Traditional and Mini Facelift and Necklift
Over time, the long-term effects of gravity, exposure to sun, dry air, and general stress takes its toll on an individual’s face and neckline. A facelift can considerably reduce these signs of aging. There are many kinds of facelift surgeries, from the traditional ‘skin-only’ facelifts to lunchtime facelifts to 3-D Facelifts.
What types of facelifts are there?
Facelifts can be categorized into a few different types. In general, ALL facelifts entail cutting the skin around the ears and pulling the skin of the face back to remove the excess. This can result in a smoother jawline, less fat in the neck, and an overall younger look. There is no such thing as a nonsurgical facelift.
The least invasive facelifts are usually the “lunchtime facelifts.“ These range from suture-only lifts, such as the Contour Threadlift and the Silhouette Lift, to the “one-hour” types of facelifts. The one-hour lifts include those “revolutionary” lunchtime facelifts you see on TV infomercials, with impressive, but misleading results. I am not a fan of any of these lifts.
The studies I’ve seen with the suture-only lifts showed results which lasted only a year or so, however the sutures stay in your face forever (long after the results have faded). Many companies which produced the barbed sutures used in these lifts have discontinued making them. Very few surgeons perform suture-only lifts anymore.
I believe the one-hour facelifts you see on TV are extremely misleading. These are not the revolutionary procedures they claim to be. Instead, they are simple variations of simple procedures which were proven long ago to be pretty ineffective. However, phony plastic surgeons pay thousands of dollars for ads touting these procedures as the greatest thing since the breast implant. Before-and-after photos are misleading, and don’t necessary protray the procedure that they are advertising. Most surgeons who work for these one-hour facelift centers are not even real plastic surgeons certified by the American Board of Plastic Surgery. Instead, they are doctors trained in other specialties (like ENT) who take weekend courses to learn these simple procedures. Follow-up care is often not provided. It’s a classic bait-and-switch. If you are considering one of these bargain lunchtime facelift centers, be very, very wary.
Most ‘real’ facelifts entail a combination of removal of skin, tightening up of the underlying muscle (called the SMAS and platysma), and removal of excess fat. Every plastic surgeon performs their facelifts differently. Some well-respected facelift techniques include the MACS Lift, the Composite Facelift, the Deep Plane Facelift, all types of SMAS-tightening facelifts, and the 3-D Volumetric Facelift. The difference in results for any of these types of facelifts vary per surgeon and patient. Most of these types of facelifts have been proven to have high satisfaction rates.
Where are the scars of a Facelift?
The scars of a more traditional facelift or a mini facelift extend from the top of the ears, around the earlobe, and in the crease behind the ear. Some plastic surgeons extend the scar into the temple area, although I prefer not to do this. In people with very heavy necks, the scar can also extend somewhat down the hairline in the back for a better neck lift. The scars usually fade nicely with time, although all patients are at risk of a thick scar depending on how their body heals. Every plastic surgeon places their scars differently. Make sure to talk with your plastic surgeon about exactly where he or she places the scars of a facelift.
How much pain is there with a facelift?
There is usually very little discomfort with a facelift. Patients may take a few pain pills, although some patients don’t need any at all. If you are having a lot of discomfort after your facelift, make sure to notify your plastic surgeon. There may be a problem.
How long does a facelift take?
A traditional muscle-tightening facelift takes approximately 3 to 5 hours to perform, depending on the surgeon and the technique used. My muscle-tightening facelifts take me about 3-3.5 hours. Most patient look very presentable within 2-4 weeks. I tell my patients who undergo a lower or mini-facelift that they should look good within a week or two. All patients have swelling which can last for 4-6 months, however.
What is the 3-D Volumetric Facelift?
Plastic surgeons used to think that a face aged in only 2 dimensions, by sagging of the skin. Hence, traditional facelift techniques treated facial aging by focusing only on tightening. This often left people looking like they were in a wind tunnel after their facelifts. We now know that the face ages in 3 dimensions, by a combination or loosening of the skin and loss of volume, mainly in the cheeks and under the eyes. The 3-D Volumetric Facelift combines a muscle-tightening facelift with volume addition using fat grafting. Therefore the neckline is tightened, but the cheeks are also softened and filled out, creating a true 3-dimensional rejuvenation. Fat is added to the cheeks, under the eyes, and even in the lips if desired. I coauthored a scientific paper in The Aesthetic Surgery Journal which described this technique.
Click here to view before and after images of some of Dr. Youn’s Facelifts.
Click here to read the scientific paper Dr. Youn coauthored on the 3-D Volumetric Facelift.
