Dr. Richard W. Fleming, M.D. FACS is a talented Beverly Hills facelift specialist who has helped numerous patients realize their dreams of subtly rejuvenated, natural-looking facial appearances. Recognizing that each patient seeking facelift in has unique aesthetic needs and desires, Dr. Fleming conducts thorough consultations in order to develop customized treatment plans. This approach allows him to consistently deliver facial rejuvenation results that exceed the expectations of his patients.
The word “Facelift” is actually a very broad term encompassing a wide range of different procedures that can be performed to improve the lower two-thirds of the face and the neck. The type of facelift that is performed depends upon the assessment of the individual patient.
Traditionally, facelift incisions have been placed in front of the ear. Our incisions start below the tuft of hair (the sideburn). In this way the excess skin can be removed without elevating the tuft, which would cause an obvious bald spot in front of the ear – a tell-tale sign of a facelift. The incision progresses into a natural crease and we then hide it within the ear canal. It is extended around the ear lobe onto the back side of the ear and into the hair, or along the hairline immediately behind the ear. When it is necessary to remove excess fat or muscle under the chin, we place a separate incision in a natural crease under the chin. In this manner we place all of our incisions in natural creases or they are hidden within the ear and hair-bearing scalp. Discomfort is minimal and treated with analgesics for a very short period of time after surgery. A dressing is kept in place for three to four days. We remove the sutures around the ears and under the chin six days after surgery. You should allow approximately two weeks for recovery from the temporary bruising, swelling and discoloration that occurs. Makeup can be worn seven days following surgery. There may be some numbness around the face which resolves over several weeks.
For many patients, especially those individuals who are just starting to note the changes secondary to the aging process, they are concerned about sagging muscles under the chin ( the turkey gobbler appearance) excess fat in the anterior neck, and relaxed skin under the jawline without jowls or changes of the face in front of the ears. Rather than having a full facelift, a more limited neck lift with a small incision under the chin and another behind the ear can reverse the physical signs of the aging neck and restore a more defined jawline.
Changes In The Aging Face
With the aging process, there is loss of elasticity in the skin, decreased muscle tone, and loss of fatty tissue immediately beneath the facial skin. Conversely there may be an accumulation of fatty tissue and relaxed muscle under the chin. Heredity and sun exposure definitely influence the progression of facial aging. Dr. Fleming performs facelift surgery to improve the appearance of the lower two-thirds of the face and the neck. He often perform forehead/browlift rejuvenation and eyelid surgery in conjunction with a facelift. A cheek lift is also frequently combined with a facelift procedure to improve the central portion of the face.
Lack of bone structure: When discussing facial rejuvenation the first and most important feature to evaluate is the underlying bone structure. Before we consider removing excess skin and sagging muscle, we evaluate whether or not the underlying bone structure will give the patient a natural, balanced result. We often need to strengthen and augment the chin, or to enhance the cheeks with the injection of fat or fillers, or the placement of an implant.
Sagging Muscles: Naturally, as we age the muscles in our face lose elasticity and they begin to sag causing jowls to form along the jawline and a “turkey-gobbler” appearance under the chin. By tightening the sagging muscles through a “deep plane” approach, we are able to improve the appearance of the jowls and prevent the mask-like appearance that can occur when only excess skin is removed. When the muscles (called the platysma) under the chin begin to sag, bands begin to form. Fat frequently accumulates in this area further exacerbating the problem. This fat is often removed by liposuction during the procedure. The muscles in the neck and chin are tightened by performing a platysma cervical lift, or essentially a removing of the bands. The “turkey gobbler” appearance is then greatly improved, if not eliminated.
Excess Skin: The next step in assessing the individual’s needs in the natural aging process is to evaluate their skin. Aging causes the skin to loose elasticity, which results in the creation of folds or pleats on the face. Excess skin is removed during a facelift procedure.
Wrinkles/Fine Lines: This is the final aspect of the aging process that we need to evaluate when considering the individual’s facelift needs. In most cases, a facelift does not address this issue and we will recommend that a patient undergo chemical peeling or laser resurfacing in conjunction with a facelift to correct these problems. Fillers and fat augmentation are also possible alternatives for treating these problems, depending upon the location of the wrinkles.
The amount of improvement with surgery depends upon the extent of sagging, the bone structure of the face and wrinkling of the skin. The goal of this surgery is to provide our facelift patients with a more rested, vibrant and natural look – not a pulled, mask-like appearance.