Facial rejuvenation must be considered holistically even if only one feature bothers you.
For many years if the subject was facial rejuvenation, it was assumed that only the face and the neck were addressed. The upper third of the face was routinely ignored. I always consider all aspects of the face —the upper third or forehead area, the middle third being cheeks and the lower third, the neck—as being one anatomic unit. When all areas of the face are rejuvenated simultaneously they share the same clinical age and going forward, will age together. In other words if the lower 2/3 of face undergoes rejuvenation, but the upper 1/3 is ignored, this part of the face will continue to age rapidly while the lower 2/3 will age at a slower rate resulting in aesthetic disparity.
Facial rejuvenation can be generally being divided into operative and non-operative options. There are many genuinely new options, but sometimes simply catchy reconstituted names for existing procedures. This can often confuse both doctor and patient. “Lunchtime lift” “Mid facelift” “Mini facelift” are just a few of the terms that are more marketing based than medically inspired.
Ulthera®–the new ultrasound therapy truly tightens and rejuvenates the skin of the face (and body). Botox continues to smooth out lines on the forehead, corners of the eyes and around the lips. Fillers (most commonly Restylane®, Juvederm® and Radiesse®) sufficiently address the symptoms of aging but not the cause. The best solution is usually a combination approach with a practitioner well versed in both surgical and non surgical facial rejuvenation.
Fat Grafting is the only procedure that addresses the symptoms and the causes of aging. Fat grafting is unique in that it addresses the cause of aging, repairing bone and soft tissue atrophy while slowing the aging process. The vast majority of patients in my practice look younger five years after fat grafting. Fat grafting is an acquired skill and very technique dependent. I have lectured and published on this subject and have built a solid reputation for great results with this procedure.
Once certain conditions are present, you cannot substitute fillers in place of a facelift. Once soft tissue descent is present and Ulthera® is not deemed an option, a facelift is advised. While a more emotional investment for the patient, the results are routinely highly successful. How do you quantify success? I would define it as replacing what is missing and tightening the underlying facial structures to their former, youthful position without visible scars for a refreshed, natural appearance devoid of any pulling or obvious intervention. Although a difficult emotional decision, to attempt to use fillers when only a lift will do is to risk a much less natural result. Overusing fillers can leave you with as bizarre an outcome as an overdone facelift.
The key to looking your best may be less dramatic, nuanced procedures. Patients frequently see a facelift as the largest piece of the facial rejuvenation puzzle. However, during our consultation I may point out much smaller nuanced procedures that when properly diagnosed and executed can be the key to looking your very best and thus making you feel the way you had hoped. Some examples might be surgical Botox (permanent removal of the lines between the brows,) a lip lift or hairline lowering browlift. Not every surgeon is comfortable performing these procedures. More information can be found under Unique Procedures.
Buyers beware: There are contradictory and confusing opinions regarding facial procedures. Being a critical consumer is an essential skill for the aesthetic physician. A surgeon must examine the viability and claims of all products, devices and techniques before bringing them into his or her practice. It can save pain, time and money for the patient. I take pride in providing the safest, proven range of services while still staying on the leading edge of the specialty. Alternative opinions will always exist so it is important to consider the source.