Most likely the buccal branch of the facial nerve was injured during your face lift.

Fortunately buccal branch injuries recover because of generous additional nerve branches in the cheek area, however recovery can take many months. This creates a problem because the inactive muscle around the lip undergoes atrophy and when the new nerve branches reach the muscle, the muscle cannot respond to the regenerated nerve.

To keep the muscle healthy while waiting for the nerve to re grow I use DC (direct current) electrical stimulation. I use a hand held device which the patient uses at home to make the muscle contract 2-3 times a day.

If you would like to learn more about this therapy please call my office at 978-369-4499.

You may also learn more about facial nerve injury during face lift by reading my book “Facial Danger Zones”.

You may read more about the face lift procedure on my website or by reading Save Your Face.

Dr Seckel

Concord, Massaxchusetts

Boston, Massachusetts

Most likely the buccal branch of the facial nerve was injured during the surgery.

Buccal branch nerve injuries usually recover because there are many other branches of the nerve in this region that can take over the function.

The problem is that it is important to maintain the viability and function of the muscle while it is waiting for the nerve to grow back.

I am also a neurologist and these types of injuries are usually referred to me in the Boston Area.

My policy is to treat the paralyzed muscle with DC (direct Current)

muscle stimulation which causes the muscle to contract and keeps it

functioning while the nerve is growing back.

I can send you a muscle stimulator with instructions on its use if you

wish since you do not live near Boston.

If you would like to arrange this please call my practice manager Kathleen Burke at 978-369-4499. I am copying her this email above.

If you would like to learn more about this injury you may read my book

"Facial Danger Zones" which is available from Quality Medical Publishers:

You may also read more about the face lift by visiting my website or reading Save Your Face.

Thank you,

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

Most likely the buccal branch of the facial nerve was injured during the surgery.

Buccal branch nerve injuries usually recover because there are many other branches of the nerve in this

region that can take over the function.

The problem is that it is important to maintain the viability and function of the muscle while it is 

waiting for the nerve to grow back.

I am also a neurologist and these types of injuries are usually referred to me in the Boston Area.

My policy is to treat the paralyzed muscle with DC (direct Current)

muscle stimulation which causes the muscle to contract and keeps it

functioning while the nerve is growing back.

I can send you a muscle stimulator with instructions on its use if you

wish since you do not live near Boston.

If you would like to arrange this please call my practice manager Kathleen Burke at 978-369-4499. I am copying her this email above.

If you would like to learn more about this injury you may read my book

"Facial Danger Zones" which is available from Quality Medical Publishers:

You may also read more about the face lift by visiting my website or reading Save Your Face.

Thank you,

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

If you are considering a face lift or any facial rejuvenation procedure it is important to understand what a facelift can and cannot achieve and the many variations of the facelift technique that are designed to correct individual variations in facial aging that appear on different faces. Your face is unique and your facelift or facial rejuvenation procedure needs to be customized to create a pleasing result on your face.

Excellent results and beautiful rejuvenation can be achieved safely with modern face lift techniques:

Most important for you is the skill and experience of your doctor. Honest expert evaluation of your face and a clear explanation of the procedure that is best for you are essential. I have written a book called Save Your Face and in chapter 10 you will find an important guide on how to choose a plastic surgeon, questions you should ask, and warnings about potential situations that I think you should avoid.

What a face lift can achieve

· Restoration of a full youthful cheek

· A smooth tight jaw line

· A youthful smooth neckline

· Some elevation of the lateral brow

· Removal of jowls

· Correction of loose skin around the mouth

· Improvement in Marionette lines and Nasal labial fold lines

What a face lift cannot achieve

· Wrinkle removal

· Eyelid rejuvenation

· Removal of crow’s feet

· Removal of eye bags

· Removal of eyelid hooding

The different Types of Face lift Procedures

There are so many different names used to describe the face lift that it can be very confusing for you the patient. Terms like week end lift, mini lift, S lift, non-surgical face lift, thread lift, lifestyle lift are often used and it is hard for you the patient to know what these terms mean. Below I will try to describe the variations of the face lift procedure hopefully shed some light on this subject for you.

