Surgical
Procedures
Facial Surgery
Facelifts
When the patient comes for a facelift consultation, a review
of the entire aging process of the face is presented. One learns,
that as we age, the face descends vertically and there is a loss
of facial fat. Newer concepts in facelifts aim for a vertical
(not lateral) pull and no removal of facial fat (except
for the neck) and fat grafting.
In most patients, not only does the neck and jowl need to be
addressed, but their needs to be vertical elevation of the mid-face
and brows. In addition, some form of skin resurfacing may be required.
Each component of this process is reviewed on the patients’
digital photographs.
Alternative procedures are presented to the patient depending
on their needs and budget. The procedures may be divided into
the following categories:
- Microlift - View
- Minilift - View
- MACS Facelift - View
- Lower Facelift -
View
- Endoscopic Brow and Mid-facelift
- View
- Full Facelift - View
Microlift - Back
Concept - A microlift
is a procedure devised by Dr. Dabb to provide a subtle lift of
the lower face and jowl. This is the least invasive of the facelift
procedures. This procedure is designed for the patents that desires
a minor lift with minimal down time.
This procedure is ideally suited for the patient who does not
require or desire a more aggressive procedure, for secondary facelifts,
for accentuating other procedures such as chin augmentation, and
with mid-face lifts when the patient wants no visible facial scar.
Surgery - It is
done through a small incision through the sideburn. Through this
incision, the SMAS (dense tissue between the skin and the
parotid gland) may be suspended vertically leaving no traditional
facelift scar, with the only scar being in the hair-bearing sideburn.
It may be performed in the office under local anesthesia.
Recovery - There
is minimal undermining of the skin, thus minimal swelling or bruising.
The patient may wash their hair the following day.
Return to Work
- Some patients may return to work as soon as 48 hours.
Full Activity -
One week.
Complications -
Bruising, wound separation, scaring, limitation of result.
Facial Surgery - Microlift
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Incision |
One side completed |
Minilift - Back
Concept
- A minilift provides a conservative facelift
utilizing conventional incisions. It has more impact on the the
lower face and neck, than the microlift. However, this is a less
aggressive procedure than a lower facelift.
Surgery - It differs
from the microlift in that it utilizes conventional incisions
and emphasizes more of a pull on the neck angle. It utilizes a
sling of SMAS (dense tissue between the skin and the parotid
gland). There may also be suction lipectomy of the neck or
a minor plication (suturing together) of the neck muscles
along with placement of a suspension suture to aggressively handle
problems of neck angle. A minilift is also a procedure that may
be done in the office under local anesthesia.
Recovery - There
will be some swelling and brushing of the facial skin around the
ears. There is minimal discomfort.
Back to Work -
One week.
Full Activity -
Three weeks.
Complications -
Bruising, wound separation, scaring, decreased sensation to the
ears or neck, facial weakness, limitation of result.
MACS Facelift - Back
Concept - Dr Dabb
has been performing the MACS (Minimal
Access Cranial Suspension Lift) facelift for over 6
months.
Surgery - This procedure can give significant cosmetic improvement with
minimal risk of complication and minimal downtime. In some patients,
it may be performed in the office under local anesthesia in the
office. Its basic principle is the suspension of sagging facial
features by a strong, permantent purse-string sutures. These
sutures give a truly vertical lift, which provide a natural,
non-facelifted apprarance.
Recovery - There is minimal dissection and the procedure is not in the
proximity of vital nerves that could lead to deformity. With
minimal dissection, there is much less recovery time.
Lower Face Lift
- Back
Concept - The lower
facelift focuses primarily on aggressive treatment of the jowl
and neck. This is the more classic procedure that people think
of when considering a facelift.
Surgery - This
procedure is performed through classical facelift incisions in
front of and behind the ear and beneath the chin. There is more
aggressive undermining of facial skin, especially in the area
of the neck. The superficial platysma muscles of the neck, which
cause neck bands, are sutured together under the skin. The SMAS
layer, the layer of fascia deep to the skin over the parotid gland,
is used to tighten the lower facial skin and jowl area and to
further tighten the neck. Having the tension on this layer allows
for significant tightening with little or no tension on the skin
itself. This leaves a more favorable scar with less potential
for deformity of the ear.
Dr. Dabb attempts with this facelift to elevate the structure
vertically with out widening the mouth. There is a meticulous
attention to detail; not changing hairlines that limit certain
hair styles or creating the tell-tale signs of a facelift.
