A youthful, spry refreshed face is a common request for facial rejuvenation procedures. Aging, weight loss, skin changes and laxity, and sun exposure, can lead to facial imbalance, where the skin descends and is not tightly supported over the bone and ordinary locations. The eyebrows fall closer to the eyes, excess eyelid skin begins to bunch up, dark circles can form at the undereyes, all giving a tired, haggard appearance. The cheek fat displaces giving hollowing and poor facial definition. Creases and wrinkles around the mouth, lips, and chin form and deepen. Jowls, or fat pockets present at the lower jawline, and excess skin, bands, fat and “turkey gobbler” appearance can negatively impact the neck.
A variety of techniques and approaches can address some or all of these issues. Non-invasive methods like botox, fillers, and skin resurfacing can begin to have a positive effect. Blepharoplasty, brow lifts, and lower eyelid tightening can immediately make you appear happier, more alert, youthful, and refreshed. In Asian patients, we can create an upper eyelid crease or fold, that may be a desired feature. Deep skin creases or wrinkles at the cheek (nasolabial area), lips and chin can be filled and tightened. Fat grafting creates facial rejuvenation and youthful fullness in areas usually well supported and contoured (malar, cheek area, lower eyes, smile creases, lips, and chin). In some instances, and age groups, facial (or under chin/neck) liposuction is performed to tighten and create a crisp neck angle. In many age groups, a chemical peel can tighten, refresh, and resurface wrinkled irregular, aged, or haggard skin.
A facelift and neck lift are required to reposition loose or lax skin or and eliminate or minimize lines from wrinkles or muscle creases. The tissue contour is improved and the face appears more structural, younger, and attractive appearing. Instead of a “melting wax” appearance the skin is appropriately positioned, in anatomic positions correlating with to a refreshed, youthful, and crisp, sculpted appearance. Incision lines are hidden in places where they cannot be appreciated. The fascial and muscle layers under the skin are tightened and repositioned as well, placing the layer in harmony with one-another. The foundational structure – bone, and facial skeleton, is at times altered, or augmented as well. Providing an ideal platform upon which the facial soft tissues can drape. Skeletal augmentation using facial implants, chin implant, or genioplasty may be advised in certain instances. Facial fat grafting provides fill, fullness, and rejuvenation. In addition to supporting the soft-tissue and adding augmentation, fat restores youthful appearance and due to the stem cells has a positive impact on skin texture, healing, quality, and overall appearance.
All components of the face are ideally addressed to achieve the best, well-balanced, youthful, contoured, and natural appearing face. It is not just the “canvas” but the support and position of the canvas as well. Just as the foundation of the house, the support, the walls, and the exterior all contribute to the most robust, long-lasting and aesthetic structure – so too, the multiple layers must be assessed and addressed in the face.
Brow and forehead position. The brow position is gently lifted and may be arced based on gender and aesthetic preferences. There are surgical and non-surgical (Botox) ways to achieve this. The forehead lines, wrinkles and creases can also be addressed (surgically and non-surgically). In gender affirming cases the forehead bone and brow ridge may be made to be less prominent, and more smooth.
Eyelids, dark circles, and eyeball position. The upper eyelids tend to develop excess or lax skin that can hang over or down to the lash line. The inability to see the upper eyelid above the lashes and skin crease can be a sign of aging and tiredness. Blepharoplasty is a procedure to remove the excess skin, and give an alert, younger, less tired appearance. The lower eyelids can be creased and wrinkled with age as well, and the skin can be tightened with lower lid blepharoplasty. Here too we like to tighten the remaining skin with a chemical peel or laser. The dark circles or creases from the lower eyelid to upper cheek also need to be blended, and filler or fat grafting, or other repositioning will address this. Again, both surgical and non-surgical options are available, and at times used in combination. Treatment (Latisse) for longer eyelashes is also possible. Some differences from one eye to the other can be present, or the eyeball itself can look more or less prominent than desired. These positional changes and relationships can also be addressed (and may involve bone alteration), to meet your goals, and create an aesthetic eye.
