Cutting
Edge
A
word about facelift incisions from two leading aesthetic plastic surgeons,
Alan Matarasso, MD and Fritz Barton, MD.
The facelift is the 'gold standard' of facial rejuvenation. By definition, it rejuvenates the face by tightening the underlying musculature, removing excess fat deposits, and redraping sagging skin of the lower face and neck. The traditional goals of a facelift operation are not necessarily to alter the patient's features or to change the patient's look, but to turn back the clock about 10 or 15 years. A facelift procedure generally refers to the lower two-thirds of the face including the neck. The eyelid and brow area which comprise the upper third of the face, is often considered a separate procedure although they are commonly performed at the same time when needed.
It is important to find out where the incisions will be located so there are no surprises after surgery. I can recall getting a call from an irate husband who happened to be an attorney, complaining bitterly about 'the line in front of' his wife's ears.
According to Alan Matarasso, MD, 'The incision for the facelift follows the natural curve of the ear, either along the margin of the tragus, or within an existing crease in front of the ear. Patient preference and individual anatomy dictate where to place the incision.' Patients often say they don't want a visible scar, but in reality, inside the ear incisions just represent a small portion (about 1/2") that is actually inside the ear. Preauricular scars (in front of the ear) usually heal well and are hidden in the natural folds of the skin. As Dr. matarasso explains, 'the disadvantages of a retrotragal (inside the tragus) incision is that it can sometimes make the face look wider, especially if the tragus is pulled too far forward, and the natural gulley in front of the ear may be obliterated.' Matarasso's assertion is that 'the key to a good facelift is to put tension on the muscle layer and to minimize the tension on the skin to avoid a pulled, stretched appearance. The overlapping excess skin should be removed comfortably. Too much tension can result in widened scars when normal facial activity resumes.' The telltale sign of a poorly executed facelift is when the hairline is pulled too high at the temples. As Fritz Barton, MD, Dallas Plastic Surgeon describes, 'the critical issue is not where the hairline starts out, but where it will end up. It is not at all uncommon for women as they age to get a little hairline recession. One of the worst looks is an overresected hairline.'
Most plastic surgeons use surgical staples to close the hair-bearing portion of the scalp, which preserve the hair follicles. A combination of removable and absorbable sutures are used around the ears and under the chin and a drain is usually placed behind the ears and removed the next morning. There is nothing more rewarding than a well executed facelift operation which looks natural and attractive. Choose your facelift surgeon wisely. Insist on seeing photographs of patients he/she has operated on, and make sure that you fully understand what the surgery can and cannot do. The more you know, the better prepared you will be.