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The vast majority of facelifts done in Dallas, New York or anywhere on the globe are skin lifts. That is - using the same incisions common to all techniques - the skin in timidly elevated in front of the ear, and the cheek mass is pulled upward using the skin as the handle.
This limited technique is popular for several reasons. First, it is simple. If you are a physician not formally trained in plastic surgery, you can take the weekend course and perform the procedure without getting into trouble. Second, it is popular with patients because the recovery is very fast -- you look great at a cocktail party in only two weeks! Plus, it is great marketing for the surgeon to have you look good fast.
There's only one problem. Skin is like taffy. It stretches when pulled and you lose half of your fabulous result in six months. That is where the concept of facelifts "falling" came from. So what do you do? You go back to your surgeon in a year or two and have a "little tuck," a "mini lift" or whatever "catchy" phrase that can be used to sound like you did not need to have your surgery redone so quickly.
It's a great deal for the surgeon - lots of repeat business - but not such a great deal for the patient. Because if you keep pulling that taffy-like skin, before long your face looks over stretched, giving you that "facelift look."
Under the skin there are partitioning layers called fascia. Their job is to hold things in place - like the partitions in a case of beverages which keep the bottles apart. By definition, these layers do not stretch like taffy or they couldn't do their job. The fascia in the face is called the "SMAS." You may have read about it in magazine articles.
If the partitioning layer, the SMAS, is used as the handle to lift the cheek, two good things happen. First, the lift is much more solid and long-lasting. Second, the skin is not pulled under unnatural tension so you don't look stretched.
That's the good news. The bad news is that it is a more extensive operation, so you swell longer. Instead of looking better than you started out at two weeks, it will take four to six weeks. You'll feel OK at two weeks, and you won't scare anybody, but you also will not fool anybody for four to six weeks.
Unfortunately, a facelift is like everything else in life. If you want more out of it, you have to put more into it - meaning, you have to be patient with the recovery period. But my advice for looking your best over the long haul is to do a facelift LESS OFTEN and MORE THOROUGHLY.
To get through your operation safely is medical science;
Facelifts by different surgeons are very different. It is not like shopping for a Lexus at different dealerships. A car is the same product at each dealer, so the difference is merely price and service.
No so with art. In any museum with fine paintings, the only elements the paintings have in common is canvass and paint. After that, they're different based on the style and the skill of the artist. The same is true of facelifts. Every surgeon does it differently, and even the same surgeon should do different sculpting sequences in different faces. It's all art.
I've spent my career teaching plastic surgeons to do these procedures, and I have performed most of the reported techniques. Many highly publicized procedures give occasional spectacular benefits, but do not do so consistently; or worse, they have a high frequency of complications. I have developed and adopted only those techniques which deliver a highly predictable, natural result.
The artistic goal is not to remove every line from a face. Many lines are caused by animation muscles, and to remove all the lines would mean releasing the attachments of all the muscles of expression. While a perfectly smooth face might look good in still photography, it looks like a mask in real life. A "without expression" face is a face without passion or personality.
The goal should be to look better without looking like a different person. We want people to think you look good, or "rested," but not that you look operated.
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