The patient is a 64 year old woman who noted joweling and neck fullness and looseness and described her neck as a “turkey neck”, a phrase commonly used by patients to describe the looseness of skin and accumulation of fat that can occur with the aging process. She was particularly distressed by the jiggling that occurred in her neck when she moved her head. The patient also felt that her brows were low and gave her a “crunched in” look in the upper eyelid area.
The patient had a face lift with a neck lift and a brow lift and her procedure was performed comfortably and safely under general anesthesia. After being seen the next morning, the patient was instructed to begin walking that same morning and to slowly extend her walks and by five days the patient was walking two miles twice a day and was back to most of her usual activities including driving and wearing make up.
Face lifts are very gratifying for patients because they cause significant change in a natural and beautiful way and also help patients to look as young as they feel inside. As we age, our minds stay young and we feel young. Lifting procedures reaffirm how we feel about ourselves and allow us to move foreward feeling young and vigorous. We can direct our thoughts away from concentrating on thinking that we look old and face the new day from a new perspective.
One of the greatest benefits of facelifting is that fat that has fallen is brought up into the face. This fills the areas under and over the cheekbone and that fullness creates a youthful appearance. As can be seen in this patient, the fat from jowel area that was very low and into the neck has been brought up and into the lower cheek to provide natural fill and create smoothness. The cheekbone itself also appears larger as the result of fat being moved from the cheek up and out and onto the cheekbone. Facial harmony results when the jawline on both sides creates a “V” shape with the chin in the middle and the cheekbones also create a “V” shape with the nose in the middle and both of these “V”‘s run parallel. Face lifts don’t just lift the face, they bring the facial parts that were existing alone back together into working together to create one unit, the face, seamless and in harmony.
Most think of a facelift as the tightening and removal of excess skin from the sides of the face but what is really moving and creating beauty is happening in the center of the face and over the cheeks, cheek hollows and jowel areas where the patient’s natural tissue is used to restore the youthful appearance of their past. This central lifting can occur without any pulls being transmitted to pull the mouth outwards or to create darts, not because of how much lifting is done but rather because of technique. The jowel and cheek fat was lifted significantly in this patient but her mouth is in the same position and the corner of the mouth at the same angle, unchanged.
This patient’s brows were very low and impinging on the skin of the upper eyelid. She was not obligated to have a brow lift and the face lift could have been done on its own but without the brow lift the patient might have looked young in the lower face and older in the upper face, creating disharmony. Just as a space has been created between the jawline and the cheekbone from the face lift, the brow lift has created a space between the eyelid and the eyebrow and again, more harmony.
The smooth and natural movements of a facelift not only lift the fat pads of the cheek and jowel but also soften and in some cases completely remove deep nasolabial folds and marionette lines. The nasolabial folds can be seen in this patient as a shadow that starts at the side of the nose, going downwardand outward toward the jawline and into the jowel. The marionette line is the fold that runs from the corner of the mouth , downward and outward towards the jawline and also ends up in the jowel. With the aging process, the fat of the cheek and jowel fall to create both of these folds. So lifting the fat pads improves the folds during the face lift.