The Standard Face lift

The standard face lift involves an incision around the ear and undermining or freeing the loose facial skin from the deeper facial attachments. Once the skin is free to move it is drawn tight back to a more youthful and normal position on the face and the excess skin is removed from the area around the ear and the incision is closed. This relatively straightforward operation can produce excellent results and has “stood the test of time”. Elements of the standard face lift are used in virtually all of the face lift variations listed below. The main difference is that the underlying “musculo-aponeaurotic” tissues are not always tightened.

One common variation of the standard face lift is the SMAS Plication which involves tightening the deep layers with a stitch rather than actually excising or removing some of the deep tissue layer. The standard face lift with “SMAS Plication” is the most common face lift I perform. Published reports document the superiority and effectiveness of this technique.

The SMAS Face lift

The SMAS face lift involves dissecting, and tightening the deeper tissue called the SMAS layer in addition to the standard facelift dissection of the skin. This is done to provide additional tightening of the face and presumably provide a longer lasting result. Studies have cast doubt on whether SMAS lifting provides a longer result, but most face lifts today include some modification of the SMAS.

The SMAS stands for “superficial muscular aponeurotic system” and describes a firm fibrous tissue layer beneath the facial skin that attaches the facial skin to the underlying facial muscles. When this tissue is tightened during a face lift additional facial tightening is achieved.

The classic SMAS face lift involves dissecting beneath and elevating the SMAS layer, excising some of the excess and suturing the SMAS layer to tighten it.

I achieve the same effect by “plicating “the SMAS layer which means I do not dissect beneath the layer but fold the layer on itself with a suture to tighten the SMAS.

I do not dissect beneath the SMAS because the facial nerves run below the SMAS and I fear damage to the facial nerve. In my experience the placation provides the same result and is safer

The Extended SMAS Face lift

The extended SMAS face lift involves a more extensive dissection beneath the SMAS layer in an attempt to get a more extensive tightening of the facial skin especially down around the mouth. In my experience I am able to get this correction by undermining skin only and plicating the SMAS.

I avoid the extended SMAS face lift because in my opinion the facial nerves are more exposed to injury by this technique

The Deep Plane Face lift

The deep plane face lift involves a more extensive dissection beneath the SMAS layer and some of the facial muscles such as the orbicularis occuli. Proponents argue a more effective correction of cheek laxity and lower and mid face correction especially around the mouth. Longer lasting results are reported and this technique is purported to be safer for people who have smoked in the past.

Beautiful results have been achieved by the originator of this procedure, Dr Sam Hamra of Texas. Others have experienced an increased incidence of nerve injury. My own experience is that while excellent results are possible, some patients find an objectionable change in the appearance of their mouth.

Some studies have shown that the SMAS Plication technique mentioned above provides superior cosmetic results.

Subperiosteal Face lift

The subperiosteal face lift involves undermining beneath the deepest facial layer adjacent to the bone. This technique is designed to elevate and tighten all of the lax soft tissue on the face. Theory holds that undermining in the area next to the bone, deep to the nerves, also helps avoid nerve injury. Nerves still can be injured by this blind deep dissection. The subperiosteal face lift is an extensive operation and in my experience offers no advantage over the standard face lift with SMAS placation

The Lateral Brow Lift

The lateral brow lift is a modification of the face lift to treat laxity and sagging of the upper third of the face, the outside portion of the eyebrow and the upper cheek. An incision is made in or on the hairline on the side of the forehead, the skin is undermined, pulled tight and the excess removed.

This technique can be effective when only the side or lateral potion of the eyebrow and the upper cheek are lax. However care must be taken to avoid displacement of the hairline and injury to the frontal branch of the facial nerve, which if injured can cause the brow to droop.

The Forehead Lift

The forehead lift is a procedure I rarely do since the advent of Botox. Proper use of Botox can correct most forehead laxity caused by contraction of the frown muscles and the standard face lift corrects most lateral brow laxity of the outside portion of the eyebrow.

A forehead lift requires and incision within or at the hairline all the way across the forehead. The results can be excellent if you are willing to accept the scar. One problem however is that for a long lasting result the frown muscles must be removed and this can result in a permanent depression or contour deformity in the mid forehead in the frown area. In the past the frown muscles could be neutralized through an upper blepharoplasty eyelid incision, but again Botox has made this operation unnecessary for most people who want to correct laxity of the middle portion of the forehead.

