Facial Rejuvenation is what I enjoy most in my career. I can meet a client, evaluate them, and envision the rejuvenation that can be achieved. I have been an artist since I was two years old and I feel that facial rejuvenation allows me to use this artistic gift, whether it involves Botox, injectable fillers, laser treatments, or surgical procedures. I find it interesting that for some patients, we need to remove excess fat from certain areas of their face, and in others, we want to increase the volume in their face by using injectables or structural fat grafting. It is literally like sculpting in clay. A little less here, a little more there, a little lift, etc. Facial Rejuvenation by no means deserves a “cookie cutter” approach since virtually every individual requires an intensely customized plan to give them the best possible results. Obviously I cannot discuss every possible option for facial rejuvenation in this short article, but I’d like to discuss the philosophy I have, and why I think my patient’s get better results.

I can’t overemphasize the importance behind a customized approach. Fortunately for my patients, I have virtually every tool in my box of techniques for rejuvenating the face, so I am not going to be limited as to which techniques would benefit them most. Frequently I see patients who were evaluated by someone else, typically in a medical spa setting, that recommended injectables as their treatment of choice, but the patient really needed a minor surgical procedure for adequate improvement. The problem is, the person evaluating them was unable to perform such a procedure and was thus trying to “shove a round peg in a square hole” so to speak. The other saying that comes to mind is that “if your only tool is a hammer, all the world is a nail”. It is incredibly true that if you only have certain techniques available at your disposal, that everyone you see seems to need only those limited techniques. Because I am well trained and experienced in virtually every aspect of facial rejuvenation, I can provide my patients with an extremely personalized approach for their cosmetic concerns.

With that said, I feel that the main reason patients desire facial rejuvenation is that they overall feel quite good, they are healthy, exercise regularly, and eat well. However, when they look in the mirror, they see someone who doesn’t fit with their inner person. They see someone who looks older than they expect, and they want the person on the outside to look as good as the person on the inside feels. Facial rejuvenation can make that happen.

Another important aspect of my philosophy on facial rejuvenation is the concept of what I call Facial Harmony. Facial Harmony means that all areas of the face go together in a harmonious way. Nothing looks out of place or doesn’t go well with another area. Harmony is beautiful. Disharmony is not beautiful. An example would be a patient in their middle 50’s who has had too much sun exposure, maybe smoked too much, and now wants to look rejuvenated. If all areas of the face have aged (which they always have at that age), then the patient really needs treatment of all areas of the face. However, if that patient decides that they only want a minilift to get rid of the turkey neck, then the neck will definitely look better after such a procedure. The problem is that the rest of the face has not been treated, and there is now a disharmony between the neck and the eyes, cheeks, lips, brows, etc. It’s as if you wanted to remodel a 50 year old living room and just replaced the couch. It’s a nice couch, but what did it really do for the overall look of the living room. Furthermore, by treating all areas of the face simultaneously, there is nothing to “notice” about the rejuvenation. The person looks great, everything is in harmony and no one really knows why they look so good because it is a very natural appearance. I have actually had patients complain that “nobody noticed”. I tell them “that is what we wanted”. Then I ask them if they have been getting compliments and they invariably say “YES”. That is the idea behind retaining Facial Harmony, and that is why I always encourage my patients over the age of 50 who are seeking facial rejuvenation to consider comprehensive facial rejuvenation.

I’ll write more about this in future articles. Please contact me if you desire a consultation for facial rejuvenation.

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What is a necklift? Why is it different than a facelift? Well these are questions that can’t be answered as easily as you would think. In reality, many facelifts incorporate a necklift, and many necklifts need to be performed in conjunction with a facelift. In younger patients (under age 40) a necklift can be performed alone. In any age patient, a facelift can be performed without a necklift, though the result is often compromised when this is done. Confusing? Let me try to explain.

A facelift is virtually any procedure that is performed through incisions in and around the ears and that lifts the tissues of the lower cheek and jawline to improve jowling and submental laxity. The submental area is the area under the chin, so most facelifts will improve the area under the chin, or what most would call the upper neck, so a facelift can improve the neck by itself. Unfortunately, a facelift is very limited in the amount of improvement it can create in this area. That’s why minilifts, Lifestyle Lifts, Quicklifts, S-lifts, weekend lifts and any other in-office type of limited facelift can not obtain the kind of results I can obtain by performing a more sophisticated face and necklift.

Having said that, I do perform many minilifts in the office setting. I do, however, discuss the limitations of this procedure with my patients before proceeding. For youger patients (under the age of 45), the minilift can be a fantastic way of getting rid of the early laxity and jowling, and many times can last for 5-10 years. At that time, the patient would be at an age that would be better served with the more sophisticated deep plane facelift that I perform in the operating room.

A necklift is any procedure that directly treats the neck tissues. Typically this is performed through a small incision under the chin. Through this incision, the underlying muscle (the platysma muscle) is reduced and tightened. Frequently, the fat above and below the muscle is treated as well. Occasionally even the muscles under the platysma (the digastic muscles) are partially removed to avoid a bulge in this area. In younger patients, the skin in this area can be redraped and allowed to heal with a facial sling. In the more mature patient, the skin in this area is not elastic enough to “bounce back” and skin laxity would result. Therefore, a facelift is performed in conjunction with the necklift so that excess skin can be removed, resulting in a nice smooth neckline without the submental fullness and without the submental skin laxity. It is truly the best of both worlds.

When I perform my deep plane facelifts in the operating room, I always perform a necklift as described above. Because I perform my facelifts using the deep plane or extended SMAS technique, I can lift the cheek fat pad, the jowl, improve the nasolabial folds (smile lines), reduce the submental fullness and skin laxity and create what I call a submental shelf. This is a relatively flat area under the chin, the same appearance that is noted in youth. These sophisticated, customized techniques allow me to obtain truly amazing rejuvenation that has an extremely natural appearance with youthful harmony. No one looks like they have had any surgery, they just look rejuvenated, rested, and brighter. It’s exactly what the doctor ordered. Please contact me and schedule a complimentary consultation for your facelift concerns.

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