Procedures

Facelift (Facial Rhytidectomy)

A facelift refers to the correction of the neck, jowls, cheeks, nasolabial folds and the malar/eyelid junction areas. The procedure is designed to reverse the effects of aging caused by gravity, fat loss and sun damage. This is achieved by addressing the skin, fat and muscle in such a way that results in a more youthful, healthy, natural and non- surgical appearance.

My surgical technique has evolved over the past 25 years. The modern standard facelift is bidirectional. The skin is moved back and underlying connective tissues are shifted upward. The skin is moved in a horizontal direction toward the ears. The connective tissues of the facial muscles are lifted and advanced vertically. Tension is placed vertically on the deep tissue referred to as SMAS (superficial musculoaponeurotic system). The muscles are then restored to their original youthful position. Incisions are well hidden in the hair behind the ears and in the temporal hair region. In a "well done" facelift, hair is minimally disturbed. The skin is not pulled or tethered, but is gently sutured in a fashion to produce lines that defy detection. To promote excellent longevity with a natural non-surgical appearance, I've developed a technique I refer to as the mandibular island pedicle to firmly support the jawline. The neck is improved by removing excess fat, plicating and suspending the platysma muscle and if necessary reducing the submandibular gland size. The result is a beautifully sculptured youthful neck and chin. If a drooping chin deformity "witch's chin" is present, this can be corrected at the same time.

There has been an increasing awareness of the role of fat loss in the aging face. The cheeks, eyes, lower lip labial folds and temples become hollow with age. Cheek fat is generally protected and repositioned to maintain a youthful appearance. Lined lips (smoker lines) and the surrounding areas that are fat deficient can be filled by meticulously injecting the areas with 1/10 of a cubic centimeter of fat at a time. This injected fat is harvested from other areas of the body.

Other facial improvements that could also be incorporated into the facelift procedure might include eyelids, elevating a low brow position, removing forehead lining or addressing wrinkled aged skin. These topics will be developed in other sections of this website.

Pain after a facelift is generally quite contained and is easily controlled with pain medication. Sutures are removed in stages (5 to 12 days). Healing is quite rapid. One may return to work generally within two weeks. Appearance continues to improve up to 12 months. After surgery, I follow my patients for about a year. I welcome and encourage these visits.

Complications from a facelift procedure are generally quite minor and easy to remedy. Minor infection, bleeding, and scar tissue can occur and are usually correctable. Problematic complications are exceedingly rare.

There are two myths about facelifts that are worth mentioning.

Once you have a facelift, you will have to keep having facelifts. False. It's up to you. It depends on your desire to maintain a more youthful appearance as you continue to age. Longevity varies from 5 to 15 years, but many gains are near permanent in the improvement of structure and appearance.

You should wait until there is a strong need for a facelift. False. In reality, the perfect age for a facelift is when you feel you are looking older than you should. Everyone ages differently. Some people in their 30's have aging characteristics of someone in their 50's. The age range for a facelift is between the early 30's (rare) up to the later 80's (also rare).The largest group for both men and women is between 40 and 70.

The actual conduct of the facelift is performed in a formal surgical suite either on our premises or a hospital. I do most of my surgery at the Plastic Surgery Center at 1515 El Camino Real. I am the medical director and we have a very safe California State Licensed Facility. Our facility is used by the Stanford faculty for some of their procedures. If desired, I can perform procedures at Stanford Hospital. Some patients choose to go home, while others may wish an overnight stay in a hospital setting or care facility.