The Mid face or Cheek Lift

The mid face lift or cheek lift is designed to tighten the cheeks and help improve the nasal labial fold lines. This is a modification of the face lift which involves an incision along the crease in front of the top part of the ear extending up onto the hairline.

The cheek lift or mid face lift is effective for people who have laxity in the cheek and nasal labial fold lines but have no laxity along the jaw line and neck.

The cheek lift or mid face lift is becoming very popular among younger patients who have early facial laxity in the mid face. Cheek sagging is often the first facial aging change to occur, and younger patients are choosing to have a cheek lift or midface lift before further facial sagging extending to the neck and jaw line occur.

The Neck Lift

The neck lift is designed to tighten sagging neck skin below the jaw line and chin. The neck lift is a good choice for younger patients who only have loose skin beneath the chin and jaw line.

In some cases the neck lift can be accomplished through a small incision beneath the chin which is well hidden. This procedure is also called a platysmaplasty or corset platysmaplasty. In some cases with more extensive neck laxity an incision behind the ear is also required.

The Short Scar Face lift

The short scar face lift describes a face lift performed through an incision which runs only in front of the ear in the skin crease. The incision behind the ear and above the ear in the hairline is avoided.

Some authors show very impressive results showing improvement in face and neck laxity with this technique. This procedure is effective for younger patients with mid face laxity and less extensive neck and forehead laxity. The smaller incision is advantageous cosmetically and should require less healing and down time.

The Mini Lift

The mini lift or mini face lift means many things to many people. Most commonly the mini lift term is used by patients who want a face lift but don’t want to call it a face lift!

To me a mini face lift is a smaller procedure than the standard face lift and is useful in patients who have early facial laxity in the cheek and jaw line who do not have extensive neck laxity.

Usually I can use a short scar or an upper scar along the upper portion of the ear crease into the hairline.

The mini lift or mini face lift is a less extensive procedure and works well for younger patients and older patients with minimal facial laxity.

The Lifestyle Lift

I include the lifestyle lift here because so many people ask me about it. I only know what I read. I have not trained in nor have I ever done or seen a lifestyle lift performed. I have seen patients who claim they have had a lifestyle lift. As advertised the lifestyle lift is done without general anesthesia or IV sedation and claims are made that recovery is less than a traditional face lift.

The Non-surgical Face lift

When most people use the term non-surgical face lift they are talking about skin tightening with the various new skin tightening machines. Some misuse this term by applying it to extensive soft tissue filler injections

The newer skin tightening technology uses radiofrequency energy or infrared energy to heat the deep layers of the skin to cause contraction and tightening but first cools the skin before the energy is applied to prevent injury and ablation of the superficial skin by the heat energy. Thus the skin is tightened but the surface is not ablated, thus non-ablative skin tightening. There is no down time following non-ablative skin tightening unlike the older CO2 laser resurfacing skin tightening.

Several new skin tightening machines are available. The LuxIR by Palomar, and the Titan by Cutera utilize infrared energy for skin tightening. The Aluma by Lumenis and Thermage utilize infrared energy for skin tightening. Refirme by Syneron uses a combination of light energies with radiofrequency for skin tightening.

All of the machines achieve about similar results when used properly. Generally there is less discomfort with the Infrared skin tightening machines. Complications have been minimal although some serious complications occurred with Thermage skin tightening early on.

In my practice I find that non-ablative skin tightening is most helpful for younger patients who do not have severe aging changes and significant sun damage, people in their 30’s and 40’s who want to correct or tighten early skin sagging along the jaw line or jowl area, neck and cheeks. I use the LuxIR on these larger areas. For skin tightening around the eyelids I use the Aluma which has a smaller treatment head and a suction device that will pull the delicate peri ocular skin into the treatment chamber for skin tightening.

The field of non-ablative skin tightening is in its infancy and will definitely become more effective in the years ahead. The companies are improving their products frequently. For now however the people who benefit most from the skin tightening machines today are younger people who still have thick healthy skin with early aging changes.

