The patient is a 64 year old woman who felt that her face was falling and did so recently. As an operating room nurse, she knew that she needed a face lift to achieve her goals of reducing skin laxity and folding and she also felt hat her eye brows were too low. She observed that her smile lines (the lines over the lower cheek just outside the corners of the mouth) that started as wrinkles have progressed to folds. She also didn’t like that the skin of her neck was not only loose but “crinkly”.
The patient’s treatment included a Brow Lift, Face Lift with neck lift, and laser treatment for facial wrinkles around the lower eyelids and mouth. She decided to take some time off from work as she had been working so much. But she was walking outside the next morning and doing most of her daily activities by the fifth postoperative day.
Facelifts generally don’t change the character of the patient’s face but in this case, the surgery changed her sullen appearance to one that is more joyous and hopeful. Patients see these kinds of results in the mirror after their procedure and their new image can be very uplifting. Others who interact with the patient see the new them and also may respond more favorably to them and begin to feel the same way.
Brow Lift procedures when combined with laser rejuvenation can lead to significant improvement in the Crow’s foot area. This is the part of the face located just outside the outer corner of the eyelid . Wrinkles in the Crow’s foot area can start when patients are very young, even in their 20’s and can become deeper wrinkles with time. As the aging process continues, the skin and deeper tissues of the outer brow can fall, causing the Crow’s foot wrinkles to change into folds because of the laxity and extra skin. Thus, when patients are younger and simply have wrinkles, laser treatment of the wrinkles can smoothen out most or all of the wrinkles. When folding and skin laxity develops in the Crow’s foot area, a brow lift may be required to achieve significant improvement. Some patients may only need upper eyelid surgery to improve on the skin folding and laxity hen that develops.
Laser resurfacing of facial wrinkles can be a powerful tool against the aging process and an adjunct when performing a face lift, brow lift or neck lift. These lifting procedures don’t change the very center of the face around the mouth and eyelids, which is good because we don’t want these structures to be affected by the pull of a face lift and so we need something that can provide improvement in wrinkling of the lower lid and about the mouth and lips and that is the laser. Laser treatment is often the best way to resurface the skin because the depth of removal can be accurately controlled and the edges of the treated areas can be feathered and brought out to the natural skin edges. When combining the laser with a facelift, the edges of both treatments can be overlapped and so one cannot tell where one method has stopped and the other method has been performed.
When face lifts, brow lifts and neck lifts are performed, it is important to balance the need for good lifting improvement with the need to keep the hairline in the same place as it was preoperatively. Our hair confers an appearance of youth to our face and also frames our face, and as much as a picture frame provides an edge to a painting, keeping the viewer inside the painting, the hair line keeps our gaze directed at the face, left to find the indefinable beauty of the facial form.
