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Surgical Facial Rejuvenation

Senior woman touching temples with fingers, close-up

Senior woman touching temples with fingers, close-up

Contributed by Ryan M. Gobble, MD, Assistant Professor of Plastic Surgery

A person’s face is an integral way we interact with others on an everyday basis. We use our face in communication through the spoken language and to express our inner feelings (e.g. joy, happiness, anger, sadness). Our face is what we present to the world and over time our faces age in predictable ways.

The primary determinant of the shape and features of a face is determine by the underlying skeleton, however, the skin and soft tissues also have a great impact on the overall facial aesthetic. As we age our skin and soft tissues thin, and our bone resorbs in certain areas such as the orbital rim, the maxilla and the prejowl area of the mandible (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404279/). Thinning of the skin and soft tissues of the face results in drooping of these tissues due to gravity. In addition at certain points in our face the skin remains attached to the deeper tissues, which results characteristic signs of facial aging (e.g. tear trough deformity, deepened nasolabial fold and marionette lines, jowling). While nonsurgical interventions (e.g. botox, fillers) can be effective for addressing certain aspects of facial aging, surgical intervention typically produces the most powerful effect.

As a plastic surgeon we are taught that there are ideal facial proportions and features. Symmetry and harmony are key components of the idea of a beautiful face and with aging these are often disrupted. While a plastic surgeon must take into account these principals part of the art of plastic surgery is in helping each individual patient to achieve their own goal rather than trying to fit all patients into a prescribed box.

Typical areas that are addressed surgically include the brow, eyelids, nose, face, and neck. A brow lift can be performed via several different surgical approaches with the goal of elevating the brow in a natural way. Eyelid surgery (blepharoplasty) is typically done to make the eyes appear more youthful. Surgery may involve removal of skin and fat, although more modern approaches may attempt to preserve fat in particular in the lower eyelid and instead focus on redraping the fat to correct the “tear trough deformity”. Rhinoplasty or a “nose job” can be performed to improve the appearance of the nose at any age range, although as we age there is a characteristic loss of bone around the nasal opening that weakens the support of the nasal cartilage resulting in a depressed nasal tip. A face lift (rhytidectomy) is performed to treat the sagging skin and soft tissues of the aging face. There are many different types of face lifts most all of which attempt to tighten the underling superficial tissues layers as well as the skin. While tightening these layers of the face significantly restores the youthful appearance of the face, in certain patients a plastic surgeon may consider injecting fat into areas of the face that typically lose fat over time to even better restore the fullness that is characteristic of a young face. Finally, a neck lift can be performed in alone or in conjunction with a face lift. The goal of a neck lift is to restore recreate an acute angle between the neck and chin, suture together the platysmal bands if present, and remove excess fat and skin as indicated. More than one surgical procedure can be combined at a time to minimize recovery time, but a patient’s safety is the most important determinant in whether or not procedures can be combined.

Helping you achieve your goal is the endpoint of every aesthetic operation, and the best way to determine whether surgery would be beneficial to an individual patient is to have a surgical consultation. During this consultation we will be able to choose what method of facial rejuvenation would work best for you.

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