NATURAL FACE LIFT & THE AGING FACE AND NECK
Since birth, the body ages with the passage of each year. At some point, the outside appearance of the body – especially the face and neck – starts to show signs of aging that is socially and psychologically unattractive. While the brain and mind can stay young and active with mental exercise and fulfilling life’s work, aging features of the face begin to diverge from one’s inner self.
Examples of these changes include (from the top of the face to the neck): saggy or tired appearance of the eyelids; baggy or hollowed appearing lower eyes; deepening creases around the mouth, or hollowed cheeks; jowls and loss of defined jawline; and hanging “turkey gobbler” of the heavy neck, or hanging, loose skin with vertical banding on thin neck.
Genetics play a major role in how and when the body progresses through this change, but accumulation of outside factors such as sun exposure, smoking, stress, or weight loss also contribute to these aging signs of the face and neck.
AGING FACE – SKIN LAXITY
There are specific features that characterize aging face and neck. Foremost, it is the change in skin texture and appearance. Environmental factors accumulated over lifetime, such as sun exposure and smoking, and genetics result in changes in skin with loss of elasticity and formation of permanently etched expression wrinkles.
Changes seen in aging skin are more than just the skin surface. Just underneath the outer layer of the skin lies the inner layer of the skin – the layers of supportive fiber network consisting of collagen and elastin. This fiber network allows the skin to stretch and recoil with each movement of the muscle every moment in life. With biological aging and accumulation of damage from the environment, the skin begins to wear out. The inner layer of the skin begins to thin as collagen and elastin begin to disappear. Since the skin no longer stretches and recoils as effectively, some parts of the skin will begin to accumulate wrinkles over time. Other parts of skin where gravity takes hold, will begin to sag and become more lax.
AGING MID-FACE – LOSS OF VOLUME AND HOLLOW APPEARANCE
Located between the skin and bone of the face, are the soft tissues of the face which consist of muscle and a series fat compartments. These fat compartments are located in specific areas of the face – especially overlying prominent bony areas, like the outer rim of the eye/cheek junction (malar prominence). Over time, fat compartments of the face begin to lose volume and deflate, resulting in hollowed appearance. This is especially noticeable in areas like the cheeks, inner corner of the eyes (tear trough), and temple areas. The loss of facial volume, especially at the bony prominence, leads to hollowed aging facial appearance and convey loss of vitality.
AGING LOWER FACE – JOWLS FORMATION AND LOSS OF JAWLINE
Underneath the skin, other structures of the face are also changing with the aging process. Skin and the soft tissue of the face (fat pad and muscles overlying the bone) are attached and anchored to the bone by series of retaining ligaments. The retaining ligaments of the face are like the supporting cables of a suspension bridge. With the aging process, these retaining ligaments begin to weaken, resulting in sagging of the soft tissue of the face as gravity pulls them down. Because these retaining ligaments are located at specific areas of the face (over the bony prominence of the cheek “zygomatic ligament” or jawline “mandibular ligament”; and along the side of the face “masseteric cutaneous and parotid cutaneous ligaments”), weakening of these supporting cables result in characteristic signs of aging face (jowls, and loss of jawline.
AGING NECK – HEAVY NECK AND VERTICAL BANDS
Type 1: Heavy Neck
Depending on the age, body habitus, and hereditary predisposition, some people present with aging neck in the forms ranging from mild fullness under the chin to hanging, loose “turkey gobbler” neck.
Type 2: Vertical Bands
Some people (typically thin people with long neck, or those who have lost significant body weight) may develop prominent vertical bandings at the center of the neck and hanging skin under the chin. This banding at the center of the neck is formed by the edges of curtain like muscle called “platysma” wrapping each side of the neck as it begins to relax and splay apart at midline.
On the day of consultation, we may mention additional procedures that the patient may consider at the same time for face lift. Most common procedures to combine with face lift include blepharoplasty (“eye lift” or eyelid procedure), cheek or chin implant, laser resurfacing of the skin around the eyes and mouth, fat or SMAS transfer to deep crease lines/lips, or rhinoplasty. Advantage of combining these adjuvant procedures with face lift are: 1. Cost efficient for the patient 2. Same time commitment for recovery
CANDIDATE FOR FACELIFT
Face lift is one of the three most common cosmetic facial surgeries with a total of over 125,000 procedures performed in the US alone in 2015 according to data published by the American Society of Plastic Surgeons. People often ask what is the correct age for facelift. Patients who undergo facelift for men and women range between the ages of 40-70, with the average age around early to mid-50. More important than the chronological age is the “biological age” determined by the patient’s hereditary features combined with lifestyle choices accumulated over time.
RECOVERY FROM FACELIFT
There is an on-call physician during off-hours, and surgical patients will also have access to the surgeon’s personal cell phone for any specific surgery -related questions/concerns.
Week 1: Patients should expect some swelling and bruising. Patients do not typically complain of pain, but they may experience some numbness which will resolve over time. Expect to have a slow and restful week. Plan for a few good read and movies during this week. Sutures will be removed on day 7 after the surgery.
Week 2: Some patients are almost back to normal by week 2, but most will take another week to fully get back to their normal selves. During week 2, each day rapid improvement (less swelling) will be noted. Some people may be able to return to work sooner than 2 weeks after the surgery. By the end of week 2, patients should expect recovery back to normal and return to work.
1 Month visit: We return to the photo room and take a full set of photos. Next, we will upload these photos and compare next to the photos from the consultation day (before pictures). This is an exciting day for everyone, and reminds us at our practice why we love what we do.
COST OF FACELIFT
The average cost of facelift was $6,759 according to 2015 statistics from the American Society of Plastic Surgeons. This number represented surgeon’s fee only, and varied widely depending on the type of facelift and qualification of the surgeon.
The figure above did NOT include the anesthesia, and the operating room facility fees. The cost of anesthesia, and the operating room facility fee will vary greatly depending on where the surgery takes place (hospital vs. day-surgery facility vs. licensed private operating suite).
The net cost for the patient includes the surgeon’s fee, facility fee, anesthesia fee, and medication/medical test if needed.
We maintain a lower than national average cost for comparable facelift to our patients, because we can control the cost of anesthesia and facility fee at our own licensed private operating suite. When the patients come for facelift consultation at Natural Face Clinics, the cost of the procedure is a comprehensive figure including the surgeon’s fee, anesthesia, and the facility fee.
CASE STUDIES – SURGICAL FACIAL REJUVENATION
These case studies are meant to illustrate the key features of the aging face and how we can improve through safe and effective surgical treatments.
Each patient is unique – they present at different biological ages with different sets of changes to their facial image. Also, each patient has a unique self-image of what bothers them, and what kind of improvement they are looking for – a dramatic make-over or a natural, refreshed rejuvenation.
Based on this, a unique treatment strategy is offered for each patient, and we focus only on those key features in this case study. To view a complete Before/After gallery, please click here