Submental liposuction removes the fat under the chin and in the neck to produce a sharper jawline and neckline. This procedure is best in patients who still have elastic skin and involves a small 1 cm incision under the chin. Patients who are older and/or have loose skin under their chin are not as good candidates for this procedure. Patients usually don’t need any pain pills, and often go back to work after just a couple days. More and more plastic surgeons are using laser-assisted liposuction (Smart Lipo, Lipolite, Slim Lipo, etc.) as an aid in tightening the skin. The jury is still out on whether the benefits of laser-assisted liposuction are significant enough to notice. Laser-assisted submental liposuction will not tighten up the submental area anywhere near as impressive as an actual facelift.
Click here to view before and after images of Dr. Youn’s submental liposuction patients.
Facial aging involves both drooping of the skin and a loss of volume. While the loosening of the skin is usually most evident by the time you reach your forties or fifties, loss of volume can be seen as early as your late twenties. Loss of volume, or a gaunt look to the face, is most often seen in the lips, the cheeks, and under the eyes. This is best treated by Facial Fat Grafting or Transfer. Fat can be removed from the tummy or thighs via a small incision, purified, and reinjected into areas of the face which have become gaunt with age or hereditary factors. The amount of fat that lasts permanently varies per patient and per area, and can be repeated if necessary for optimal results. There is usually minimal discomfort and scars, although significant swelling may persist for two to three weeks. I tell my patients that most people have a ‘take’ of 30-70%, with a lower take in people who have a high metabolism (really thin). Some surgeons use a more traumatic fat grafting procedure which can result in swelling that can last months. Because there are many ways to perform facial fat grafting, make sure to discuss your expectations with your plastic surgeon.
Click here to view before and after images of Dr. Youn’s Facial Fat Grafting patients.
Eyelid surgery is designed to remove excess skin and fat from the upper and lower eyelids. The procedure usually takes about 1 hour and can be performed using sedation or general anesthesia. The discomfort is usually minimal, as most patients don’t take any pain pills. Patients usually look good within 1-2 weeks.
An upper blepharoplasty is used to correct drooping upper eyelids that tend to sag with time. A thin scar is placed in the crease of the upper eyelid, where it is well-hidden. Excess skin is removed, often along with herniating fat.
Insurance plans occasionally cover upper blepharoplasty surgery when the upper eyelid skin is so excessive that it disturbs the vision. If you believe you may be a candidate for insurance-covered blepharoplasty, be sure to visit an optometrist for visual field testing prior to your consultation with a plastic surgeon. The requirements of insurance plans vary, so be sure to consult with your insurance agent for details.
Lower blepharoplasty is used to remove excess puffiness or bags from under the eyes. The lower eyelid puffiness is caused by excess herniating fat, which is removed during the procedure. In general, lower eyelid wrinkles are not removed by lower blepharoplasty. Wrinkles are best treated using lasers or chemical peels.
Lower blepharoplasty can be performed under sedation or general anesthesia, takes about an hour and fifteen minutes, and results in very little discomfort. Most patients don’t take pain pills and look good within a week or two.
There are three techniques of lower blepharoplasty surgery:
The traditional technique entails a small incision under the eyelashes and is best for patients who have excess skin on their lower eyelids in addition to puffiness. Skin can be removed, along with the herniating fat. The scar is usually well-hidden and can be difficult to see. The benefit of this technique is the ability to remove excess skin. The drawback is the potentially visible scar and the higher rate of lid retraction. Some plastic surgeons believe that this technique can result in a higher rate of ectropion (or eyelid drooping) due to the fact that the muscle is disturbed during this procedure. For that reason, the next two techniques have been developed.
The transconjunctival technique utilizes an incision inside the eyelid, allowing a plastic surgeon to remove the lower eyelid fat without any visible external scars. This technique is often preferred for younger people without loose skin or people who do not desire any visible scars. Often, chemical peels can be used to improve any fine wrinkling under the eyes. This can be done at the same time as the transconjunctival blepharoplasty. The benefits of this technique are the lack of visible scars and low incidence of eyelid retraction. The drawback is the inability to remove any excess, crepey skin of the lower eyelids.
The pinch technique combines the two above techniques. In the pinch technique, the plastic surgeon removes the excess fat via an incision inside the eyelid. Once this is performed, the surgeon then removes excess skin from the front of the eyelid by pinching off skin only, leaving the muscle undisturbed. This therefore allows the plastic surgeon the ability to remove fat AND skin, all while minimizing the risk of eyelid retraction (since the muscle layer is undisturbed).
Click here to view before and after images of Dr. Youn’s eyelid surgery patients.
Click here for information regarding Asian eyelid crease surgery.
