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Using modern techniques, it is very straight forward to achieve natural results with facelifts. Many patients will tell me they can always tell when someone has had a facelift. I gently correct them and inform them that you can always tell when someone has had a poor facelift. When someone has had a good facelift, it makes them appear as though they have aged well and others cannot tell. I often show my patients before and after pictures to prove this point.

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The goal, I explain to them, should not be to look like they have never aged. Putting a 30 year-old face on a 60 year-old body never looks natural. Having said that, some patients who are 60 may look closer to 45 or 50 years old and yet others may appear in their 70s. There is a wide spectrum of ‘normal’ appearances for a 60 year-old and our goal is to bring the patient back to the younger portion of that spectrum, while still looking natural. In order to achieve this, you need to understand how the body and the mind perceive what constitutes a young-looking face.

When you meet someone and look at them, subconsciously you form an opinion of the person’s approximate age. This is done without thought and occurs almost immediately based on our years of accumulated knowledge of what people look like at a given age. What we are noticing is not the tightness of the person’s skin.

If you look at a young person, they do not have tight skin. What you are actually noticing is the shape of their face. Young people have a fullness and volume in their cheeks and they do not have jowls. Young people have a well-defined jaw line with an angularity to their neck. They do not have large amounts of fatty accumulation under their chin; they do not have loose skin that hangs there or vertical muscle bands. Loose skin and muscle in the neck, fatty accumulation in the neck, loss of volume of the cheeks and fatty tissue collecting in the jowls are all signs that the person has aged and we process this instantly.

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Older facelifting techniques focused primarily on tightening the skin. Incisions were made in well-hidden areas around the ears and the skin was elevated off the underlying tissues. The skin was then pulled somewhat tightly in order to attempt to mimic the signs of youth. While there are benefits to removing some skin, firm traction on the skin that gives a tight look is not what we strive for today.

Using modern techniques, we still elevate the skin in a similar fashion; however, prior to removing excess skin the underlying tissues are re-shaped. In the neck, excess fat and tissue is removed and the muscles are tightened so there are not bands running vertically from the chin towards the chest. The skin is also gently removed. Using this technique, the result is a nice angular region between the chin and the neck and a well-defined jaw line.

Jowls are basically fatty tissue that has descended from the cheeks. As people age, the volume in the cheeks drops down towards the jowls. To reverse this sign of aging, the jowl is sutured back up to the cheek region where it was in the patient when they were younger. This accomplishes two goals: It creates volume in the cheeks and removes fatty tissue from the jowls. Not only does this give a very natural result, but the patient looks very similar to the way they did when they were younger. Even though the cheeks are fuller, they are being augmented with the patient’s own fatty tissue so there is not change in appearance from their younger self.

Using these modern techniques, we can turn back the clock 10-15 years, achieve natural results and still maintain the person’s over-all appearance so they look like a younger version of themselves.

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