Jesse E. Smith, M.D., F.A.C.S
Dr. Smith is Board Certified by the American Board of Facial Plastic and Reconstructive Surgery. He is one of a small group of surgeons that has achieved Dual Board Certification in Facial Plastic and Reconstructive Surgery as well as Head and Neck Surgery.
Have you ever looked in the mirror and used your fingers to elevate the skin and structures of your neck? Did you like what you saw because it reminded you of a more youthful-looking you? If you answered yes, you may be a candidate for facial or neck rejuvenation. You may also be pleasantly surprised to find that you may not need surgery to look younger.
Four components of the face and neck change with age: skin, muscle, bone and fat. Skin loses elasticity and luster, bone loses volume, and muscles and ligaments become weak, contributing to sagging appearance. Every person has a different mix of these factors and correcting them requires each one to be addressed in a special way. As we age the cheeks descend, exacerbating end deepening lines and hollows. Many surgeons have attempted to alleviate these problems with a lifts alone; however, the primary issue can be volume loss that needs to be restored. There are a variety of products currently available to help including: Fat Grafting, Sculptra, Juvaderm, Radiesse and Restylane. These are non-surgical options that can be done in the office. Correcting volume loss alone can take years off of a person’s appearance, and we commonly use these products in combination to produce the Liquid Face and necklift. The Liquid Facelift restores volume to hollows, while lifting the cheeks, jowls, temples, and forehead, thus, restoring a natural, youthful appearance to the face and neck.
Until recently, most neck lifting techniques consisted of extensions of skin only lifts, which resulted in a somewhat unnatural and un-refreshed appearance that seemed to be “pulled too much.” Beneath the surface of the skin runs a thin sheet of muscle called the superficial musculoaponeurotic system, or SMAS. This forms a critical support network for the face and neck and actually stretches with time, leading to laxity of the overlying skin. The effects of gravity result in drooping of the facial skin because of decreased elasticity and stretching of the underling structures. Surgeries with “SMAS plication” techniques (also known as “S” lift or “J” lift) yield somewhat better results than simple skin lifting in most individuals.
In most patients though, a “deep plane” neck lift will provide the most natural appearing results. This surgery involves broadly elevating the muscle layer (SMAS) of the lower face and neck, and re-draping it at a higher area, where it was in more youthful times. Only a small amount of skin is excised during a deep plane neck lift, as opposed to skin-lifts where large amounts of skin are removed. Since most of the patient’s skin can be preserved with deep plane necklifts, there is a minimal possibility for the “wind tunnel” look of older style lifts, and minimal scaring because there is less wound tension.
Deep plane neck lifting is more technically challenging and not all surgeons feel comfortable with this technique. The recovery time is slightly longer than with simple skin-only lifts or their cousin, the mini-lift or lunchtime lift. The results, however, are more natural and long-lived.
Recently, the use of small cameras, through camouflaged incisions within the hairline and inside the mouth, has allowed for effective, minimally-invasive lifts to be performed. These allow for enhancement of the central neck, making it an ideal procedure for the patient in his or her 40s and early 50s. Endoscopic techniques are often combined with rejuvenation of other facial features as well.
Often combinations of the above techniques are needed to turn back the clock in a natural, long-lasting manner, making modern face-lifting techniques quite gratifying for the patient. A tailored approach must be made for each patient to offer the best possible results.