The use of the term non-surgical face lift to describe non-ablative skin tightening is an overstatement with technology available for skin tightening today. At best a 30% result is possible when compared to a traditional face lift.

Result Oriented Face lift

A face lift can create a truly beautiful and refreshed look to your face:

The important components of a beautiful Face lift result are:

• A smooth, firm neck and jaw line
• A full elevated cheek high on the cheek bone
• A normal appearing ear lobe
• Hidden scars
• A normal “unoperated” appearance
• Looking “like you” just younger

The Face lift is one of the most enjoyable surgeries that I do. After 25 years in practice I usually achieve the result you want and it is a joy for me to share your happiness and enthusiasm for your new refreshed look.

The Face lift requires experience and skill and is a complex procedure which requires both artistry and a clear understanding and shared image of the final look you hope to achieve.

Your Consultation

When we meet I will talk with you and ask you to explain to me the specific facial rejuvenation goals you hope to achieve. I will examine you and tell you my findings and describe the areas where I think improvement can be made. I will demonstrate on your face the appearance that I believe the face lift will create on your face.

I will then recommend the procedure I feel is best for you. I will discuss the procedure, your recovery, and expectations and answer your questions. Photos of your face will be taken. You will be given an estimate or quote of the cost of the procedure. Financing plans are available.

The Face lift procedure

I perform different types of Face lifts designed to meet your specific needs for your unique face.

A Full face lift elevates and firms the entire face and neck, including the lateral brow, the cheek, the jaw line and the neck. A neck lift just tightens the neck and lower jaw. A midface lift or cheek lift tightens the cheeks and nasal labial folds. An upper face lift or brow lift elevates the outside of the eyebrow and the upper face.

A mini face lift is a less extensive full face lift which is appropriate for people who have minimal facial laxity and need only minor facial tightening or tuck. The mini lift is usually appropriate for younger people in their 30’s and 40’s, or those lucky people in their 50’s and up who have very little facial laxity.

A good face lift result requires tightening of both the skin and the deeper facial tissues which also sag with age. I tighten the deep layers of the face; the SMAS face lift, which tightens the deeper muscle like layer of the face. This is necessary to achieve a good result that lasts. Minor lifts that are advertised as being quick, easy and with no down time usually only involve skin removal and they do not last, often only a few months. A well done SMAS lift should last years.

Face lift Vectors

A very important concept in face lifting is the Vector. The vector is the direction of pull required to lift the face to a younger more attractive look. The appropriate face lift vector is unique to your face and the face lift must tighten your face along the appropriate vector if you are going to achieve the result you want.

When you see a person who has had a face lift and has the surprised look, or looks too tight, unnatural or like a “weasel”, it usually means that their surgeon did not tighten the face along the appropriate vector.

I always examine your face, determine the best most natural vector for your face and draw the vectors on your face before I make my lines to mark my planned face lift procedure. This helps to assure a natural looking face lift result.

Scars

No one wants scars on their face and everyone is concerned about face lift scars.

Usually face lift scars are not visible to those around you. 75% of the face lift scars are behind the ear or in the hairline and people do not see them unless they closely inspect you and look for them. Yes your hairdresser will know, but he/she is likely the only one other than your partner.

The 25 % of the scar that is in a visible location is also hidden. This scar is placed into the fold in front of your ear. It is usually not visible and is easily covered by your make up.

Your Ears

In my opinion, the worst sign of a bad face lift by an inexperienced surgeon is the “Spock ear” or “elf ear” deformity. This occurs when the ear lobe is fused to the cheek and pulled down to where it looks like the ear is attached to the angle of the jaw.

I have developed a very specific technique for creating a normal looking ear lobe following a face lift-check my photos; you will not see the “Spock ear”.

Pre OP

The pre operative visit is the time when we will sit down and clearly define your face lift goals. We will discuss what you hope to achieve and what I believe I can achieve with your face lift. I will try to give you an honest image of what you can expect for a result.

You will also undergo a history and physical exam to make certain that you are healthy and have no medication allergies or contraindications to surgery. An EKG (electrocardiogram) may be done if you have a history of heart problems or have reached a certain age. You will also be given prescriptions for post operative medications. You also will be asked to read and sign surgical consent forms which outline the risks, potential complications, limitations and expectations of face lift surgery.

