Facelift: What We Hear Patients very commonly tell us, "although I look older, I feel much younger." As our society has become more fitness oriented, many people remain active longer than they did in the past. Although someone maybe 65 or 70 years old, they frequently can be found on the tennis courts and giving a younger person a very challenging tennis match. I hear the patient's say, "I want to look as young as I feel." New Philosophy, New Surgery For over 50 years the practice of facial plastic surgery involved a "nip and tuck" philosophy. That is, the excess skin which has lost its elasticity had to be excised (nipped) and then the incision closed (tucked). The results were good; however, quite often the early result gave the person a pulled stretched appearance. Since the underlying structures were not surgically altered, the tightly pulled skin was the supporting structure for the results of the nip and tuck facelift. Skin assumes the shape of the underlying structures. As the skin relaxed following the facelift, the underlying aged face began to "show through". Over the last 10 or more years, plastic surgeons have been adopting a "redraping" technique. That is, the skin is elevated, then the underlying structures such as the facial fat is elevated and the muscles of the neck are tightened. The excess fat is removed from the appropriate areas and replaced in the areas of deficit. The skin is then redraped over the new underlying frame and any excess skin removed. This results in a less pulled or stretched appearance. Also, as the skin relaxes the underlying structures have a new shape and the results of the facelift are retained for a longer period of time.

Figure 1: Note in the example given that the postoperative result does not appear pulled or stretched. This is the result of the redraping technique. The fat, which once was on top of the cheekbone and had dropped into the mid face, has been repositioned. The lax superficial muscles of the neck have been tightened. The skin has been redraped over the new frame and the excess skin excised.

Comprehensive Approach Loose skin of the face, which causes jowling, and loose skin of the neck can be corrected by a facelift. In addition to removing the excess skin, newer techniques are used to tighten the muscles of the neck and the deep tissues of the face. The SMAS facelift, otherwise known as the S-lift or deep plane facelift, places less tension on the skin, thus avoiding the "swept back" appearance of a "skin only" facelift. . To obtain a comprehensive result, the forehead, the lower eyelid and the face should all be corrected as unit. There are exceptions to this, as some people may only need one part of this triad corrected.   Figure 2: Please refer to the diagram. Note how dramatic the result can be when the entire face is addressed as opposed to one segment only. (Diagram Courtesy and Permission of Sam Hamra, MD) Preparation for Surgery: Should you decide to undergo a facelift procedure, you should allow adequate time for recuperation. In general, 3 to 6 weeks is adequate for recovery to allow you to return to your normal social activities. Immediately following the surgery, pain is controlled with narcotic pain medications. After approximately 2 to 3 days, most people require pain medications at night only for sleep. At 10 to 14 days, most people will not require narcotic pain medications and will be comfortable with Tylenol or a mild narcotic for pain control. A comfortable dressing is applied to the face and neck for the first 24 to 48 hours following the surgery. This dressing is removed and replaced with a light weight garment to help support the neck and the face. This is worn for approximately 1 week following the surgery. For the first 24 to 48 hours, activities are restricted to short trips to the bathroom and to a chair. Activity increases with each persons' comfort level. In general, most people return to their normal activities at 2 to 3 weeks. Please email us if you have further questions regarding this procedure. Dr. William R Burden, MD, FACS and Dr. L. Scott Ennis, MD, FACS are known for their experience and dedication to staying in the forefront of leading technology in plastic surgery.   Drs Burden and Ennis not only treat many patients from Panama City, Pensacola, Fort Walton Beach, Tallahassee, Dothan, Atlanta, and Birmingham but also from around the world.  Many people travel from Europe, South America and Asia to Destin to seek out their services.   Before and After Photos