There are many options and a myriad of procedures that can be done to improve and rejuvenate the face. The important thing is to be able to identify what the problem is so that the right procedure can be done. In the aging face, there are two problems - deflation of tissue (loss of fat) and descent of tissue (laxity). Hence you can see that the treatments either attempt to LIFT or FILL to correct the signs of aging. Once in a while, you may see or read of a patient that has a bloated look from too much fillers. This happens when too much filling is done and there is no attempt to address the laxity. The attempt to FILL your way to a LIFT can give you that problem.
In this age of advancing aesthetic medicine, there is an explosion of non-invasive and minimally invasive techniques which is good for the patients as they can seek such treatments for early facial aging changes. However, like some of the doctors mentioned, there are limitations of these non-invasive techniques as they require the skin to have a certain amount of elasticity and it certainly is unable to get rid of the excess skin laxity.
Non-invasive and minimally invasive techniques for facelift
Ultrasound based devices such as the HIFU or Ulthera are ideal for the younger patients as they cause skin tightening and provide a modest lift of the face. Personally, I have used both and I prefer the use of the Ulthera as it provides a more definite lift with a long lasting result. Some of the concerns are that it can be more painful so we provide the patient with ample anaesthetic to numb the skin before the procedure to reduce the discomfort. There are also some radio frequency based devices which I have used but with limited success.
Thread lifts have also become more popular as this is a minimally invasive procedure with rapid recovery and requires little time off work. The concept behind threadlift is the use barbed sutures that anchor the skin and the lift is obtained by securing these stitches to a stable point such as the temple.
Injectables such as botolinum toxin (Botox) and fillers can be done alone or in conjunction with the above methods to reduce wrinkles and also to fill the deflated areas of the face brought about by aging.
Fat grafts to face
Fat grafting is a technique that has been around for many years. In recent times, with a better understanding of the science and physiology behind fat grafting we are now able to reliably and reproducibly restore the lost volume to different areas of the face hence rejuvenating it and restoring a youthful look. Fat grafting is a highly operator and technique dependent procedure. This has to be done carefully so that one does not cause a hyperinflated face. I use the proprietary Tulip cannulas that are specially designed for fat graft harvest so that the correct sized fat particles are harvested. The fat is harvested from the tummy or thighs using liposuction techniques. Following that, the grafts are prepared with the use of a centrifuge using standard Coleman technique which is the current gold standard and proven to have the highest yield. The fat grafts are then injected into specific areas of the face using Tulip cannulas.
Traditional Facelift vs. Composite Facelift
A traditional facelift is a skin only facelift which gives immediate and gratifying results. Patients will know this as the facelift that can be done under local anaesthesia and it only takes 1-2 hours. There are reasons for its simplicity because it only addresses the skin and not the underlying tissue. During the aging process of the face, it is not only the skin that is ages and becomes lax, the underlying muscle (called the SMAS) and the tissues also sag. The criticisms of this technique is that the results does not last as only the skin is tightened and the patient often has a wind-swept face with tell tale signs of a facelift due to the undue tension and pull on the skin.
A composite facelift is a more refined and advanced technique where both the skin and SMAS is separated and lifted separately to address the problems of the aging face. The SMAS, which is the layer of the face that contains the muscles of facial expression is tightened directly hence reversing the aging changes, restoring contour to the cheek, jawline and neck and producing a more natural and longer lasting result. The composite facelift is a more complex procedure that is only performed by trained plastic surgeons as there is a risk of injuring the nerves that can affect facial expression. A composite facelift is able to address the nasolabial folds, the marionette lines, the jowls and can also be done with a neck lift to tighten the saggy skin around the neck. In certain patients, a brow or forehead lift is done in combination to elevate the upper 1/3 of the face and sometimes a lower eyelid and mid cheek lift also also performed concurrently if there is laxity around the periorbital region.
I hope this answers your question. Have a great week ahead and all the best!
Dr. Terence Goh
Plastic Surgeon
The information provided is purely for educational purposes and does not constitute medical advice or create any physician/patient relationship. Results may vary between individuals.