The Operation

A full SMAS face and neck lift usually takes me about 90 minutes to 2 hours. If I am doing eyelid rejuvenation or 4 lid blepharoplasty at the same operation, as is often the case, then the surgery can take 3 hours. Mini lifts, neck lifts and cheek lifts usually take only an hour.

You are asleep during the surgery. I have very experienced superb anesthesiologists who will be taking care of you. Safety is our first concern. We use modern, very safe anesthesiology techniques, and take precautions to avoid nausea after surgery.

Following your surgery you will go to the recovery room where a nurse will take care of you and make sure you are comfortable.

Some patients prefer the comfort of an overnight stay in the hospital. In this case I will examine you the next morning, remove two tiny drains from behind your ear, remove your bandage, and have you shower and comb out your hair, and then discharge you. When you go home a small scarf placed over your head and a pair of sunglasses will usually hide the fact that you have had surgery.

For those of you who want to go home the same day after surgery, you will spend about 2 hours in the recovery room with a nurse taking care of you. As soon as you are comfortable, able to drink and eat a bland food such as crackers or cookies, and able to go to the bathroom, you will be discharged. The nurse will escort you by wheel chair to your car.

We require that someone bring you to the surgery center and take you home, and that you have someone staying with you the first night after your surgery.

Post op- What to expect

My patients do not always complain of pain following a face lift. Your face and neck will feel tight, which means that I have done my job correctly. After a few days the tight sensation will go away as the facial tissues relax. If you have had a blepharoplasty for eyelid rejuvenation you will have ice packs on your eyes to reduce swelling and bruising.

I place a bandage around your face which comes off the next day and you may shower and wash your hair on the first day after surgery. I usually place a tiny drain behind each ear which is removed the first day after surgery.

Bruising on the face is unusual; bruising when it does occur is usually on the neck and upper chest and is usually minimal and easily covered with make up.

Usually after 1 to 2 weeks you will be comfortable being seen in public and will be back to most normal activity. I ask you to wait 3 weeks before heavy weight lifting or aggressive work outs.

I have you take an herbal supplement called Arnica Montana before and after surgery which helps reduce bruising. I also have excellent mineral cover up make up to cover any visible bruising.

Consultation with Dr Seckel

I can tell you a great deal more about face lift and how it would work for you if I see you in person. Call me or contact me by email. If you would like to email me your photos I can email you my thoughts about how I think a Face lift would work for you. For more information on face lift read my blogs on face lift.

I look forward to meeting you.

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts

Thank you for your email. Thermage and the other non-surgical technologies do work but achieve only a 20 % skin tightening compared to surgery.

It is possible to tighten the neck skin with a neck lift without visible incisions.

Depending on your particular anatomy and laxity, the neck may be tightened through an incision behind the ear. Alternatively a neck lift can be achieved with a procedure called a Platysmaplasty through a small incision beneath the chin in a skin fold which is well hidden. Either of these neck lift procedures can be done in an hour or less.

Please visit my clinical website to see my results:

http://drseckel.com/surgical-procedures/face-lift/

I do not have a picture of the neck lift alone but the face lift picture
shows the type of result that is typical in my patients.

I have a practice in the Boston area and would be delighted to see you. I have many patients from out of town in the US and the UK who come here for surgery.

Since you are from out of town I would be happy to review your photos if you would like to email them to me, then I could give you a more informed opinion about what I would recommend for you.
For further information on neck lift, face lift or non-surgical facial rejuvenation read Save Your Face or contact me.

Sincerely,

Dr Seckel
Boston, Massachusetts
Peabody, Massachusetts

Thank you for your email about the face lift. A well done face lift should tighten any loose skin on your neck and beneath your chin. If there is a lot of loose skin on your neck and lax muscles, you may need a platysmaplasty which is a specific technique done with the face lift which tightens the neck and creates a youthful neck line.

A face lift tightens the entire face, neck, jaw line, cheek and forehead. A neck lift only tightens the neck. The Lifestyle lift is a modification of the face lift done under local anesthesia. I do not do the lifestyle lift so I cannot tell you much about the lifestyle lift technique.

