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The Facelift: a multifaceted intervention

Today, while women remain the leading partakers of facelifts, about 20% of requests come from men and this percentage tends to increase year after year. The motivations are generally the same for men as for women: personal as well as professional. In companies, the “youth bonus”, which many patients speak of, does not seem to be reserved for women. In some sectors, such as communications or advertising, it appears that age is a larger hindrance than in other sectors because appearance plays a more important role. These are not the only areas where this phenomenon occurs. Patient testimonies have taught me that, for example, in the world of finance, whose traditional image was rather rigid, appearance and “youth” are now becoming important assets for success. They confirm what we see today in England. London is experiencing a boom in cosmetic surgery clinics, many of the patients are the so called “Golden Boys” in the City. In the London Stock Exchange sector, we no longer see the bowler hat, the graying hair, the overweight and rigid suits that gave away the bankers and financiers.

The facelift is the most well-known act of cosmetic surgery, but it is not the most widespread intervention (although it is the procedure that’s frequency increased the most between 1995 and 2005). On the other hand, behind this term lies a variety of interventions. The Facelift – meaning “to raise up” – aims to correct the relaxation of the face when the aging process has taken away its firmness.

Through the years, the face undergoes a series of “attacks”: at the visible, surface level of the skin and at the invisible level, in the subcutaneous tissues. What are the effects? The skin sinks and the underlying tissues weaken. But these two phenomena are not related and in cosmetic surgery are the subject of different and distinct treatments. The facelift does not work on the wrinkles directly but intervenes on the subcutaneous tissues by repositioning these tissues, and remodeling them by either removing fat cells or to the contrary, by injecting fat cells to create curves.

It must also be explained that the facelift cannot repair “broken” skin, or completely remove the nasolabial folds or laugh lines (folds that descend from the outer region of the nose to the corner of the mouth). I don’t hesitate to disappoint my patients a little, by stretching the skin of their face to indicate the desired correction. This level of correction would only be possible if we could nail the skin to the skeleton like that of an upholsterer; or if we could sew the skin onto another piece of skin. Normally, after a few weeks of complaints of their skin being too tight, the patient notes with slight annoyance that there is a little slack coming back. The gradual disappearance of the effects of the facelift is called the “Cinderella effect”, where the wrinkles gradually come back. This must be well explained to the patient before making their decision to have a facelift.

Faces do not all age the same way.

The shape of the face: thin faces tend to break-down or “crumple” and lose volume as a result of the softening of fat, but we’ve observed with round faces however, through the years, skin tends to sag and masses shift and lose shape. On the other hand, the quality of the skin also influences the effects of aging. Very thick skin is correlated to deeper wrinkles. Very thin skin shows the smaller superficial flaws but offers better support against wrinkles. A very elastic skin, has a tendency to relax and to take on more marked expressions of the face (there are more than twenty-seven muscles that make our facial expressions possible). A face with a large amount of fat has the advantage of appearing younger up to the age of 45 or 50, but, after, to the contrary, when the skin starts to loosen. The fat tends to weigh down the face leaving them with an more aged appearance.

It is important to analyze the shape of the face from a geometric perspective. A young face is triangular with two cheekbones and a chin point. When aging, the cheekbones fall, and jowls appear, the face becomes square and the purpose of the facelift is to bring back this triangular appearance to the face.

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Today, the facelift is the only technique that can counter the sagging and weighted down effects that time has on our face. Plastic surgery will strive to correct these aging effects as best as possible but the results attainable depend on the state of the skin, the patient’s requests, and the skill of the practitioner. When retightening the skin, it is also essential to intervene on the volumes and masses of the face in order to attain a result that respects the harmony and shape of the face. A technique, developed by Dr. Fournier and refined recently by the American physician Dr. Coleman, consists of taking fat from the buttocks or hips, passing it through a centrifuge for purification, then injecting it into the areas of the face that we choose. Usually the nasolabial fold, the cheek, and the chin.

 

After a facelift, the firming effect is sustainable usually for a decade or more provided that the client leads a healthy lifestyle. Indeed, if the skin is “broken” or weakened by the effects of smoking or from sun damage, the surgeon will only be able to stretch the subcutaneous tissue to a certain extent and these “flaws” will only be moderately improved and will require other interventions to repair the damage, like laser IPL, and fillers, for example. The facelift reworks what is there, but in no case changes it. Depending on the individual, the results can go from spectacular to a simple stroke of radiance. Not so long ago, we only practiced the “total” facelift. In photographs, the result was satisfactory; the face looked rejuvenated, but in reality, as soon as the person began to speak, the face looked rigid and frozen, like a face made of wax struggling to express itself. In addition, several weeks were necessary for the person undergoing surgery to resume normal activity. All of this is now ancient history because the techniques have evolved considerably so now we can offer a more localized facelift. These less invasive and precisely targeted interventions meet more closely the expectations of our patients.

What is a facelift?

The operation takes place in three stages schematically. First, the surgeon detaches part of the skin from the face, the extent of which depends on each case; then, it is stretched backwards and upwards, in an extremely precise and measured manner. Next, extra skin and sometimes fatty tissue is removed, and finally stitching of the remaining tissues. For a long time, facelift procedures focused on the visible skin only. Today, these procedures include a subcutaneous facet that repositions and stretches the muscles underneath the skin. This corrects the loose and fatty deposits present under the skin. This greatly improves the result, both in terms of quality and duration. One of the most commonly expressed questions from patients is the loss of facial expression caused by a facelift. Of course, this fear is fueled by the images present in the media of some people with frozen, stretched and stiff faces after having had a facelift. Is this fear justified? I’ll say it very directly: these faces were the result of procedures practiced at a time, not very long ago, where the techniques were not the same as those practiced today. Currently, a facelift performed by a qualified and skilled surgeon does not change the expression of the face and does not give it that stretched look. Facelift techniques have evolved considerably in recent years. Surgical procedures progressed in precision, in efficiency and safety. Physicians knowledge of the mechanisms of the skin’s aging process has improved also, partly due to cosmetology, a precious ally of cosmetic surgery. Today in France, patients want the results of the intervention to be as discreet as possible, unlike, for example in the United States, where it is fashionable to display a facelift.

Different types of facelifts are characterized by the part of the face they treat.

Paris Match N° 3330

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