Advice for 43 Year Old Considering Facelift?

Question

I am a 43-year-old (athlete) with facial volume loss, a turkey neck, and signs of jowls just beginning to form.  I recently had a consult with a plastic surgeon who recommended a deep plane facelift, as it would give the best and longest lasting result.  He also told me a facelift at this age would ultimately hold up better than not having it done, as the muscles and other deep facial structures would be fixed in place, thereby making them more resistant to the natural downward migration of tissue in the aging process.  Is this true?

Rod J. Rohrich, MD · Answer

Aging is dependent upon your genetics. If the patient has significant facial fat loss and jowling, one could consider doing a “Lift &
Fill” facelift. I would usually not recommend a “Deep Plane Facelift” as it has
certainly not been shown to provide a longer-lasting facelift result, but does
increase morbidity and recovery. I do recommend that you see a true facial
rejuvenation expert with Expertise and Experience and has Exceptional results
in facial rejuvenation. Especially, in the younger age group so that you have a
natural look and not a “windswept” Hollywood appearance.

Larry S. Nichter, MD, MS, FACS · Answer

If you feel that your face does not reflect how young you feel on the inside, a facelift may be the solution to help you look and feel younger. During your consultation, your doctor will evaluate your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure. Based on this evaluation, he/she will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. Your doctor should make sure you have a full understanding of what results to expect.Always insist on a board certified surgeon!
#drright #facelift

Jonathan Kulbersh, MD · Answer

The most important decision in undergoing a facelift is choosing the best doctor. There are a variety of techniques for facelifting. It is known that all facelifts that lift the deeper facial muscles/SMAS have the best long term results. Some believe that a deep plane will last longer but others disagree. There is no proof that a deep plane last longer. A deep plane has potentially a longer recovery and increased risk due to it more aggressive surgical nature and an increase proximity to vital structures such as the facial nerve.

I hope this helps.

I hope this helps.

Jed H. Horowitz, MD, FACS · Answer

Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. The LiteLift™ is an innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself which benefits many male patients. The goal of the #LiteLift is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.The technique requires limited incisions and takes a vertical lifting approach, in contrast to the traditional facelift, which requires extensive incisions and lifts or pulls the face towards the ears horizontally. The modern techniques used allow us to perform most LiteLift® procedures in the office under local anesthesia. Also, removing the risk of general anesthesia opens the door for more people to pursue facial surgery. All too often people do not move forward with undergoing the desires facelift surgery due to their overwhelming fear of the risks associated with general anesthesia.This is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.The best candidates for #LiteLift are non-smoking patients 35-60 years old with stable skin elasticity, well-defined bone structure but showing early changes of the lower face and the neck. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. All in all, Lite Lift™ surgery is individualized for each patient.

Anil R. Shah, MD · Answer

The key for any facelift is does it address the proper anatomic cause of aging and your individual anatomy. At 43 years of age, one of the key issues for you would be laxity of the skin, to determine which procedure would be best for you.

Toby Mayer, MD · Answer

Get a second opinion and see what another experienced facelift surgeon says after he is able to examine your face. Also, a facelift resets the clock---it doesn't stop it. So you will continue to age.

Kenneth D. Steinsapir, MD · Answer

Dear Jenny
One has to be careful what you look for.  The deep plane facelift is a technical tour-de-force.  The anatomic dissection is requires an in depth knowledge of the facial planes and the anatomy which requires intimate exposure of the facial nerves to carry out the deep plane dissection. The deep plane facelift can results in motor nerve damage in up to 3% of cases although the incidence of permanent damage to the nerves is less than 1% of cases. If the deep place facelift made for a better, longer lasting facelift result, this might provide a rationale for taking this increased risk.  
However, a number of studies have demonstrated to benefit of the Deep plane face lift over safer means of perform the facelift such as SMAS flap or even tight the SMAS with sutures and not actually incising it.  Why do surgeons persist in performing the higher risk procedure?  Some might say it is machismo. However, I don't think it is reasonable to put people at greater risk just to satisfy the thrill seeking of the surgeon.
One other thing about the deep plane is that many end up with an other pull look form this procedure. I am now fairly convinced that this effect is not inherent to the deep plane method but rather the bias of certain surgeons to try and get the biggest affect event if the result is not an aesthetically optimal result (Mach 1, or wind tunnel look).  
I would encourage you to seek a variety of opinions and in particular by attention to the before and after images. Be critical. You will be shown what the doctor considers their best work. Look at the edges of the mouth, evidence that the cheek fat pad is over pulled and how the ears and hairlines are tailored. If you don't like what you are seeking, don't expect your results to be any better.

Tanveer Janjua, MD · Answer

You have to be very careful with a facelift. You might still look gaunt because of lack of fatty tissue in your face. In fact sometimes facelift can make you look worst.
Most of your face issues can be resolved with Sculptra injection. The only area where you might need surgery is the turkey gobbler neck deformity.
I would recommend starting with Sculptra injections and once the face is looking better, than look for a possible necklift if needed.
Regards

Remus Repta, MD · Answer

Hello,

	Thank you for the question.  Facial rejuvenation is the process of reversing some of the signs of aging including volume loss and sagging soft tissue and skin.  A face lift may be needed to improve the sagging part of aging but it will not address the volume loss.  Often, fat grafting is combined with face lift surgery to accomplish the best result when volume loss is also the case.  I would define your aesthetic goal and seek consultation from several board certified plastic surgeon.

	All  the best,

	Dr. Remus Repta

Raj S. Ambay, MD · Answer

The basis of a facelift is not pulling the skin rather it is repositioning of tissues under the skin and then re-draping the skin over the more youthful understructure. In some patients neck liposuction, fat grafting and other procedures to the eyes or forehead are done concurrently. The quality of the skin, loss of volume, or descent of tissues can only be accessed by a physical exam. Also each surgeon has a technique which works in their hands. I would be less concerned about the plane of dissection and more focused on before/after and comfort with the surgeon. Consult with a board certified plastic surgeon to get a detailed exam and treatment plan. Most have complimentary or low cost consultations.

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