The neck lift requires a less extensive incision and procedure than the full face lift. Usually a neck lift can be done with incisions behind the ear which are less visible. If however you also have facial skin laxity along your jaw and cheek, pulling the neck tight alone without lifting the jaw line and cheek can accentuate the laxity along your jaw line and cheek. Your plastic surgeon can advise you if the face lift is a better option than the neck lift alone.

A full face lift tightens the neck, jaw line, cheek, and upper face and creates a more harmonious facial rejuvenation than the neck lift alone.

The face ages as an entire unit, facial laxity usually begins in the cheek, so tightening only the neck and not the rest of the face can accentuate the appearance of the aging changes in the cheek and along the jaw line.

Face lift incisions are usually well healed and 75% of the incision is hidden behind the ear and in the hair. While the neck lift incision is hidden behind the ear, if there is facial laxity in front of the ear it can distract from the result more than the incision in front of the ear required by a full face lift.

The most important issue for you is to seek and follow the advice of an experienced, board certified plastic surgeon who is experienced at face lift surgery.

For more information on face lift and facial rejuvenation read my book or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

Peabody, Massachusetts

The cheek or midface is usually the first area of the face to sag with aging. The cheek fat pad is normally high on the cheek bone creating the “chubby cheeks’ which people like to touch on the face of a young child.

The full cheek creates a very youthful appearance to the face and when the cheek fat pad moves downward with facial sagging, usually in the 30’s and 40’s it creates a tired aged appearance to the face.

As the cheek sags downward, the skin forms the nasal labial folds around the mouth, also creating a tired appearance. Some people choose to have fillers like Restylane or Radiesse injected into the folds. This is a camouflage technique and is temporary and does not fix the problem that requires a cheek lift or midface lift.

The cheek lifts or mid face lift is about 1/3 of a face lift. An incision is made usually just above the ear into the hairline so the cheek lift incision is usually not visible. The skin of the cheek is elevated and the cheek fat pad is pulled back up and replaced back onto the cheek bone.

The cheek lifts or mid face lift is a simpler and less invasive procedure than the face lift and usually creates a very nice result. Check the link on face lift on drseckel.com to see how a lifted cheek creates a very youthful appearance to the face.

Thank you for your question. For more information please call 978-369-4499

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts

Thank you for your question. Interestingly the average age of patients seeking face lift surgery in my practice is 53 years old, so there are many women who share your concerns and want a non-surgical face lift. I have written a great deal about facial aging and its prevention and correction. I believe you would find my book “Save Your Face” very helpful. In the book I discuss the various face lift options, non-surgical face lift and surgical face lift, and there is also advice on how to choose a plastic surgeon.

If you would like to see pictures of a face lift result visit my clinical website drseckel.com.

I have had a lot of experience with the non-surgical face lift and can tell you that the best results with current technology are about a 20-30% tightening of the facial skin with some improvement in skin texture and wrinkling especially around the jaw line. While these results are definitely visible when you review pre and 6 month post treatment photographs, most patients in there 50’s, who have significant facial skin laxity in the face, jaw line, and neck are disappointed with the non-surgical face lift. The skin tightening procedures are expensive, about a third of the cost of a face lift.

I repeatedly advise that the most important factor in deciding to have a face lift or non-surgical face lift is your rapport with and the skill and experience of the plastic surgeon. The various names that are marketed on the web, mini face lift, mini tuck, lifestyle lift, thread lift, face tuck and others are names used to market individual variations in the face lifting technique. The most important factor behind that name is the skill and experience of the doctor who will be performing your surgery. All of the procedures you mentioned are surgical procedures and the success of a surgical procedure is dependant on your particular anatomy, medical condition, and skin type and on the skill and experience of the doctor.

My quick answer to your question is to pick your doctor first and let him or her pick the facial rejuvenation procedure that is most likely to achieve the face lift result you want. The face lift is a very complex procedure which requires skill and experience to perform and no internet description or marketing term can compensate for that basic fact.

Having said that there are general guidelines that can be helpful to consider when you are considering any facial rejuvenation procedure such as a face lift. Almost everyone who has seen there facial skin sag on the cheek, jaw line, and neck has looked into a mirror, placed their hands on their face and pulled the skin up. I do this frequently and I always look better and younger when I pull the skin of my face up. This is what a face lift does, it pulls the facial and neck skin back to a firmer more youthful appearance.

