What are your options for a facelift?
Dear doctors, I would like to know your opinion. I am just desperate looking at recent photos.
I am 36 and doing sports, eating healthy and use sun protection cream, but I realized that
I look horrible. I probably need face lifting (full?) urgently. Or maybe neck lift? Because
all the other treatments should be just redundant. Thank you.
Thank you for your question. You’re 36 years old and you’ve submitted a single photo
which must be focused on the area that bothers you the most which appears to be the outer
area from the corner of your mouth down we refer to as the nasolabial fold area. And
that you’ve described that you’re doing all the right things; you’re eating healthy,
you’re doing sun protection, you feel you look bad and you’re considering the idea
of having a face lifting procedure.
Well, I could tell you that in my practice the youngest patient I ever did a facelift
on was 37 years old and there are certainly exceptions like this patient who is 37 years
old who come at different stages who have laxity and most of the time is a genetic issue.
Now that being said, the majority of my patients who are women, who have face lifting procedures
are usually in their mid-40s and older and so I would be hesitant to recommend that you
absolutely should have a face lift. And if you were to consider a face lift let’s understand
what you are addressing.
So it appears that the genetic factors that have affected you have to do with two things.
One is volumetric loss which means you lose bone muscles and fat and the skin kind of
deflates a little bit and it appears to be in excess. The second part is laxity, when
you look in the mirror and you pull up gently do you see a significant improvement we sometimes
refer to that as the mirror lift. Now if you feel that the skin moving up looks right to
you and not with a lot of pressure. Very often patients will exaggerate and pull very tightly
whether it’s their eye or their face lift and surgically that’s simply just not attainable
because the face has to move; you turn, you move up and down, you smile, you move it’s
dynamic. You put excess tension on the skin nothing good comes out of that. So consider
when you do this limited lift does that look better.
A lot of time patients come to me who are in your age range and are ready and willing
to get a face lift. I tell them that it is probably worth trying some type of volume
correction such as a filler like Restylane or even a thicker filler that goes under the
skin like Radiesse. Just to see how you like what you look without doing surgery. There’s
always time to do surgery but if you can delay it there is benefit to that, if there is other
things that are lifestyle associated that you can do whether it is smoking cessation,
whether its sleep, other things that could also help with your healthy lifestyle, also,
adding that into the factor can affect your facial appearance. But if like the patient
that I described when the skin was just laxed and the fold just kind of just hung over a
little bit and there wasn’t going to be that much benefit from the filler then a limited
face lift maybe appropriate.
So I think the best way to really decide whether or not it’s right for you is to meet with
qualified experienced cosmetic surgeons. There are many different surgeons who do facelifts
and you can certainly choose from a wide variety and get a sense of what your options are.
My approach to face lifting surgery for example is to do the surgery under local anesthesia
with LITE™ IV sedation. Again it is also an art and it is also about the communication
between the doctor and the patient as what the desired outcome will be. So with those
understood when you do your consultations, you’ll hopefully find a doctor who you resonate
with and will help you, help guide you to whether or not you should have a face lift
or whether you can buy some time with some injectables.
The one thing that I am going to say that may be a little controversial is that I would
advise you to avoid thermal devices that are trying to tighten skin in order to avoid a
face lifting surgery. These thermal devices are marketed very aggressively, they feature
them on various TV shows and they are very very sophisticated on how they create the
perception of being highly effective. But for at least 10 to 15 years of different types
of thermal devices I’ve seen, I have never seen one that does anything close to what
a face lift does nor do I have seen anything that had a really significant effect. Very
often thermal devices create the illusion of benefit because of swelling and everything
fills out a little bit.
But more importantly what my observations has been that people who’ve had these more
recent very aggressive thermal devices that heat up the skin very rapidly at a very high
temperatures are actually losing collagen, that they’re getting damaged, that their
skin is losing fat. You know for years, back in the day, liposuction was done very aggressively
because fat was the enemy.
And in our practice where we are doing a lot of regenerative medicine particularly the
use of platelet rich plasma and methods I’ve developed for hair loss, I am really appreciating
the critical importance of that thin layer of fat that’s just below the dermis and
that typically unfortunately with thermal devices being used very aggressively literally
cooks that fat and I think really accelerates the aging process. Again a statement like
this makes me very unpopular amongst people who sell thermal devices and amidst all the
hype but 20 years of practice and taking care of patients continuously, I feel that this
is an opinion that I’ve drawn based on my experience so it’s something for you to
also think about as you learn about your options. So I hope that was helpful. I wish you the
best of luck and thank you for your question.