Face Lift Information

Definition of a Face Lift

Over the years, the definition of a “face lift” has changed and become ever more confusing to the lay person. The first face lift was performed just over 100 years ago in Berlin, Germany, and last year, in America alone, 221,398 face lifts were performed by board certified plastic surgeon members of the American Society of Plastic Surgeons. That number does not include board certified non-members, or board certified facial plastic surgeons or thousands of other face lifts performed by doctors not board certified in this specialty. Confusing? Yes, when it comes to face lifts in particular, it’s a jungle out there because everyone claims to have a new technique, a brand name, or to be certified in something that sounds like plastic surgery. As a consumer, you owe it to yourself to understand the differences between all these different face lifts and the different surgeons’ qualifications for performing these procedures.

In the simplest terms, according to a medical dictionary, a face lift (Rytidectomy) is a procedure that removes excess facial skin with or without tightening the underlying muscles and or defatting the tissue below the skin and or adding additional fat to make up for the volume loss due to aging and gravity.

Pay close attention to the letters after the red "with or without." Old face lifts and many of these "simplified" or "lunch-time" lifts are just skin lifts (before the red) whereas a very good face lift performed by board certified plastic surgeons includes what comes after the red.

Natural vs. Stretched

The original face lift of 1901, as well as the thousands that followed in the first half of the 20th century, were all procedures that cut away excess facial skin without doing any of the additional work that creates a Natural Face Lift. It’s not surprising that these early face lifts did not look natural. Look at yourself in the mirror, pull the skin that lies between your eyes and your ears towards your ears, and at the same time, place your thumbs on your jowls and pull that skin also towards the ears. That’s what you would look like with one of these old face lifts, the so called swept-back-wind-tunnel look. Unfortunately, many doctors are still performing this procedure. More importantly, some doctors are also performing abbreviated versions of this procedure and calling it a lunch time procedure, or mini lift, but in our opinion, the only people who will benefit from these procedures are people who don’t need a face lift.

Advanced Face Lift Techniques

Over the last 30 years, many innovations have been incorporated in the face lift. Some of these are the SMAS (facial suspension of face through tightening of deeper tissues with sutures), the MACS lift (Minimal Access Cranial Suspension), and a variety of small improvements such as the location of incisions resulting in less scarring or quasi invisible scars. All these innovations have resulted in more natural looking face lifts that are increasingly more difficult to detect even for the expert eye.

The Human Brain Can Detect Millions of Facial Data Points

Bad face lifts, however, are easy to detect because the human brain has millions of reference points that define a face. Any small deviance from these reference points and we naturally begin to inspect the face looking for more asymmetry or imperfections (Over millions of years, our species as well as our hominid ancestors developed the ability to memorize millions of facial data points in order to be able to recognize relatives as well as to find the best mates). This is the main reason why finding the best possible face lift surgeon is so important. If a surgeon makes a small mistake on a tummy tuck or a breast augmentation, it’s hardly likely that anyone will notice except you and maybe your spouse. However, a small imperfection on your face and everyone will know, even those who haven’t seen it and just hear about it from a third party.

All Plastic Surgeons Are Not Created Equal

A Natural Face Lift is art as well as science. In medical school and during their plastic surgery residency, plastic surgeons learn about the science of a face lift and the techniques they need to master to be able to lift the skin, uplift underlying tissues, excise excessive skin, and re-drape and suture the skin. There are thousands of plastic surgeons in the USA and they all more or less have learned the same science, but there are not two plastic surgeons that perform exactly the same facelift. The differences are based on experience, artistic ability, and a willingness and ability to stay technically up to date. We estimate that in America, a maximum of 15% of the plastic surgeons do 90% of the facelifts. These figures are no different than in other fields where top performance is skewed completely towards the best performances. For example, less than 5% of the rock stars earn 95% of the music royalties and less than 1% of the pro tennis players win more than 99% of the tournaments.

Experience & Vision in Face Lift Surgery

Staying with our tennis analogy, everything else held equal, a tennis player who has hit one million balls will be a better tennis player than one who has hit 1000 balls. A plastic surgeon that has performed 1000 face lifts will, everything else held equal, be better than one who has only done fifty. And, with respect to artistic ability, aren’t we all amazed by those gifted people who have never studied art but can draw perfectly, or the musician who can’t read music but can play anything by ear? It doesn’t seem fair. Medical doctors are not accepted in medical school because they can draw or sculpt, but there is no doubt that if they have that God-given ability, they can become better facial plastic surgeons. If a plastic surgeon cannot conceptualize what defines beauty or youthfulness in a three dimensional space, his/her only reference points are techniques and experience. The problem with that equation is that no two faces are exactly alike, and hence, three dimensional visualization of what the “after” face should look like is very important. Although the ink markings that all plastic surgeons use to guide their scalpel are important, nothing replaces vision.

You Cannot Sue a Plastic Surgeon for Poor Esthetic Results

Not surprisingly, there are many board certified plastic surgeons that will not do face lifts and there are many more who should leave that work to others. Keep in mind that you cannot have a malpractice claim against a plastic surgeon if you don’t like the face lift they did. Read the consent forms and understand that well before you agree to a surgery. Nor can you sue a practice surgeon because they sever a nerve or because your friends don’t like the “after” you. You give up that right in a consent form you will sign before surgery. Therefore, before you select a plastic surgeon that does your face lift, you need to ask several questions:

• how many facelifts have you done in your lifetime?
• how many complications have you had?
• Could I see as many before and after pictures as possible

Great, Good, Average & Poor Results: What Are The Numbers?

If a surgeon says they have done 100 facelifts and they show 20 great before and after pictures, that’s a great ratio. However, if they say they have done 500 and only show you two good ones, you had better think twice. Nothing replaces good before and after pictures. If you see lots of natural looking results, you have probably found your surgeon. We can tell you what our criteria are for selecting plastic surgeons:

• They must be board certified in this specialty (that’s the science)
• They must show us lots of great natural results (that’s the art & experience)
• They cannot have any law suits they lost where the court found them to be at fault for a medical judgment error (more science)

Your Facial Type Impacts Results

Very little is written about how your facial type impacts results, but this is certainly worth taking into consideration. Rounder faces with less pronounced cheekbones will not show as good results as Northern European, Slavic, or any ethnic group with a facial morphology that is oval with high cheek bones. The reason is that facial changes  due to age are more pronounced on people with oval faces and high cheek bones. The two before and after pictures below explain these differences. Both of these results are great results, however the perceived change is greater in a more angular Northern European Face as opposed to the  rounder Mediterranean Face.

Rounder Mediterreanean Face

Angular Northern European Face

Summary

In summary, a Natural face Lift is a face lift using a variety of techniques that have been refined and personalized by plastic surgeons resulting in a natural rejuvenation of the face. The name and pedegree of a face lift whether it’s mostly a MACS or a SMAS, or a vertical lift, or an L-lift or S-Lift or a Featherlift or Refresh Lift or a lift by any other name is less important than the results which need to be natural, not stretched, and age appropriate.