It is crucially important however that the face lift tighten the facial skin in a natural direction and to a natural appearing degree of firmness and tightness. A non-surgical face lift simply cannot do this as well as a face lift. There is a perfect appropriate direction and degree of tightness for every individual face, I call this the face lift vector and I determine the appropriate vector for each individual face when I make my markings for a face lift just before surgery. If this is done incorrectly the result of the face-lift will be unnatural and the patient will be unhappy and look “operated on”. It is very unusual for the face to be tighetend too much during a “first facelift”, but the too tight face is common when a second facelift is done by an inexperienced or less skilled surgeon. Determining the appropriate vector and degree of pull in the various facial areas requires skill, aesthetic judgement and experience-there is no substitute. Thus again, the skill and experience of your surgeon is the most important determinant of a satisfactory outcome following a face lift.

The second important component, in my opinion, is the technical detail of the facelift operation. The skin covering the face and neck is all attached to the same musculofascial structure called the SMAS which stands for Superficial Musculo Aponeurotic System and after 30 years of research and study most, but not all, experts agree that tightening the SMAS layer as well as the facial skin during a face lift produces a better, more lasting, and safer face lift result. In my opinion the SMAS should be tightened during a face lift, and any mini facelift which only tightens the skin and ignores the SMAS will not last as long as a standard SMAS face lift. Furthermore, since the facial skin moves and sags as a unit, that is brow, cheek, jaw and neck all sag together, doing a minilift on one area such as the cheek will not produce the same harmonious facial tightening that a standard facelift will produce. Since in my experience most people who decide to have a mini or other lift instead of a standard facelift do so to save money, I think it is true that “you get what you pay for”. A standard SMAS face lift takes time and skill; taking short cuts gives sub standard results. That is why I say pick an expert surgeon you feel you can trust and follow his or her advice.

The next important factor in determining the outcome of a face lift is your facial skin type. Patients with very fair, thin skin that never tan and always burn and who have blue eyes and blonde or red hair can have an excellent facelift result, but generally the facial tightening does not last as long as other skin types. Patients with this skin type, which we call Fitzpatrick Type 1 skin, age earlier and more severely than people with darker skin. In addition thinner skin has less elastic tissue and is less resistant to sagging. Consequently aging will continue after the facelift and the result will not last as long. Tightening of the skin and wrinkle removal can be enhanced in these patients by laser procedures which increase the collagen in the skin after a facelift has been done, and improve the results of the facial rejuvenation achieved by the facelift.

Conversely, patients with darker thicker skin age less rapidly and have more skin elasticity, thus a facelift in a darker skinned person who always tans will last longer, often a satisfactory appearance of 10 to 15 years.

Another important consideration when considering a face lift is your general state of health. A face lift is a surgical operation, and surgery is safest in people who are in good general health. High blood pressure can cause bleeding and should always be under very good control before considering a face lift. Severe diabetes or anything that impairs wound healing poses a serious risk during and after a facelift. Patients who smoke cannot have a facelift unless they have been free of nicotine in any form for at least 8 weeks. I have seen patients who have not smoked in 20 years still have slow wound healing after a facelift.

You will need help and support after a face lift. Although many people can have a face lift as day surgery someone must drive you home and stay with you at least the first night. You will need help negotiating stairs, getting to the bathroom etc. Don’t believe what you read about returning to work the next day. Even after having a face lift with local anesthesia you are not going to be able to work the next day. I tell my patients to plan to take at least 2 weeks off of work after a face lift. You will be up and around with make up after 4 to 5 days, but you are not going to feel like a full day’s work and you are not going to want your fellow employees to see you. Generally I take some stitches out at day 5 or 6 and the remainder, those in the hair out at day 12-14.

Surprisingly most of my patients who have had a face lift do not complain of pain. They tell me the face feels tight but not painful. I believe this is because when the facial skin is lifted it is removed from the underlying nerves, and in fact the cheek is often numb for several months after a facelift.

