Full Facial Rejuvenation

Full facial rejuvenation

As a Beverly Hills facial plastic surgeon and facelift specialist, I take care of people from all walks of life and from all over the world who are looking to rejuvenate and improve the appearance of their aging faces. The term facelift can be a very confusing term as it means different things to different surgeons. Most people who come to see me tell me, "I want to look younger and better, but I don’t want to look weird or pulled". My prospective patient will often put their hands on their face and pull so hard that their lips will pull to the side and say, "I don’t want to look like this."

It is understandable that people have those concerns given the extremely strange appearances of the many older celebrities on television who have had old style facelifts that pull the face in an unnatural way. I am proud to say that based on the facelift results I have been able to expose to the world; the public’s perception of expected results is changing. More and more of my patients tell me that they know that I will not give them that pulled or weird look and that is why they have traveled great distances to see me. I have been able to refine the techniques that I use to create full face rejuvenation such that the results are always natural and there is never a chance of looking "pulled."

The old style of facial rejuvenation usually involved an aggressive skin pull facelift with the thought that the tighter the pull, the more areas of the face could be rejuvenated. Therefore, the cheeks would be pulled back towards the upper ear and often times the eyes and lips would be affected with this lateral pull. This is a technique that I have never used and I have never liked the results of that style of facelift. It took us years to really understand the anatomy and the process of the aging face, but we now have a thorough and sophisticated understanding of the aging process and how to correct it. We now know that the aging face loses volume; meaning that the thickness of the bones and skin thins and the amount of facial fat lessens.

Facial Fat Grafting

We can think of the face as a beach ball; when a face has good volume it is like a beach ball full of air with a taut appearance. The aging face with volume loss is like a ball that has lost air, which would make it look flaccid and saggy. Using this basic concept, we know that one of the essential steps to rejuvenate the aging face is to restore the loss of volume. This can be done by one of several ways including facial fat grafting, specialized facial implants, and repositioning of one’s own facial fat. By replacing volume to the upper cheeks and the central part of the face, we can limit the areas that need to be actually pulled and lifted to the lower neck and jawline. This will ensure a natural nonsurgical appearing result.

The area around the mouth and nose (nasolabial folds or laugh lines and marionette lines) are best rejuvenated by adding volume and not pulling. The pull would have to be so strong to affect that region that it would guarantee a very unnatural appearance. By adding volume to that region of the face, a youthful and natural result is achieved. This is done by fat grafting, specialized chin implants, or repositioning of the jowl fat, depending on the individual’s anatomy and pattern of aging.

The cheeks should be addressed in the same way. The aging face loses fat volume and bone density which causes deflation that is often seen in the cheeks. A lateral pull on the cheek looks unnatural so this avoided. The cheek can be rejuvenated by elevating it in a vertical fashion either with a cheek lift, cheek implant, or fat grafting. This again will allow for beautiful rejuvenation to that area and prevent the unnatural appearance that is all too common with the old style, aggressive face pull. The most beautiful faces have full cheek volume and smooth contours to the mid face such that there are no grooves and valleys that light can get caught in, which creates shadows that are unattractive. The best method of volume restoration depends on the individual. All the techniques that I use have been perfected and refined over the years to create very natural and beautiful changes.

Lower Eyelid Rejuvenation

Rejuvenation of the lower eyelids has changed drastically as well. It is now understood that with age comes loss of volume creating a hollow appearance in the area of the tear trough, which is where the lower eyelid meets the upper cheek. It is evident to most people that the bags under the eyes are a problem, but the hollowness is not always recognized by the lay person or inexperienced surgeon. This hollowness magnifies the bags and creates a more aged appearance. When there is a bag just above a hollow area, it is like having a mountain right next to a valley. There is a very large contour discrepancy that causes light to get caught in the valley and that creates a dark shadow that often is responsible for the appearance of dark circles under the eyes and a tired appearance. In the past, surgeons would attempt to correct this problem by removing all of the fat from the lower lids, resulting in more hollowness and more shadowing. The result was a more tired and aged look. To obtain the best results, volume loss in the tear trough or lower eyelid area needs to be replaced. This is done by several methods including facial fat grafting, repositioning the lower eyelid fat, elevating the cheek fat, or specialized implants into the hollow area. Again, the best method depends on the individual’s anatomy and aging pattern. The fat creating the bag is also reduced, but it is not as aggressively removed as it used to be. Now the fat is carefully trimmed just enough to create a smooth contour, but not enough to create hollowness.

Loss of bone density in the jaw secondary to aging leads to jowl formation and/or a pointy or droopy chin otherwise known as a "witch’s chin." This problem is best addressed by adding volume in the form of specialized chin implants, designed to perfectly restore the loss of bone and recreate the defined and sculpted jawline that is desired by all. The overall theme is that much of the face is rejuvenated by adding structure and volume and not by pulling and cutting.

The brows are addressed by very subtle elevations to create a rested appearance but the degree of brow elevation should be very minor for most people. The endoscopic browlift allows for a subtle and natural elevation to the brow and forehead without the risk of looking pulled or surprised.

The upper eyelids loosen and sag with age and excess skin can be removed with an upper Blepharoplasty; however, the degree of fat and muscle removed from the upper eyelid should be minimal. The older techniques were designed to remove as much fat and muscle from the upper eyelids as possible, but this creates a sunken appearance to the eyelid that looks very aged and unattractive. In keeping with the theme of preserving volume, removing only the skin and fat that is necessary will reduce the sagging and preserve the youthful contours. This ensures a youthful and natural appearance to the upper eyelid.

This brings us to the lower face and neck. This is the area where surgical techniques are used to pull and tighten to improve the appearance. The only area of the face that I am very aggressive in tightening is the neck because this area cannot be over-tightened. The flatter the contour under the chin, the better! Even in the most unnatural looking celebrities, the area under the chin is not the area that makes them look pulled or weird. When evaluating the faces of the most attractive models and actors, the neck is very flat and contoured. By using the submental techniques described above, I perform a very aggressive neck contouring rejuvenation for most people. The "Turkey Neck" appearance that so many people complain of is a result of the loose platysma or neck muscles. The only way to correct this is to tighten those muscles. Tightening of these muscles is done with a technique called a corset platysmaplasty. Those muscles can be very stubborn and if an aggressive tightening is not performed the loose appearance is very likely to return within a short period of time. Furthermore, many people have fullness to the region under their chin they wish to have reduced. There is a deep layer of fat called the subplatysma fat layer. I have been removing this layer for the last 5 years and this procedure allows me to achieve very contoured necks on even the worst surgical candidates. It is standard thinking that if a person is heavy or overweight their thick neck cannot be improved and therefore that person is not a good surgical candidate. Typically, results are not significant for people with heavy, thick necks. By using the aggressive neck techniques that I have described, I can achieve amazing results that I previously thought were not possible.

In addressing the jawline, I am very conservative. The facelift technique used for a given person depends on that individual, their anatomy, and their desires. I have refined many different facelift techniques over the years and have had the pleasure of helping thousands of people. The details of the deep plane, vertical, and mini facelift are described above. Many of my patients come from far distances and wish to have full facial rejuvenations. I have had a wealth of experience with this type of procedure and have tailored my techniques to create the most natural, rejuvenating results.

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