Will the facelift improve the appearance of
the eyes?
Will the facelift improve the appearance of
my forehead?
Are all facelifts the same?
Where are the incisions (cuts) made?
What are the different types of facelifts?
Which type of facelift is the best?
What is submental lipectomy?
What is submental liposuction?
Will the facelift improve the appearance of
the jowls?
How long does the facelift procedure take?
What types of anesthesia are used? Will I be
asleep?
What is the cost of the facelift?
What is the preferred face-lifting technique
of Dr. Bader?
What is a facelift?
Facelift is a surgical procedure that tightens the
understructures of the lower one third of the face and neck with removal of
excess skin resulting in a more youthful appearance. The facelift procedure
helps redefine the cervico-mandibular angle (sharpen the angle where the neck
meets the jaw), redefine the jawline, and elevates the cheeks to a more youthful
position. This procedure is often combined with submental lipectomy (removal of
fat under the jaw from a 1 inch incision under the chin) or submental
liposuction (removing the fat from the chin from an incision less than 1/8
inch). In addition, liposuction of the jowls can be performed as well.
Newer techniques now concentrate on the mid-face and have been
appropriately named, "mid-face-lift". These techniques are frequently combined
with more conventional types of facelifts to help redefine the
cervico-mandibular angle (sharpen the angle where the neck meets the jaw).
Will the
facelift help smooth out fine wrinkles?
Although there is tightening of the skin, deeper rhytids
(wrinkles) are more improved than fine wrinkling. Improvement of fine wrinkling
may be best achieved by other procedures, including laser resurfacing, chemical
peel, or dermabrasion.
Will the
facelift improve the appearance of the eyes?
No! Often, blepharoplasty (eyelid surgery), laser resurfacing, or
chemical peel is performed at the same time of the facelift to improve the
appearance of the eyes. BotoxÔ (botulinum
A exotoxin) can be used alone or in combination with the above mentioned
procedures to improve the appearance of the crow's feet.
Will the
facelift improve the appearance of my forehead?
No! Often, a forehead lift, laser resurfacing, or chemical peel
is performed at the same time of the facelift to improve the appearance of the
forehead. In addition, the above procedures may be combined with BotoxÔ
(botulinum A exotoxin) which paralyzes the forehead muscles resulting in a
smoother, less furrowed forehead.
Are all
facelifts the same?
No! There are several different types of facelifts performed
today. Each surgeon utilizes his or her own technical variation of one of the
types of facelifts. Some facelifts tighten the understructures of the face and
neck (called the SMAS) using sutures (stitches). Other types of facelifts
involve loosening the deeper structures of the face and remove (cut out) the
excess SMAS, which carries a significantly higher risk of nerve damage and other
complications with no proven long term advantage over the formerly described
facelift.
Newer facelifting modalities, which include the endoscopic
facelift, sub-periosteal facelift, and pre-periosteal facelift, concentrate on
the mid-face which attempt to raise the cheeks in an upward direction through
incisions made in the scalp or just beneath the eyes. Unfortunately, these newer
techniques have not yet been proven to have significant long-term results and
may carry an increased risk of nerve damage or bleeding in addition to a longer
recuperation time.
Where are
the incisions (cuts) made?
There is some variability in the placement of the skin incisions
(cuts). In women, some surgeons place the incision behind the tragus (bump just
in front of the ear) while others place the incision in front of the tragus.
Some surgeons believe that by placing the incision behind the tragus, the scar
is less noticeable. In most facelifts performed today, the incision in front of
the ear extends up into the hairline, which tends to pull the hairline up and
back, thus distorting the natural hairline. Using a newer technique called the "minilift"--minimal
incision facelift, the incision does not extend beyond the top of the ear and
therefore does not displace the hairline.
These incisions extend down around the front of the ear, around
the earlobe, and about halfway up the back of the ear. As there is considerable
variability in the placement of incisions used by surgeons in front of the ear,
the same is true behind the ear. Some surgeons extend the incision straight back
into the hair, which is believed by some to be more easily concealed. Other
surgeons bring the posterior (behind the ear) incision down along the hairline.
This type of incision is believed by some to be more noticeable, especially if
the patient has shorter hair or intends on wearing the hair up.
The "mid-face-lifting" techniques often utilities incisions in
the scalp or just under the eyes. These techniques are frequently combined with
those previously mentioned to further improve the neckline.
What are
the different types of facelifts?