You see a youthful face right away after surgery! I always ask my patients to look into a mirror when I see them the morning after a face lift. You can always see the results immediately, the nice tight neck and jaw line and full cheek. There is swelling and slight bruising but bruising usually does not show up for a day or two and then mostly in the neck. I also have my patients shower and wash out their hair the next morning so they can put on a scarf and dark glasses and draw less attention as they go home. Most patients have a small drain placed under the skin which I remove the next morning. Men, because they have more blood vessels in the face because of their heavy beard, are more likely to bleed, thus I leave their drains in longer.

Scarring is not a problem with a properly executed facelift. Only 25 % of the scar is visible, as 75% is hidden behind the ear and in the hair. The visible portion is placed in a crease immediately in front of the ear and is not visible to most people. A person would have to look closely at your ear to see it.

The decision to have a face lift is a very personal one. If you are healthy and having a youthful looking face is important to you, and a qualified, experienced, skilled board certified plastic surgeon thinks you are a good candidate, and you can afford a two week recovery time then a face lift is a good option.

I am not sure why the doctor also suggested a blepharoplasty. It is my custom to never suggest any procedure to a patient unless the patient specifically asks about the correction of a condition. If you are also troubled by loose eyelid skin, hooding of the eyelids, bags and dark circles under the eyes there are many links to informative articles on these subjects at the Saveyourface.com website.

If you decide to have a face lift by all means the most important factor is to find an experienced skilled plastic surgeon. Ask friends or relatives who have had a good experience for a recommendation. Ask the surgeon to show you pictures of patients who have had a facelift with the doctor. Ask to speak to prior patients who have had a facelift.

Although non-surgical facial rejuvenation and skin tightening or non-surgical face lift techniques have improved and are getting better I believe they are more appropriate for younger patients in their 30’s and 40’s who have minimal facial laxity and have younger skin which responds better to skin tightening techniques. In my experience most patients in their late 40”s and older get a better result by choosing plastic surgery and are happier after a face lift done by an experienced skilled plastic surgeon.

Please feel free to email me your photo which will be kept confidential. There are many other facial rejuvenation options including the 6-step non-surgical facial rejuvenation program which may interest you.

For more information on face lifts, plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Dimples or depressions in the skin are one of the complications of the plastic surgery thread lift procedure, the modified face lift procedure for facial rejuvenation and tightening. Dimples like this do not happen when a traditional face lift is done. This happens when the one of the small “barbs” on the thread hooks the skin and pulls the on the skin and creates a dimple when the thread is tightened to pull the facial skin upward. Whether the thread lift dimple can be corrected easily depends on where the dimple is located. If it is near the hairline the attachment could be released with a scissor. If it is in mid face and the thread lift dimple cannot be reached from above the hairline, direct release would require an incision on the face and would leave a scar. In this circumstance it may need to be removed via an incision above the hairline or inside the lip. I will be happy to review your photo confidentially.

For more information on thread lift,plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

A well-done face lift by an experienced board certified plastic surgeon is still the most effective long-term solution for facial jowls and neck laxity or the “turkey wattle”. The new skin tightening treatments are not a non-surgical face lift.

The new skin tightening machines often referred to as the ‘non-surgical face-lift” are effective in the jowl and neck area but the tightening is about 20-30% of what you can get with a well done face lift. Most of the best results I have seen with skin tightening still require a pre and post treatment photograph to appreciate the results at 6 months.

There are several skin tightening machines available. I use the LuxIR made by Palomar and the Aluma made by Lumenis and am happy with the results. Others are Thermage and Titan by Cutera. They all get similar results. The Thermage is the most painful and there have been complications with Thermage. Skin tightening provides slight wrinkle removal, but for effective wrinkle removal you need an ablative laser skin peel.

The Active FX laser skin peel is a very exciting new laser skin rejuvenation procedure that produces a deep peel and works very nicely for wrinkle removal and to superficially tighten the skin of the cheek and around the mouth. Recovery time is very short-4-6 days compared to the older lasers, which required 3-4 weeks.

For tightening around the jaw and neck I would recommend the skin tightening machines mentioned above, the Lux IR and the Aluma with FACES rather than the Active Fx.

If you would like to see photos of facial rejuvenation results visit my clinical website drseckel.com.

For more information on skin tightening, wrinkle removal, and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel
Boston, Massachusetts