The face lift is a procedure designed to tighten and remove extra tissue in the lower part of the face, cheeks and neck. This extra tissue usually begins to appear in the decade of the 40’s. This procedure was first described as early as 1901 by Dr. Hollanderin. The initial procedure involved just skin removal and closure. Later, surgeons found that lifting the skin from the underlying fat layer and repositioning it, followed by excess skin removal produced better results. The “skin only” face lift was the basis for facial rejuvenation for decades. While the results were satisfactory the one complaint is that the effects tended to be short lived. Then, in 1974, Dr. Skoog described a deeper plane face lift in which the muscle and connective tissue layer underneath the fat layer, later named the SMAS (superficial musculo-aponeurotic system) layer, was dissected and tightened. Since Skoog’s initial description the “new era” of face lifting has begun. There have been a dizzying number of modifications to the Skoog method, all of which manipulate in some form or another the SMAS layer. These include SMAS excision techniques such as the short flap lift, the long flap lift, the deep plane, the composite lift and others. Other techniques meant to simply tighten the SMAS layer have also been explored including the MACS lift, Swift lift, thread lift and more.
The placement of the incisions used to access the SMAS layer and remove excess skin have also evolved over time. Initially, they were placed out on the face, in front of the ear to avoid distortion of the lobe. Many plastic surgeons today continue to use these outdated incisions. Incisions used in our practice are specifically designed to be almost invisible and do not distort the ear (see photo). The incision starts behind the hairline in the temple area, crosses the junction of the upper ear with the cheek, wraps behind the notch of cartilage in front of the ear canal, goes through the ear lobe crease and back up behind the ear. Many patients will also require an extension of the incision into the hairline behind the ear. Again, over time the incisions will virtually disappear.
Dr. Bitner has studied and learned the many different types of face lifts. He has broken it down to two types of lifts, the full lift and the mini-lift. The full lift involves SMAS elevation and imbrication. This produces maximum benefits and will last for a decade or more. The mini-lift is designed for sagging in the cheek, jowl and some of the upper part of the neck. The incisions are shorter, the undermining less extensive with a shorter recovery period. During your consultation Dr. Bitner will take the time to discuss the goals and benefits of all the face lift options.
Dr. Bitner is an expert at endoscopic, trichophytic and coronal brow lifts. During the aging process the brows will begin to descend. As they reach around the level of the bony rim just above the eye, they begin to portrait a mean, angry or distrustful impression and appearance. Further, descent of the brow will begin to accentuate any extra sagging of eyelid skin leading further to a tired or unrested appearance.
The brow lift is a procedure commonly performed in conjunction with rejuvenation of the lower face during a facelift. In fact, Dr. Bitner feels that rejuvenation of the lower face without rejuvenation of the upper face gives an imbalanced appearance and we usually consider a facelift and a browlift to be one single operation. For this reason, we have one fee for both the browlift and the facelift. If a person wants just the face lift without the brows, the cost is the same as doing the face alone. He does not want anyone to compromise on facial rejuvenation of the lower face while neglecting the upper face, so cost is removed from the issue by having just a single fee. However, a browlift alone can and is commonly done.
The classic coronal brow lift involves an incision extending from ear to ear, lifting up the forehead skin, freeing it from the bone and repositioning it in a higher plane. The effect is to raise the brow, lift the hairline and leaving a scar from ear to ear across the top of the head. The scar generally disappears in the hair and the results are acceptable. A person who is a candidate for a coronal brow lift is usually also a candidate for an endoscopic brow lift. Consequently, this operation is uncommonly performed.
The endoscopic brow lift is performed through small incisions in the hair. The endoscope is introduced through these incisions and used to visualize the elevation of the tissue off the skull. The most important area to elevate is the arcus marginalis, a connective tissue layer that attaches the forehead and brow to the bone above the eyes. It is also important to see and preserve several sets of sensory nerves that come out of the skull just above the eyes. Once this tissue is freed from the underlying attachments it can be lifted and the brows can be repositioned to a higher location. No skin is removed. A small ridge is left in the hair just above the incisions. The ridge will gradually flatten down over the course of 4-6 weeks. The frontal hairline is raised slightly and no scars on the face are left. The overall effect is to support and elevate the brows without giving an overly lifted or surprised appearance.
The trichophytic brow lift is done through an incisions that made right where the frontal hairline joins the forehead. The indication for a trichophytic browlift is when someone has heavy brows, but a large forehead and high hairline. The endoscopic or coronal browlift would further lift the hairline unacceptably. Once the incision is made, the forehead skin is elevated, the arcus marginalis is released then the brows are repositioned to a higher location. With a trichophytic browlift, forehead skin is actually removed with the overall effect being to lower the frontal hairline. The only drawback to a trichophytic browlift is that the incision is initially somewhat visible, especially if the person styles their hair such that the hairline is exposed (i.e. the person does not have bangs).