Again it is the surgeon not the surgery that makes the difference

Dear Catalina

Everyone is looking for the exact formula.  The reality is that a great surgeon can do almost anything with any technique.  Having said that there has been a realization that higher risk facelift have not produced more profoundly improved results.  Deep plane and composite facelifts increase the risk of facial nerve damage.  How high is the risk compared to a SMAS flap facelift?  One or two percent compared to essentially a zero incidence.  Is the risk justifiable?  Time has told us that no it is not.  Consequently facelift surgeons have been modifing their facelift procedures accordingly.  Over pulled and unnaturally contoured face lift results are now giving way to more conservative and natural results.  We recognize that there is no one right way to do a facelift and these structural surgeries do not replace the need for the expanding use of facial fillers, and skin resurfacing procedures.

We abandoned the composite facelift more than 5 years ago, in favor of the 360 Facelift concept.

The reason is simple:  the way the technique is described, a great alteration in the hairline occurs.  The composite lift is not done in a multiplanar fashion.  It is not possible to independently manipulate the deep tissues and the skin.  Rather, they are attached to each other.  Thus in order to elevate the deep tissues, the skin must rise as well.  This, in my opinion, raises the sideburn in an unsatisfactory fashion.  Women cannot grow a sideburn to compensate for its loss.  Loss of temporal hair and sideburn results in a prematurely aged appearance.

Modern facelifts incorporate numerous ancillary procedures as well, not just to tighten, but to replace volume.

The paradigm of just tightening a face and not restoring lost volume is, in my opinion, dated.

The composite lift is easy to perform for an experienced plastic surgeon.  It may not, however, be the best choice for the reasons above.

Experienced plastic surgeons will be able to show the prospective patient many short and long term results.  Every patient is, however different.  Their results are also different.  Identical twins who have very different exposures to the sun, for example, will have entirely different long term results.  And that is just one variable.

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