Case Studies Facelift

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*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a 56-year old woman who sings in a 70’s and 80’s cover band and wished to look more vibrant and youthful. She was concerned with her upper and lower eyelids and neck but was open to suggestions that would help improve her appearance.

Assessment

The patient had significant upper eyelid hooding due to excess lid skin. Her lid excursion was normal and there was no evidence of lid ptosis. She had hollowness of her lower eyelid-cheek junction and moderately crepe skin changes of her lower eyelids. Lower eyelid tone was excellent. Her smile lines were deep but otherwise her skin looked good. She had a loss of jawline definition and a heavy neck.

Procedures

Under general anesthesia in a certified outpatient surgical facility, the patient had an upper eyelid blepharoplasty to open up her eyes making her look more vibrant. Her lower eyelids and crow’s feet area were tightened and smoothed with CO2 laser skin resurfacing and her lower face and neck were contoured, tightened and lifted with neck liposuction and a modified deep plane facelift including platysma muscle midline plication. About 3 months after surgery, she had Restylane® placed in her tear troughs and Juvederm® to her smile lines. The patient is shown 1 year after her fillers.

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*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a woman in her late 60’s who was generally dissatisfied with the appearance of her face and neck. She was healthy and stayed fit but was concerned that there was a disconnect between how she felt inside and her outward appearance.

Assessment

The patient had significant facial volume loss represented by deep hollowness under her eyes (tear troughs) and sunken cheeks. Her fair skin was heavily sun-damaged as represented by significant lines and wrinkles and due to her soft tissue and boney facial volume loss; the skin was loosely pleated in the area of the lateral chin (marionette area). There was significant loss of skin elasticity resulting in skin sagging in both the face and neck and separation of the platysmal muscles in the neck. Her upper eyelids had asymmetric skin excess with normal lid function and the lower lids had poor lid tone with the left lower lid beginning to sag downward.

Procedures

The procedures were done in 3 stages. The first entailed re-volumizing the patient’s face with Restylane® under the eyes and Voluma® to the cheeks. This was important to re-establish a more youthful facial shape. The patient then had her first procedure under general anesthesia in a certified outpatient surgical facility in which the upper eyelids were balanced with an asymmetric blepharoplasty, the lower eyelids were tightened with bilateral lateral canthopexies and the lower face and neck tightened and lifted with a modified deep plane facelift including platysma muscle midline plication. After several months of healing, the patient underwent full-face CO2 laser skin resurfacing under general anesthesia in an outpatient surgical center to address her skin texture. The facelift and laser procedures were deliberately separated to protect the integrity of the facial skin. Since a facelift compromises blood flow to the undersurface of the skin and the laser injures the out layers of skin, combining these procedures, particularly in older, thin skin can compromise healing if done simultaneously. The patient is shown 4 months after her CO2 laser procedure. Her skin is slightly red as she is still healing from the procedure and suffers with rosacea.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
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  • Before
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  • Before
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*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a woman in her mid-60’s who told us that she “never felt beautiful” and wanted to feel better about her appearance.  She also noted that her neck was sagging and her eyes were puffy and she wanted to look vibrant and beautiful for her age. She was from another state and flew in to have her facial rejuvenation procedures.

Assessment

The patient had significant facial volume loss represented by deep hollowness under her eyes (tear troughs) and  a loss of youthful cheek fullness. Her brow position was normal and attractive. Her upper eyelids were heavy and her lower eyelids were puffy which made her eyes appear small. Upper lid function was normal and her lower eyelids had good tone. Her facial boney skeleton was somewhat deficient, particularly in the area of the chin, which was weak. She had normal occlusion and no jaw complaints. Her dentition was intact but crowded with some overlap. Her lower face revealed moderate loss of skin elasticity, moderate jowl formation and marionette creases that were deeply etched into her skin. Her neck had substantial loss of skin tone as revealed by the rippling skin of the central neck, ptotic submandibular glands, platysmal band formation and a blunted chin-neck angle with loss of jawline definition.

Procedures

The patient had Restylane® injected under the eyes in the tear trough and Voluma® injected  into the cheeks the day before surgery to re-volumize these areas. She also had Botox® to her crows feet to keep this area resting during the healing process from CO2 laser skin resurfacing . The next day, under general anesthesia in a certified outpatient surgical facility, the patient had  an upper eyelid blepharoplasty, lower eyelid transconjunctival (through the inside of the lower eyelid so that no scar is visible and the lower lid position does not change) fat contouring blepharoplasty, placement of a small anatomic solid silicone chin implant, CO2 laser skin resurfacing of her lower lids and a modified deep plane facelift including platysma muscle midline plication (a procedure to lift and tighten the lower face, neck and jawline). The patient is shown 6 months after her procedures. She told me that for the first time in her life, she felt beautiful!!

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

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*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a 70-year old woman who’s concerns are limited to her loose neck, marionette lines and wrinkles around her mouth.

Assessment

The patient had significant neck skin and muscular laxity. Her jawline revealed early jowl formation. There were well healed and appropriately  placed scars from a previous facelift done years earlier. There were deep etched marionette creases and moderate lip lines. The remainder of her exam is not discussed as the patient was solely focused on surgical correction of the aforementioned areas.

Procedures

Under general anesthesia in a certified outpatient surgical facility, the patient had a secondary modified deep plane facelift including platysma muscle midline plication with excision of the previous scars and preservation of her hairline. she also had CO2 laser skin resurfacing of the peri-oral (around the mouth) area. She is shown 3 months post-operatively. Notice how the surgical result facilitated an entirely new and more youthful look for the patient. She shared with me that the results have been emotionally uplifting, which is obvious from the photographs.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

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*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a 63-year old man who’s concerns are limited to his lower face, jawline and neck.

Assessment

The patient had moderate facial volume loss represented by a loss of youthful cheek fullness. His facial boney skeleton was somewhat deficient, particularly the chin.  His lower face revealed moderate loss of skin elasticity and moderate jowl formation. His neck had substantial loss of skin elasticity and moderate skin laxity, ptotic submandibular glands, platysmal band formation and a blunted chin-neck angle with loss of jawline definition.

Procedures

Under general anesthesia in a certified outpatient surgical facility, the patient had a modified deep plane facelift including platysma muscle midline plication.  It should be mentioned that a chin implant was discussed, but the patient chose not to pursue it. He is shown 3 months post-operatively sporting a light beard, which in combination with his surgical result, gives the patient a new and more youthful look.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.