I had hoped we’ve grown away from the windblown over pulled look characterized by so many face lifts done in the eighties and nineties. But sadly, we all can still see these faces everywhere. Sometimes they are as a result of a cookie cutter approach, and sometimes they are from over pulling the skin to compensate for under dissection of the deeper tissue planes that contribute to sagging. Nevertheless, the outcomes to me are suboptimal. Excessively tight pulled faces have skin which looks shiny and it tends to flatten the face. Flattening ages the appearance. Youthful faces have volume right?
Excessive pulling causes odd pull strains which set up as strange lines across the face. In my estimation, people want to look younger, not more strange. At least most people anyway!
We all are guilty of gently pulling our skin back across our cheeks and neck in a horizontal motion as we look into our mirrors! It probably happens countless times a day across America, but this is not how surgeons need to correct facial aging. There-in lie’s the trap. The face ages complexly, so the corrections can’t rely on one force to make change, and that is where weird outcomes stem from. For example using “Threads” to tug on the undersurface of the skin, or doing a “skin only” lift. The corrections have to take into account the many levels of aging, problem is that there are anatomical considerations of where facial motor nerves run which prohibit certain things from being done. So knowing that surgeons must compromise for patient safety of outcome we have devised approaches which satisfy most of the requirements.
The face, including the eyes, age in pockets. We have areas of good adherence and areas of poor adherence. Well adhered areas stay fixed to underlying tissues. Poorly adherent areas sag. The sagging progresses to the next fixed point. The interface between lower eyelid skin and cheek skin is one example. The nasolabial fold is another. The jowl is a third. Restoring these to their youthful location and adding back volume to some faces at the same time is the solution.
My approach is simply this.
1- Make a proper diagnosis. What really is happening to that face?
2- Listen to the patient. What are they trying to achieve?
3- Design a plan. Do they need volume added and where? Should it be fat grafting or filler? Combine this with a good extended “SMAS” face lift and extended skin undermining without extensive pull.
4- Execute the surgery well
5- Have patients agree to a long term skin surface replenish program with products and light periodic peels
And there you have it. A primer on plastic surgery of the face!
Best of luck!