The Art of Facelifting

Posted Wednesday, September 12, 2007 to PROCEDURES > Face

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Beverly Hills plastic surgeon Lawrence Koplin MD explains to Holly O'Neill components of the aging face & how they are considered when performing a facelift.

There have been many advances in the modem facelift. Surgeons are looking towards techniques to restore youth to a face, rather than just stretching out wrinkles. Beverly Hills plastic surgeon Lawrence Koplin MD explains this to patients when they come in for their first consultation. "I tell my patients something they intuitively know but have never really thought about - that there are three things that happen in aging of the face."

1. The skin becomes discolored, rough and wrinkled
2. The skin becomes looser
3. The face loses volume

Discolored, rough and wrinkled skin

This is helped by treatments such as peels, laser resurfacing and dermabrasion. Lines, like lipstick lines around the mouth, aren't eradicated by just pulling the skin tighter. "Wrinkles and fine lines on the face don't really get better with a facelift; they may need something else, like a peel or resurfacing," explains Dr Koplin.

Loose skin

Everyone develops a degree of looseness of the skin with age. This occurs with time and gravity. Lifting techniques can help. "The goal of that part of the surgery is to put things back where they used to be," says Dr Koplin. "Pulling hard on the skin is not the way to make someone look better." Dr Koplin moves not only the skin but the underlying muscle layer, called the SMAS. "In treating the aging face you have to fix each layer that is loose," explains Dr Koplin. "Because the skin is attached to the deeper muscle layers, when you take the deep layers and put them back where they belong the skin comes along with it. The result looks much more natural, less operated on and lasts much longer."

Volume Loss

The face becomes thinner as we age. "This is not properly fixed by pulling the skin tighter," explains Dr Koplin. "A tight face is not a young face. A round face is a young face. Restoring volume to the face in fat layers is just as important as taking care of the skin and putting things back where they used to be."

Dr Koplin uses fat grafting to restore volume to the face on nearly every facelift he performs Fat is taken from the lower abdomen, like a mini-liposuction. About three times as much fat is placed in the face as will be eventually needed to allow for the reabsorption that invariably happens. The patient may look swollen for 2-3 weeks but this is explained to them. "My concern is how they look in the long term, not in three days," says Dr Koplin. "I rarely do a facelift now without fat grafting unless the patient has a very round face and a good fat layer, which is rare if a facelift is needed. Often I can delay a facelift because the fat graft makes such a difference."

Fat Grafting Without A Facelift

Sometimes a younger person may only be showing signs of volume loss and not the other aging face problems. If this is the case, a fat grafting procedure alone may result in a more youthful look. "Fat grafting can be performed as a procedure on its own, especially for a patient whose lips are thinning and who has a haggard look with deep nasal labial folds, the corners of the mouth are turning down, but there is no jowl or neck looseness", explained Dr Koplin.

In the past, there was some controversy surrounding fat grafting. Now the success rate is very high due to two factors: how the fat is removed and treated before injection and how much fat is injected. "You have to overfill - I tell my patients I expect them to only retain about 30% of the fat that is injected permanently," said Dr Koplin. This means three times the amount to achieve the desired result is injected, leaving the patient puffy for 2-3 weeks at which time the fat settles rapidly and only incremental loss is observed over the next 3-6 months. The final result is seen at 6 months.

The way the fat is removed and treated prior to injection has changed dramatically. Some surgeons pass the fat through a tiny needle and, after washing it, reinject it into the face through an equally tiny needle. Dr Koplin explained the drawback with this procedure: "Fat is not a liquid or a paste; it is made up of little packets called "fat pearls". Fat shouldn't be liquefied; theses small packets need to be injected for it to survive. So you need to draw them through a cannula (used for normal liposuction procedures) and under extremely low suction, to create less damage".

A small cannula is also used to reinject the fat. Less damage to the fat means more fat will remain in the injected site. The only fat to survive is that which has a blood supply or blood vessels in it. Dr Koplin explained the technique to maximize fat survival: "If you inject in tiny strips like strands of spaghetti, then the surface area is greater and the blood vessels can attach to most of the fat. So you inject in multiple tunnels that are next to or above or below each other, but don't inject into the same place".

Recovery time is usually a week and there is slight bruising and swelling and a feeling of tightness may occur. The area where the fat is removed from may feel tender as well. If the fat is injected evenly, it will survive evenly and one of the rare complications such as lumpiness or asymmetry won't occur.

Fat can be reinjected as needed. However Dr Koplin recommends waiting at least six months to see the final result before undergoing a further procedure.

For those patients who aren't showing loose, saggy skin, filing out the wrinkles such as between the eyes and around the mouth may be all that is needed for a younger, fresher look.

The degree of the individual's needs will determine the facelift procedure required. Rejuvenation facial surgery is becoming more complex and Dr Koplin concludes: "The paradox is you have to do more to look less".

Add Comment

To discourage SPAM, we ask that you type your code (displayed below) in the text box.

Your Code:
Enter Code:	*