The goal in face-lifting today is to achieve a natural inoperative look. A recent discovery shows that facial aging is not only gravitational pull and skin descent, but also a gradual deflation of the entire face filling. A recent article by Rohrich and Pessa, published in the Journal of Plastic and Reconstructive Surgery (The Fat Compartments of the Face: Anatomy and Clinical Implications for Cosmetic Surgery. Plastic & Reconstructive Surgery. 119(7):2219-2227, June 2007. Rohrich, Rod J. M.D.; Pessa, Joel E. M.D.) has shown conclusively that facial aging is different in different areas of the face. How do we apply this to our patients to improve our result? In most patients, the traditional facial technique pulls or LIFTS one way only WITHOUT FILLING and then often resulting in an unattractive “windswept” operative look. The procedure for modern facelifts includes deep lifting and filling in multiple planes. Without this understanding, the patient will have a much higher chance of having the "windswept Hollywood" appearance. THE GOAL OF MODERN FACELIFT IS TO RESHAPE, REFILL, AND RESTORE A NORMAL YOUTHFUL NONOPERATIVE LOOK.
In 1992, American Plastic Surgeons were forced into a noble experiment when the FDA halted the routine use of silicone gel implants for cosmetic breast augmentation. Now 15 years later, the data revealed from this noble experiment and after placing hundreds and thousands of implants in American women for breast augmentation, many pleasant surprises. SPECIFICALLY SALINE IMPLANTS ARE INDEED AN EXCELLENT CHOICE IN MOST CASES. SALINE IMPLANTS REMAIN AN OPTIMAL CHOICE FOR COSMETIC BREAST AUGMENTATION FOR THE FOLLOWING REASONS.
They are safe, they have a much lower capsular contracture (hardness rate) than silicone gel, less then half the incidence, the incision size for silicone implant is less than half, and the cost is less than half of a breast silicone gel implant. Perhaps most important is that when implants need to be replaced, and all breast implants need to be replaced between 10 and 15 years, saline implants are much easier to remove and replace than silicone gel implants, they usually require no drains, and can be done as a simple outpatient procedure.
All silicone gel implants require removal of the capsule and potentially some breast tissue and require drains and have more post operative morbidity. These facts are not well known or distributed for various reasons.
Saline implants are an excellent method for breast augmentation in patients because they are safe, simple, have a high patient satisfaction rate greater than 95%, and low complication rate. They remain an excellent and premier choice for breast augmentation today and continue to do so. The United States market for breast augmentation now offers the potential patient a choice between saline and silicone gel implants. When my patients ask me what would I prefer if my wife, significant other, or a family member wanted to have cosmetic breast augmentation, I would unequivocally tell them that it would be a saline breast augmentation.
The goal of cosmetic facial surgery today has changed. TODAY OUR PATIENTS WANT MAXIMAL RESULTS AND SIMPLE TO MINIMAL RECOVERY. However, true facial rejuvenation and facelifts is real surgery that is performed by real surgeons in real operating rooms.
THERE ARE MANY NEW PROCEDURES THAT ARE TOUTED AS BEING FACELIFTS OR REPLACEMENT FOR FACELIFTS THAT ARE NOT FACELIFTS AT ALL. Specifically, they do not have the longevity of a true facelift which is between 7 and 10 years. Many facelifts today are skin lifts only while it is well known that deeper layer lifting and repositioning of the deep layers and filling gives you the longevity that is desired. Facelifts that promise a short recovery (2-3 days) will also have a very short lifespan (3-6 months). This is true of many different franchise type facelifts that are being marketed all around the United States. These minimally invasive lifts are in essence a skin pull and often lead to a distorted facial appearance. THE OPTIMAL FACELIFT PROCEDURE IS ONE THAT INCORPORATES LIFTING BOTH SUPERFICIAL AND DEEP LAYERS AND FILLING TO REPLACE LOSS FACIAL VOLUME TO REJUVENATE THE FACE. These techniques give the patient a more natural, youthful appearance.
Facial aging is different in everyone thus; we should not perform the same facelift surgery on everyone. All faces and facelifts are not created equally. Therefore, there is not a facelift for ALL REASONS AND ALL SEASONS.
In traditional facelifts the same facelift technique is performed for most patients. Today in order to obtain the natural youthful look, the surgeon should TAILOR A FACELIFT to the PATIENT’S INDIVIDUAL and UNIQUE FACIAL SHAPE. Everyone has unique features such as a long and short side of their face as well as a wide and narrow side to their cheek area. This should be recognized and discussed with the patient so one can INDIVIDUALIZE FACELIFT SURGERY FOR A NATURAL UNOPERATED YOUTHFUL APPEARANCE.
This individualized approach is discussed at length with each patient preoperatively allowing the opportunity for the patient to participate, via computer imaging, in how their facial shape can be improved or restored. GONE ARE THE DAYS OF PERFORMING THE GENERIC/SAME FACELIFT FOR ALL PATIENTS WHICH IN THE PAST HAS BEEN WIDELY USED, COAST TO COAST RESULTING IN A “WINDSWEPT” OPERATIVE LOOK. Today, similar to what occurred in rhinoplasty over a decade ago; the unoperative natural look is what patients’ desire and should be our goal as Plastic Surgeons. The modern facelift surgery is performed based upon the patient’s individual preop analysis. Each part of our face ages differently and what we need to do to RESHAPE AND REFILL the patient’s facial areas for a youthful unoperated look. The deep layer is called the SMAS which is reshaped and suspended to add longevity to a facelift. This technique helps to suspend the different fat layers as well so one can not only LIFT BUT ALSO FILL with fat augmentations as needed to resuspend the fat layers of the face. This further rejuvenates the face in a youthful manner. This NEW TECHNIQUE HAS LAUNCHED A FACELIFT REVOLUTION THAT WILL ALTER HOW WE PERFORM FACELIFTS TODAY.
Over the past decade, the refinement of open rhinoplasty as advocated by our Dallas Rhinoplasty Symposium has not only revolutionized the thinking of nasal surgery but also the approach to the management of rhinoplasty patients worldwide. NO LONGER IS A ROUTINE RHINOPLASTY DONE IN A CLOSED MANNER IN WHICH ONE BLINDLY MANIPULATES THE UNDERLINING STRUCTURE WITHOUT DIRECTLY VISUALIZING THEM.
Rhinoplasty is the most difficult operation in cosmetic surgery as it is a surgery of millimeters so precision is essential for a successful and reproducible results rhinoplasty. The quantum leap in this approach and how patients are analyzed in rhinoplasty has established an era where upon open rhinoplasty is done with a small (6mm) incision in the columella, that allows you to look at the deformity and see what the problem is and correct it accordingly. This along with properly analyzing the nose before surgery allows you to have an individualized approach to rhinoplasty which delivers consistent reproducible results. The true HALLMARK OF MODERN RHINOPLASTY is an unoperated natural nose that matches and is in harmony with your face.