The classic SMAS facelift utilizes undermining (loosening from
the underside) and removing the excess supporting structures of the face, called
the SMAS. This extensive undermining is thought to destroy connections between
the SMAS and the skin which one is trying to suspend (lift). In addition, some
surgeons believe that this plane, just beneath the SMAS, is too superficial to
be effective in tightening the neck. Jost & Levet (1983) believed, from their
experience from fresh cadaver dissections, that the parotid fascia (the layer
just over the parotid gland which is just beneath the SMAS), and not the SMAS,
is in continuity with the platysma (muscle of the neck) which is pulled to lift
the neck. Additionally, dissection and manipulation which include the parotid
fascia avoid injury to the facial nerve, which innervates (sends signals to) the
muscles of the face, signaling them to contract (move).
Dr. Richard Webster, in a classic paper, described the surgical
technique which utilized minimal undermining of the skin without undermining the
SMAS (deep supporting structures of the face) or parotid fascia. His technique
utilized plication and imbrication sutures (stitches) to suspend the SMAS
without undermining (loosening from the underside) or removing (cutting out)
excess SMAS. His studies proved that the results from this facelifting
technique, using stitches to suspend the understructures of the face without
cutting them, are at least as effective and as long-lasting as any other
technique available, while having the lowest complication rate of any
facelifting technique. Since then, many other studies have been performed with
similar results.
Which
type of facelift is the best?
Of course every surgeon believes that their technique is the
best. Fortunately, clinical studies have been performed comparing the different
modalities (types of facelifts) used. Studies performed by Dr. Richard Webster
confirmed that: (1) extensive undermining, as performed in the 'classic' SMAS
facelift, does not facilitate the removal of more skin; (2) extensive
undermining does not result in a 'better' lift; (3) extensive undermining does
not give longer lasting results than a more conservative approach. Another study
was performed by Peterson in the 1970's evaluating extensive undermining versus
limited undermining with plication (suspension sutures) alone for facelifting.
This study showed that only 15% more skin (by weight) was able to be removed by
performing extensive undermining, although no discernible difference in
the cosmetic results was seen. Additionally, 80% of the complications were
seen on the extensively undermined sides. As there was less impairment of
circulation on the sides which were sides which were not extensively undermined,
more tension (tighter lift) was able to be placed on the flaps which healed more
rapidly.
The findings from these studies clearly show that extensive
undermining (as is used in the 'classic' SMAS facelift, Skoog rhytidectomy,
subcutaneous rhytidectomy with SMAS technique, deep-plane rhytidectomy, and
composite rhytidectomy) is associated with a much higher rate of complications,
slower wound healing, and no appreciable benefit in the final appearance of the
facelift when compared to the facelift which utilizes more conservative
undermining with plication and/or imbrication (tightening sutures) of the
underlying SMAS.
One of the limitations of the facelift procedure is that fine
lines and dyspigmentation (pigmentary changes such as "age spots") are
unaffected. In a revolutionary study performed by Dr. Emil Bisaccia, et. al. in
Dermatologic Surgery in 1998, the combination of the "Mini-face-lift" (which
utilizes smaller incisions, conservative undermining, and plication and
imbrication sutures to suspend the understructures of the face and neck) and
carbon dioxide laser resurfacing was safely and effectively used in forty
patients. This combined procedure has overcome the limitations of facelifting
alone in that fine lines, wrinkles, dyspigmentation (pigmentary changes such as
age spots), jowls, and sagging neck could all be safely improved in a single
session.
Newer facelifting techniques have become available which
concentrate on the mid-face. Unfortunately, no long-term studies are available
to support any long-term benefit. In addition, these newer procedures may be
associated with an increased risk of complications. Therefore, many surgeons
will utilize safer modalities (procedures) which have proven long-term benefit
to further enhance the mid-facial region.
What is
submental lipectomy?
Most people have extra fatty deposits under the chin that can be
cosmetically bothersome. This technique utilizes a 1-inch incision placed just
under the chin, from which the fat is directly removed. From this incision, some
surgeons will cut and/or suture platysmal bands (bands in the neck) which can be
cosmetically displeasing. The incision is then sutured and results in a scar.
This technique is most often used by plastic surgeons today, although some
surgeons prefer performing submental liposuction to submental lipectomy.
What is
submental liposuction?
Most people have extra fatty deposits under the chin that can be
cosmetically bothersome. This technique utilizes a small 1/8-inch incision just
under the chin. Through this incision, the fatty tissue is expanded using saline
(a naturally balanced salt solution) which contains tiny amounts of lidocaine
(an anesthetic) and epinephrine (adrenaline, which closes down tiny blood
vessels to minimize bleeding). This instillation technique is referred to as
tumescent anesthesia that is performed using a slender blunt-tipped infuser.
