Thank you for your question!
You submitted without any photos a question stating you’re 47 years old.
You are considering some facial cosmetic surgery in the future and you state you saw a colleague,
a British colleague perform a procedure called transconjunctival deep plane mid facelift
which involved using a drill holes and titanium screws in the cheekbones.
You’re asking can this be combined with other forms of facelifts and I think you looking
for some kind of guidance as far as the overall benefit of such procedure.
Well I can give you my perspective as a practicing surgeon.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
The concept of mid facelift actually is not a new concept and it has been basically advocated
very aggressively by a very small group of doctors but I can tell you historically my
experience and around 1997.
One of our senior oculofacial plastic in our society presented his results and we were
all very excited about the benefit of mid facelift.
Now that being said, I want to review with you a little bit about what the concepts are
of facial aging and where does mid facelift fit in this context.
Well to begin with, we need to understand as we get older there is a loss of bone, muscle,
fat, and soft tissue.
So everything goes inward and in addition there is sagging and there is descent.
What I have concluded over time and experience, especially for someone who is 47, is that
you’re in a place where your mid-face has not actually descended so much as it has deflated.
There is a big difference.
This mid face lifting procedure is passionately advocated as it is by some colleagues.
I, as a specialist, has been in a position to fix a lot of these so called ideal procedures
because one of the challenge is the mid-face is lifted vertically upward and two methods
such as the use of screws and titanium screws and various types of fixation devices whether
it’s at the rim, at the cheek bone, in the temporalis in the temple area.
I have found that many of these mid facelift procedures, the patient looks too elevated.
They almost look like chipmunks or like a lion and then a lot of those cheeks drop and
when they drop, they pull the lower lids down.
Now again, my view may be a skewed as a specialist where I get to see people who had ectropion
and lid retraction after mid facelift but I would tell you what my thought process is
because as a oculofacial plastic surgeon, mid facelift is technically something I have
done and have no problem in terms of comfort working in that space.
But I would say that proportionally in the mid face volume loss is greater than descent
and that the rest of the face where the skin sags and there is jowls and there is loosening
of the neck skin.
That is where traditional facelift is more appropriate.
So depending on what your situation is.
In my practice, for someone who is 47, I would probably do something that is more likely
to correct the mid-face volume loss either with facial implants like a cheek implant
or by structural volumizing using a method application of fillers at the mid face level.
From my aesthetic, my aesthetic is a more of a natural aesthetic.
I feel like you really restore structure then you can be more conservative with these more
aggressive procedures and there is no question that mid facelift, if you are trying to get
a lot of lift, is an aggressive procedure and you want to be sure that the character
of your face remains the same.
So think through this as impressive a surgeon can be, there is a time and place that is
right for everybody but you want to think what kind of outcome you will ultimately have.
And I would suspect that if you keep yourself fit and healthy, now you’re 47, then volume
correction.
Although it may require some maintenance, there is a much more natural look to it than
aggressive vertical lifting of the soft tissue of the cheek.
The thing about it is there is not much tissue to lift that’s also something a clue as
to what has really descended.
With facial volume loss in your 40’s, I think that you’re probably be off considering
volume correction before doing a more global more aggressive procedure.
I think that you need to meet and learn with doctors who perform these procedures and learn
about these options and I think you will find that a lot of doctors will approach the facial
aging process differently but I think you need to really get a good understanding of
what is the outcome and what are the relative risks involved.
So in my experience over patients who need a facelift in their late 40’s and 50’s,
I’ll do the facelift first and do some volume correction afterwards and really create the
ideal balance where you look like yourself and you still look natural.
Again, this is an art and there are many people who agree and disagree so you really have
to find the right doctor you are comfortable with so that you can proceed with the solution
that fits your needs.
So I hope that was helpful, I wish you the best of luck and thank you for your question.