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Is a Facelift Enough?

A facelift is often the most effective cosmetic surgery solution for the progressive signs of aging through the lower face, neck and jaw line. It’s also one of the most commonly performed cosmetic procedures in the United States. Yet, with the growing popularity of less invasive treatments like BOTOX® Cosmetic and dermal fillers, it’s clear that a facelift isn’t the only solution for looking younger. Are there some occasions when a facelift alone isn’t enough to deliver optimum results?

The History of Facelifts

Cosmetic facelifts have been performed for over 100 years. In the early days, the surgery consisted of removing loose excess skin without much consideration for the underlying facial structure. As surgical techniques progressed, the concept of repositioning and redraping the skin emerged. However, it was not until fairly recently, in the 1970s, that the concept of direct subfacial dissection gained momentum.

Newer techniques will retighten the face's deeper superficial muscular aponeurotic system (more commonly referred to as the SMAS) to restore firmness to the face. SMAS facelifts and the more involved deep plane facelift have become the new standards of facial rejuvenation, and remain in regular use today.

Yet, despite the efficacy of the traditional SMAS facelift, the surgery is not completely comprehensive; not all the signs of aging can be improved through muscular suspension and surgical retightening of the skin. To understand why this is the case, it’s necessary to examine the technical aspects of the aging process itself.

The Science of Aging

To the untrained eye, aging is most evident in wrinkles and loose skin. Those who have extensively studied and worked with facial anatomy recognize that wrinkles and other superficial evidence are really more reflective of the effects aging has below the skin’s surface, down in the deep structural facial components of bone and muscle.

With age, the continued growth of the jaw physically changes facial structure, affecting the way skin is pulled and positioned. Muscles, too, change over the years, losing strength and elasticity. Textural changes in the skin’s surface as well as loss of facial volume only serve to further accentuate these shifts. The effects of gravity, redistribution of subcutaneous tissue and decreased skin and tissue elasticity also contribute to an aged appearance in the form of hollowness at the cheekbones and eyes, surface wrinkles and looser skin.

During a facelift, the muscles are stitched together and tightened to recreate a firmer framework for the skin and soft tissues. The visible qualities of laxness and hanging skin are effectively resolved through surgery. Yet, the finer lines and wrinkles in the skin’s surface often remain behind. Like ironing a shirt, surface treatments must then be employed to smooth the residual effects of aging from the skin’s surface.

The Finishing Touch

With men and women both saying that the aging process is one of the most common reasons for pursuing cosmetic surgery, minimally invasive rejuvenation procedures are rapidly gaining popularity. Nonsurgical treatment options offer an alternative to traditional cosmetic surgery as well as serving as the finishing touch in addition to surgery.

After a facelift restores the deep anatomical facial structures to a more youthful appearance and placement, the more minor signs of aging can then be addressed through a number of complementary procedures. Facial resurfacing treatments can diminish age spots and hyperpigmentation as well as improving skin tone and texture and removing fine lines and wrinkles. Dermal fillers offer a solution for restoring lost subdermal volume, especially for very deep nasolabial folds that remain visible even after surgery. With the right combination of nonsurgical and surgical treatments, a more comprehensive approach toward minimizing aging is achieved.

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