This tumescent anesthesia numbs the area, expands the fatty layer to facilitate
easy and safe removal, and closes down minute blood vessel so that virtually no
bleeding occurs. After the fatty deposits are 'tumesced', a slender blunt-tipped
instrument called a cannula is used to remove the fat. As the incision is so
small, suturing is rarely necessary and the scar becomes virtually undetectable
with time. Some surgeons prefer submental lipectomy to submental liposuction.
Will the
facelift improve the appearance of the jowls?
Yes! All types of facelifting aim at tightening the
understructures of the skin, which improve the appearance of the jowls. In
addition, some surgeons will perform liposuction of the jowls to eliminate their
appearance entirely. This technique utilizes a small 1/8-inch incision adjacent
to the earlobe. Through this incision, the fatty tissue of the jowls is expanded
using saline (a naturally balanced salt-water solution) which contains tiny
amounts of lidocaine (an anesthetic) and epinephrine (adrenaline, which closes
down tiny blood vessels to minimize bleeding). This instillation technique,
referred to as tumescent anesthesia, is performed using a slender blunt-tipped
infuser. This tumescent anesthesia numbs the area, expands the fatty layer to
facilitate easy and safe removal of fat, and closes down minute blood vessel so
that virtually no bleeding occurs. After the fatty deposits are 'tumesced', a
slender blunt-tipped instrument, called a cannula, is used to extract the fat
from the jowls. After this is accomplished, the surgeon will perform the
facelift.
Studies have shown that patients are more satisfied when
liposuction of the jowls is performed with the facelift than the facelift
performed alone (without liposuction of the jowls).
How long
does the facelift procedure take?
Typically the facelift alone takes 90 minutes to well over 3
hours depending upon the surgeons technical abilities and which technique is
used.
What
types of anesthesia are used? Will I be asleep?
Most plastic surgeons today perform the facelift under general
anesthesia in which patients are put to sleep, intubated (a breathing tube is
placed down the throat), and are placed on a ventilator. This obviously carries
a much higher risk of complications, especially for longer procedures. In fact,
there have been several deaths reported when additional procedures (i.e. major
liposuction or 'tummy-tuck') were performed concomitantly (at the same time)
with the facelift.
New face-lifting techniques and the advent of tumescent
anesthesia (a very dilute form of local anesthesia) have allowed the facelift to
be performed without the need for general anesthesia. Now the facelift can be
performed with the patient entirely awake or under 'conscious sedation' in which
patients breathe on their own without the need for intubation (breathing tube)
or ventilator, are arousable, and unaware of what is going on. For shorter
procedures, conscious sedation may be a safer alternative than general
anesthesia.
What is
the cost of the facelift?
The national (U.S.A.) average cost of the surgeon's fees for the
facelift alone is over $4700, which does not include anesthesia costs, facility fees,
and follow-up visits, all of which can well exceed $1000. Additional procedures,
such as blepharoplasty, forehead lift, laser resurfacing, fat transfer, Gore-TexÔ
implantation, and chemical peel, which are often performed at the same time,
will add to these costs.
What is
the preferred face-lifting technique of Dr. Bader?
For most patients, a minimal incision cervico-facial rhytidectomy
("Minilift") is performed. This differs from the 'classic' facelift in that: (1)
extensive undermining is not performed; (2) undermining of the SMAS or parotid
fascia is not performed; and (3) extension of the incisions into the hairline
above the ear is not performed. This technique: (1) results in less visible
scar; (2) is a safer procedure; (3) can be combined with other procedures, such
as laser resurfacing, which virtually erases fine wrinkles and dyspigmentation
(pigment changes such as age spots), and (4) has the long-lasting benefits as
does the 'classic' facelift.
For most women, the incision (cut) is put behind the tragus (the bump just in
front of the ear) which minimizes the visible scar. For men, the incision is
about 1/8 inch in front of the ear so that the beard does not extend onto the
ear. Behind the ear, the incision is extended straight back into the hair. It is
Dr. Bader's opinion that the resultant scar tends to be less noticeable, and
often undetectable, than the scar resulting from an incision that is brought
down along the hairline.
For nearly all patients, liposuction of the jowl is performed in
addition to submental liposuction. This is preferred over submental lipectomy as
the scar which is produced will be hardly noticeable compared with the 1 inch
scar produced with lipectomy.