This procedure is done in the surgicenter with either general
anesthesia or sedation and local anesthesia. It is usually performed
as an out-patient.
Recovery - There
is some swelling and brushing of the face and neck. There is discomfort
behind the ears for up to two weeks. There is a feeling of numbness
of the neck for at least three months.
Back to Work -
10 days in make up.
Full Activity -
3 to 4 weeks.
Complications -
Bruising, bleeding, infection, wound separation, scaring, decreased
sensation to the ears or neck, facial weakness secondary to facial
nerve injury, skin slough, limitation of result.
Facial Surgery - Lower Facelift
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After |
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Before |
After |
Endoscopic Brow
and Mid-facelift - Back
Concept - Dr. Dabb
has extensive experience in this procedure as one of the originators
of endoscopic plastic surgery. This procedure addresses the mid-face,
especially the youthfulness of the eyes and the depth of the naso-labial
folds and the positioning of the lateral lips more effectively
than any other procedure in the past. It has the advantage of
having minimal scars and giving a truly vertical elevation of
the face. There is also a subtle lifting of the jowl and a subtle
lifting of the lateral lip which is classically depressed with
age.
Many patients may desire to have this procedure over having their
eyes done alone do to the significant rejuvenation which takes
place.
Endoscopic Brow and Mid-facelift
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Before/After
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Surgery - Three
small incisions are made in the hair-bearing scalp along with
standard blepharoplasty incisions. There are no visible facelift
scars. Through these incisions the dissection is made in what
is called a sub-periosteal level (directly adjacent to the
bone). This is a safe location due to the fact that one is
deep to the more commonly injured structures. The dissection is
facilitated by the use of an endoscope, a lighted retractor with
a scope attached to a video monitor, allowing for careful visualization
of the dissection plane. Once the dissection is complete, suspension
sutures are placed at appropriate locations to lift the face and
brow region vertically. There is no longer any need to use the
large coronal incision which crosses from ear to ear. The procedure
is usually performed in a surgicenter as an outpatient under sedation
or anesthesia.
Recovery - After
the procedure, the patient is placed in a dressing along with
a drain which is removed the following day. There is initially
the significant amount of swelling, causing the rather "alien"
appearance for several days.
Back to Work -
The patient is usually prepared to wear makeup and return to work
environment in approximately 10 days.
Full Activity -
10 days. It takes several months for the residual swelling to
totally resolve and approximately nine months for the procedure
to "maximize" in result.
Complications -
Bruising, bleeding, infection, wound separation, scaring, small
areas of hair loss, decreased sensation to the forehead or scalp,
facial weakness secondary to facial nerve injury, ectropion (pulling
the eyelid downward), limitation of result.
Full Facelift - Back
Concept - A full
facelift is performed when one desires the total rejuvenation
of the face. This combines the endoscopic brow and mid-facelift
with a lower facelift. This gives the maximal rejuvenation to
the forehead, eyes and nasolabial folds, along with an aggressive
rejuvenation of the jowl and neck region. Due to the deep plane
of these procedures, full face laser resurfacing may also be performed
simultaneously if skin resurfacing is desired.
An ideal facelift gives a rejuvenated appearance without the
tell-tale appearance of a pulled look in a posterior direction.
It should simply reposition the soft tissue of the face vertically
where it sat previously. Fat grafting may be added to the procedure
which replaces the fat lost with aging and laser resurfacing may
be performed which alters pigmentation and fine wrinkling.
Surgery - This
procedure is done at the surgicenter under general anesthesia.
The procedure takes approximately four hours. Most people are
admitted overnight. The surgical procedures are technically a
combination of a browlift, mid-facelift and lower-facelift. Frequently,
procedure are also performed on the eyelids and the patient may
also have fat grafting to the lips and chin.
Recovery - After
the procedure, the patient is placed in a dressing along with
a drain in the scalp and in the neck, which are removed the following
day. There is initially the significant amount of swelling, causing
the rather "alien" appearance for several days. There
is moderate swelling for up to a week.
Return to Work -
2 weeks.
Full Activity -
4 weeks.
Complications -
Bruising, bleeding, infection, wound separation, scaring, small
areas of hair loss, skin slough, fluid in neck, decreased sensation
to the forehead or scalp, facial weakness secondary to facial
nerve injury, ectropion (pulling the eyelid downward),
limitation of result.
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Before/After |
Before/After |