Face, cheeks, and lips. The facial skin quality, spots, irregularities, scars, or discolorations can be addressed with surface treatments, chemical peels or topical creams. The skin itself may need tightening or repositioning – via a facelift. The fascia underneath the skin as well tightened or repositioned to optimize support. The cheeks can be made more full, from soft tissue manipulation, fat grafting, and facial (cheekbone) implants. The folds and creases of the face are addressed with filler, skin tightening, and/or fat grafting. The lips can be altered – made more plump with filler or fat grafting, and made longer or shorter – to show less or more teeth with smiling, using a variety of techniques and strategies.
Neck, neckline, jawline, and chin. The lower third of the face is addressed by muscle tightening (platysma plication or repositioning), skin repositioning, fat removal or redistribution (lipectomy, liposuction, or other removal), skin surface treatments (chemical peel or laser), dermabrasion and/or topical treatments. The necklift can correct the “turkey gobbler” jowls, skin excess, crepe paper skin, and other irregularities. The jawline can also be altered using genioplasty (or chin implant), jaw surgery (mandibular projection), jawbone implants (angle or jaw line implants), submandibular gland removal, and other muscle tightening or removal. These variety of strategies can give you the best, most aesthetic, sculpted and chiselled neck, jawline, and chin.
In summary, appreciation or the layers, and areas of correction, will permit the best, most stable, comprehensive, long-lasting, youthful, aesthetic result.
- Skin (topic, treatments, fill, repositioning, tightening)
- Substructure/fat/ligaments/fascia (SMAS) tightening, supporting, repositioning.
- Bone and facial skeleton – augmentation, reduction, contouring, repositioning.
Click on the images below to see the animated sequences. Note that these are actual results, not simulations.
Before the Procedure: What to Expect
During our consultation we will discuss which option(s) are best for you and your goals. Interventions may include: non-surgical and surgical options, either alone or in combination. Skin care and protection are important aspects to discuss, and a prelude to any formal intervention. At times, we can perform non-operative, injectables, fillers, botox, peels, on the spot, to begin an immediate change. In other cases we can discuss phases of care and treatment, lifestyle changes, and weigh the surgical options that will achieve a more dramatic, youthful and long-lasting result. We will obtain a 3D photo and analyse this together. We may perform some general simulations, to see potential before and after results, though the 3D camera cannot assess all the changes that will occur. Regardless of the procedure, you will be asked to stop smoking for several weeks before surgery, and optimize nutrition via consuming a healthy, well-balanced diet.
It is important to convey expectations prior to surgery. A skin and dietary program and/or a weight loss plan may be recommended prior to surgery. Surgery may be deferred during times of significant weight fluctuations. We may wish for you to avoid specific foods / supplements / medications, and refrain from certain behaviours prior to surgery. Blood pressure control is also critical before, during, and after facelift / necklift procedure. We may work with you and your primary doctor to keep this well-controlled. We will discuss in depth expectations for procedure length, recovery, mediations, return visits, return to work and so on.
After the Procedure: How to Recover
Face, eyelid, and brow procedures are typically outpatient/day surgery type cases. You will need a ride home after the procedure. You will have a dressing in place for facelift and necklift procedures. Eyelid surgery only we place ointment alone postoperatively. There may be skin applications we recommend for chemical peels or resurfacing. Ice is frequently recommended, as is head elevation, and “taking it easy” for several days post-procedure. We may see you back as soon as 2-days following the procedure or at 1-week depending on the procedure. If facial bone alteration, augmentation, or procedures are done too, we will discuss those instructions and expectations in detail. Sutures may need to be removed several days following surgery.
Some soreness, decreased skin sensation, tiredness, bruising, and swelling afterward is completely normal. We ask that you avoid strenuous activity for several weeks following the procedure. You will be prescribed some medications after the procedure. We will all benefits, as well as potential risks and expectations during our consultation. It is important to follow the instructions for recovery to ensure that your body heals properly.