A forehead lift or browlift is used to correct a drooping browline (eyebrow area) reducing the horizontal lines and furrows (worry lines) that often make a person appear angry, sad or tired. The procedure creates a refreshed, youthful appearance to the forehead area above the eyes. There are two surgical methods, and during your initial consultation the procedure that your plastic surgeon believes works best for you should be recommended.
I most often perform the Endotine Endoscopic Browlift. This enables the procedure to be performed with a minimal number of incisions and a minimum of downtime. With the Endotine system, I’m able to perform an endoscopic browlift using small absorbable implants instead of metal screws. The brow is lifted, creating a refreshed and youthful look. The implants are palpable, but absorb completely within a few months. I utilize five separate 2 cm incisions for my endoscopic browlifts. Some other surgeons may use four. Recovery is minimal, although patients may have bruising that can last for a few weeks and swelling that can persist for a couple months.
The traditional method of browlift utilizes a longer surgical incision that is hidden either in the hairline or in the scalp, typically extending from ear to ear. This is a time-tested procedure with great results, but a higher rate of numbness and bald areas. Basically, the forehead is peeled off the skull, pulled back, and the excess scalp is cut off. I typically reserve this procedure for patients who are not good candidates for the endoscopic browlift or have not had lasting results from an ‘endobrow.’
Click here to view before and after images of Dr. Youn’s browlift patients.
Surgery to reshape the nose is among the most common plastic surgery procedures. This procedure can reduce or increase the size of the nose, remove an unwanted hump, change the shape of the tip or the bridge, and/or narrow the width of the nostrils.
There are two types of rhinoplasty surgeries: The Open Technique and The Closed Technique.
During the Open Technique, the plastic surgeon makes an incision just inside the nostrils and connects the two incisions via a cut on the columella (the skin that separates the two nostrils). The surgeon then peels the skin back, revealing the inner nasal anatomy. Alterations are made to the bone and cartilage under direct vision to alter it to the desired shape. Once the surgeon is done, the skin is laid back down and the incisions are sutured together. The open technique allows better control and visualization of the procedure for the plastic surgeon, but has the drawback of a visible columella scar and longer swelling.
During the Closed Technique, the plastic surgeon makes incisions only inside the nostrils. He or she then shapes the nose by performing procedures under the skin. While this technique does not allow as much visualization of the internal nasal anatomy, many experienced plastic surgeons can achieve nice results with less scar and less swelling. I use this technique almost exclusively, but with the knowledge that it can be limited.
Most plastic surgeons have their patients wear a splint on their nose (typically made of plastic, metal, or plaster) for at least a week after surgery. If your nasal bones are broken during the procedure (used to straighten or thin the nose) then you will likely have some bruising around your eyes. This bruising can last 2-4 weeks. Some plastic surgeons put packing or splints inside the nose as well, for varied amounts of time. Most rhinoplasty patients do not have a lot of pain with the procedure, and often take only a handful of pain pills.
Rhinoplasty is a very complicated procedure and should only be performed by skilled, board-certified plastic surgeons. In my experience, this may be the cosmetic plastic surgery procedure with the highest revision rate. Make sure you and your surgeon share the same vision for your nose if you undergo this procedure.
Click here to view before and after images of Dr. Youn’s rhinoplasty patients.
Chin augmentation can change the shape of the chin to extend the chin from the face. The contour of the chin can be reshaped to be smoother or more angular in appearance. Chin augmentation can be tailored to create a more balanced yet feminine look in females, and a stronger, more masculine appearance in males. There are two ways to insert a chin implant, either through an incision in the mouth or under the chin. Chin implants are composed of many substances, although the most common is smooth solid silicone. The benefit of using this type of implant is that it is 100% removable. Some other implants are made to grow into the bone and cannot be removed as easily.
Dr. Youn performs this procedure using either the patient’s own fat or a small implant placed through the mouth with no external scars. Swelling is usually minimal, and most patients can return to work within a few days.
Full and vivacious lips have always been recognized as aesthetically important features which signify youth and beauty. Some of us however, are born with thin, ill-defined lips, or lose the fullness in their lips as they grow older. Dr. Youn performs lip enhancement in a variety of ways, including using fat grafting or injectables like Juvederm, Restylane, and Prevelle to increase the fullness and enhance the shape of lips.
The corners of the mouth tend to droop as people age. Dr. Youn corrects this in two different ways. For minor drooping, injections of Restylane, Juvederm, or fat can provide a lift for the corners of the mouth. For patients with more severe drooping, a surgical corner mouthlift can be performed. It is a procedure which can be performed in the office under local anesthetic, and can result in a significant lift with a small scar.