Hi garotadeipanema,
He performs a " plication standard
face lift" That means he will lift the cheeck without performing a periostal mid face lift or deep plane or extended SMAS.Is that possible?
Maybe, but the cheeklift may have more to do with the
facelift incisions than with the technique of the facelift. I will also discuss whether or not a deep plane will have long lasting improvement of the nasolabial fold which should stay improved if the cheek/midface stays in the lifted position.
The cheek/mid-face (middle third of the face, upper third-> forehead/brow, and lower third->lower cheek/jawline) is somewhat lifted with a lower facelift, but less than with a subperiosteal midfacelift which is usually performed endoscopically (AKA- endoscopic midfacelift.)
A short scar facelift typically has a short incision from the top of the ear going horizontally across the sideburn/temple hair tuft. The advantage of limiting the incision here is it will maintain more of the sideburn. This avoids one of the tell-tale signs of a facelift which is to lose a significant portion of the temple hair. The traditional incision facelift has an incision which goes vertically into the temple hair instead of horizontally. The advantage of the vertical incision is that the cheek and temple can be lifted more than with the short scar incision. However, depending on the laxity (looseness) of the cheek area, more or less of the temple hair can be lost as the excess hair-bearing skin is removed from the scalp in the temple area. An alternative to this incision is to extend the short scar incision around the front of the temple hair, which allows the excess skin in the temple and cheek to be trimmed in front of the hairline. This allows for maintenance of the hairline while also removing more non-hair bearing skin from the temple/cheek area, but the trade-off is that the incision is potentially visible, since it is in front or along the front of the hairline.
Traditional facelift incision with vertical incision going up into the temple
Image Credit:
http://www.centrplastiki.ru
My short scar facelift incision with a short incision under the sideburn hair tuft.
As you can see surgery has trade-offs and pro's and con's to each technique. If the ps you consulted with performs a "standard plication facelift" with the traditional incision which goes up into the temple, then I think there will be some lifting of the cheek/midface. However, even with the best of techniques, the improvement of the midface can be subtle, and also potentially short-lived. A well-known facelift surgeon, who coined the term deep-plane facelift and composite facelift, Dr. Sam Hamra, had performed a study on his own patients following the longevity of their facelift results. He felt there was an initial improvement of the nasolabial fold [smile line from the nose (naso-) to the corner of the mouth (-labial)], but the improvement was not present by the 1-2 year follow up. The conclusion that Dr. Hamra made at the time the article was published (2002) was that the only a direct excision (cutting out) the nasolabial fold was the only permanent correction for this problem. This was before
injectable fillers became popular, and before the discussion of loss of facial volume was common place.
If Dr. Hamra (a world class facelift surgeon) was not able to maintain the improvement of the midface to keep the improvement of the nasolabial folds smooth, I don't know who would be able to do it with less of a surgery (SMAS plication facelift.) Dr. Hamra's surgeries are very aggressive to get the lift in the midface which he is able to achieve. Yet he concluded it doesn't hold up long term.
See if your consulting surgeon can show you significant midface improvements on his or her facelift patients using the "standard plication facelift." Of note, the after photos cannot be smiling. When a person smiles, they can lift and "mound" the cheek better than a surgeon can do with their surgery, so this does not count. The after photo needs to be at rest, just like the before photos. If they want to compare a post-op smiling photo, it should be compared to a smiling pre-op photo for a "fair comparison."
What is your opinion regarding lateral
brow lift, with incision on the scalp
That question is really difficult for me to answer, because my
philosophy of facial aging and facial rejuvenation surgery has led me away from this procedure. I will give my opinion by discussing my observations of facial aging, and let's see if any of it makes sense to you.
Lateral browlifts have their place as a surgical procedure to lift the tail of the brow, but it is my observation and opinion that youthful brows tend to be relatively flatter, and in some cases lower, when comparing photos of my patients currently (typically in their 50's-60's) to photos of themselves when they were younger in their (20's-30's). I think that it is a procedure that both patients and surgeons consider more for the lateral hooding of the upper eyelid, than for the positioning of the lateral brow.
Take a look at one of my patients here:
If you look at her left eyebrow (the side with the elevated lateral tail of the brow) on her pre-op photos, the initial diagnosis may be to perform a lateral
browlift on the right side to match the left side, and make both eyebrows elevated at the lateral tail and have arched brows. This would also relieve the lateral hooding of the right upper eyelid. However, if you look at her photos at age 23, her eyebrows were symmetric and was not elevated and arched like her left eyebrow. According to the current philosophy of
plastic surgeons, the eyebrows "fall" as we age, therefore the proper procedure is to lift the brow to counteract the change. However, if I look at my patients younger photos and current photos objectively, I have noticed that in many cases, the patient's brow may actually be higher than they were in youth. I also see patients who have deeper set eyes who do not lift their eyebrows and their eyebrows really do look lower. However, when compared with their younger photos, the eyebrow heighth hasn't changed. How is this possible?
I strongly believe that as we age we are losing fat between the eyebrows and eyelid crease. If deflation of this area of skin between the eyebrow and the eyelid crease can result in "excess skin" which can manifest as lateral hooding of the upper eyelids. The patient can react to this excess skin in two ways, which are shown in the patient above. Either the patient will raise their eyebrow, which gets the excess skin off of their upper eyelid and actually show more eyelid than they may have had in youth, or the patient may keep their eyebrows stationary, and their upper eyelid appears heavy, with lateral hooding.
Take a look at her before and after photos:
Non-smiling
Smiling
On her after photos, you can see that her left eyebrow has relaxed to a "neutral position" as compared to the initially elevated left eyebrow arch of the pre-operative photo. The upper
eyelid surgery with fat grafting has increased the amount of skin showing below the eyebrow, although it has reduced the amount of eyelid showing on the her left side, while increasing the amount of eyelid showing on the right side. No browlift, or lateral browlift was performed. An equal amount of skin was removed from both eyelids, the only difference was that her left upper eyelid required more fat replacement than the right side.
I think it makes more sense that a person's face can lose fat at different rates on the left and right side as they age, as opposed to, a person gradually "dropping" their brow on one side over the years, or a person somehow "grows" extra upper eyelid skin which then needs to be removed. An upper eyelid surgery "cuts out" extra upper eyelid skin, while a browlift, scrapes the scalp off of the forehead bone and positions it higher on the forehead bone as it heals. I just don't see how the forehead and brow, slipped down the forehead bone over the years. It seems to be quite a secure attachment, to the point that if the forehead and brow, is not completely released off of the forehead bone, the browlift will not be long lasting, and may return to its original position.
I'll end my explanation here for now. It's a lot to digest, so please follow up with any questions you may have.
Good luck on your surgeon search.
Best,
Dr. Yang
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