Facelift: can it look more natural for longer?
	By Dr. Jeffrey A. Fialkov M.D., F.R.C.S.C. www.plasty.ca View Dr. Fialkov's profile

There is a consensus amongst plastic surgeons who perform facelifts that the key to more natural longer lasting results is the minimization of tension on the skin, in other words, less skin tightening. This may seem counterintuitive to a patient seeking facial rejuvenation surgery, until one understands how the face is lifted, and more importantly, how it remains in its more youthful, gravity defying position.
		Before and After Facelift

Facelift surgery, known as facial rhytidectomy, involves the resuspension of soft tissues of the face (skin, fat and muscle) to the position in which they were prior to the onset of visible facial aging. The latter results from gravity pulling on the facial soft tissues which have lost their elasticity because of time, sun and other environmental factors (smoking for instance). In addition the quality of the skin deteriorates (photoelastosis) resulting in wrinkles and the volume of fat decreases, resulting in an aged sallow look.

Surgery can address the decrease in volume of soft tissues due to aging and, to a certain degree the change in skin quality. Facelift surgery is best, however, in reversing the descent of the soft tissues from their higher, more youthful position. During the surgery, these soft tissues are freed and suspended to solid structures using sutures (stitches) that remain buried under the skin. This “pull” brings with it the overlying skin, which remains attached to a certain extent, depending on the technique used. Some of the skin then becomes redundant and is trimmed. This results in a “mild tightening” of the skin, but most of the tension is placed on the deeper muscle and sinew layer. This technique allows for better “fine tuning of the lift, and reduces the risk of having that unnatural “wind tunnel” look following surgery. Although multiple stitches hold the soft tissues in their new position, it is up to the patients own body to form the “glue” to keep them there. That glue is scar tissue. The stronger the scar that forms between the lifted soft tissues and the solid structures to which they are sutured, the longer the results of a facelift will last. A further factor in determining the longevity of results after facelift surgery has to do with the patients underlying bone structure. In general, patients with prominent facial bone structure (high cheek bones, strong chin) appear to age more slowly. Similarly, such patients tend to get more dramatic, longer lasting results from facelift procedures. One strategy for rejuvenating the face in patients with weak bone structure is to enhance that structure prior to performing a rejuvenation procedure. Thus, a person with a weak chin may have a better reversal of the signs of aging around the jowls and neckline if they undergo a chin augmentation (implant) prior to facelift.

A qualified Plastic Surgeon should take all of these factors into account when assessing a patient seeking facial rejuvenation surgery. Only after careful assessment and discussion can a patient be assured that they are choosing the procedure that will achieve the longest lasting natural results safely.

Dr. Jeffrey Fialkov is Assistant Professor of Plastic Surgery at the
University of Toronto and a staff Plastic Surgeon specializing in facial
surgery at Sunnybrook Health Science Centre