The aging process is inescapable. Elastin fibers in
the skin break down at a genetically predetermined
rate. Human growth hormones may at some future time
help to modify this, but for the present, this is our
reality. In addition, the organization of the skin's
collagen fibers and its capacity to hold fluid
decreases. The skin is perpetually stretched and
loosened in response to the pull of the underlying
muscles of expression and mastication, and it faces
the relentless pull of gravity. Thus, there are these
three major factors working to produce wrinkles:
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Changes in skin structure and physiology.
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The action of underlying muscles exemplified by the
fine lines that appear around the lips and eyes: the
pucker lines and crow's feet. In these locations,
the muscles are intimately attached to the skin, and
when the muscles contract, reducing their surface
area, the skin is thrown into folds perpendicular to
the line of contracture, producing a purse-string
effect.
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Gravity. The deep lines between the nose and mouth
as well as the jowls, the double chin, and the loose
neck are examples of wrinkles that are due primarily
to the pull of gravity.
The fine lines of the cheeks, the crow's feet, the
vertical lines of the forehead and the transverse
lines of the upper nose and the lines around the lips,
are caused mainly in response to the pull of closely
applied muscles. They respond to dermabrasion,
chemical peel, and collagen injection. The heavier,
gravity-caused lines and folds require re-draping that
can only be provided by the facelift operation. More
limited problems may be aided by facial liposuction,
fat injection, skin shrinkage that follows laser
resurfacing, or segmental lifts such as mini-face
lifts, temple-upper face lift, or the neck lift.
Skin that has been dried by a combination of sun and
wind has less resistance to the muscle pull and will
show earlier wrinkling. Sunscreens and moisturizers
help. Smoking has been shown to adversely influence
the skin turgor (moisture content plus elasticity),
thus leading to earlier wrinkling. Vigorous facial
massaging and muscle tightening exercises have not
been found effective and may even be detrimental,
while a regimen that promotes muscle relaxation, such
as meditation, may be beneficial.
The Facelift Operation
In general terms, the facelift is a procedure wherein
the skin of the face and neck is detached and
re-draped with a mild upward and backward pull. It is
performed for those wrinkles that develop in response
to gravity – the jowls, the nasolabial folds (the
folds between the nose and mouth), and the redundant
neck.
The procedure for the facelift operation is as
follows:
The hair, face and neck are thoroughly cleansed. The
areas of skin bearing hair just above and behind the
ear are clipped, and the incisions are marked. These
marks are in the clipped areas and in front of the
ear; the exact configuration of these markings varies
with the individual surgeon and patient. The operation
may be performed with the patient either tranquilized
of fully asleep. In either case, the skin is
infiltrated with an adrenaline solution to keep
bleeding to a minimum, and a local anesthetic is
administered. The incisions are made and the skin
undermined, using scalpels and scissors, all small
blood vessels are coagulated as the procedure
progresses.
When Dr. Gutstein determines that sufficient
undermining has been carried out to allow smooth and
natural draping of the skin for this particular
patient, the skin is pulled upward and slightly
backward and held by approximating sutures. The excess
skin is removed and the incisions are repaired with
fine sutures.
The foregoing brief description outlines the basic
procedure for a facelift. There are many ancillary
procedures, any combination of which may be selected
by Dr. Gutstein to extend and improve the result for
each individual patient. The ancillary procedures may
include: an additional coronal incision in which the
forehead wrinkles and fallen brows may be treated; the
platysma neck muscle redistribution which is generally
combined with suction or fat excision under the chin
which provides a more sharply defined jaw; liposuction
of the cheeks, jowls or nasolabial folds; the lifting
of the facial muscle layer, deeper plane sub-periosteal
release and cheek fat pad elevation, chemical peel or
dermabrasion around the mouth to reduce the prominence
of the fine radial lines in that location. Eyelid
surgery, nasal, cheekbones, and chin modification may
also be added at the same time, or as separate
procedures, either before or after the facelift.
The number and range of modalities and types of
additional procedures has greatly expanded the facelift
concept and enhanced both the result and the longevity
of the lift. Nonetheless, the clock is turned back,
not stopped; and the forces that produced aging do
reassert themselves, but now you have a means of
fighting back.
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