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The concepts regarding facial aging has changed over the years, and early descriptions of face lifting in New York were performed as simple skin lifts or direct skin excisions. As our understanding of the anatomy has improved, surgeons recognized the importance of repositioning the deeper connective tissue layers, leading to the development of more advanced facelift procedures. More recently, surgeons recognized that there are not only changes to the connective tissue, causing laxity of the skin and underlying soft tissues, but there is also facial deflation or atrophy of the fatty soft tissue layers as well, leading to sagging.
The goal of facelift surgery for Dr. Wallach’s Manhattan patients is to create a more youthful appearance by lifting the sagging tissues and elevating them. In addition, some patients may require facial fat grafting to also treat facial soft tissue deflation. A New York facelift can reposition the soft tissues. Facelift surgery procedures can accomplish this, but further minimally invasive facial rejuvenation treatments may be required to treat the fine lines and wrinkles that a face lift will not treat. This can be accomplished with lasers, chemical peels, and skin care products that reduce the appearance of signs of aging.
No one New York patient undergoes the same exact facelift. It is very important when performing the facial rejuvenation plastic surgery to avoid creating “telltale” signs, or unfavorable looking results that make the face appear “unnatural.” This would include distortion of the ear shape, hairline and/or sideburn. Dr. Wallach, a New York City Plastic Surgeon, usually works on the deeper layers of the face to provide the so-called “lift” and to create a “natural” result. The deeper tissues of the face are mobilized to recreate the soft tissue for a youthful appearance. He may also perform fat injection to the face to treat the fat wasting seen as an individual ages. Just as important, he does not “pull’ on the skin, which can result in a distortion of the face.
Dr. Wallach uses the analogy of a bed to describe this dynamic. The deeper tissue of the face is like the mattress of a bed and the skin is like a sheet covering the mattress. In order to smooth out the bumps in the mattress, or improve the contour of the face, you have to work on the mattress, or the deeper tissues of the face (and not so much on the sheets, or skin). Dr. Wallach is an experienced facelift surgeon who always strives for the best results possible with the minimum amount of incisions.
Therefore, some patients may undergo a short- scar facelift (mini facelift) to improve their neck and jowls while others may require a more involved facelift procedure that improves the neck, jowls, and cheeks. The plastic surgery procedure usually takes between two and four hours to perform. The recuperation from a facial plastic surgery is from one to two weeks. Facial plastic surgeon Dr. Wallach has presented at national meetings and published articles on this subject in peer-reviewed journals.
What is the mini facelift procedure?
The mini facelift is a popular facial rejuvenation cosmetic surgery procedure. Mini facelifts address different signs of aging like wrinkled skin and sagging skin on the lower face area. Plastic surgeons tailor the mini facelift to ensure you get natural looking results and a youthful appearance. The mini facelift procedure includes the removal of excess skin from the chin and neck area and the tightening the remaining tissue, giving patients better chin and neck definition. When compared to the full facelift techniques, the mini facelift is minimally invasive and offers facelift patients natural looking results with minimal scarring. Since mini facelifts are less invasive, Dr. Wallach may use local anesthesia for your facelift procedure.
If you have excess skin or sagging skin in your lower face, you should schedule a consultation with Dr. Wallach to discuss the mini facelift procedure. He also may choose to add liposuction to the facelift procedure. This adds the advantage of recontouring the neck area as well, effectively giving you a neck lift.
What is a facelift?
A facelift is a plastic surgery procedure that treats the telltale signs of facial aging and offers complete facial rejuvenation. Facelifts improve the appearance of patients with excess skin, sagging skin, excess fat and skin laxity in the face and neck, as well as jowls and platysma muscle banding.
Who is a good candidate for a facelift?
A good candidate for a facelift in New York City is a healthy patient who has facial signs of aging, including cheek fat descent, jowling, and loose and excess skin or sagging skin in the face and the neck.
How much does a facelift cost?
The fee for a facelift in NYC will vary depending upon the complexity of the plastic surgery procedure. This may cost anywhere from $15,000-$40,000.
What should I expect during a consultation for a facelift?
During the consultation, you will spend a lot of time with board-certified plastic surgeon Steven Wallach reviewing your aesthetic goals. An exam will then be performed and a surgical plan for your facelift will be discussed with you at length.
What are the risks of facelift surgery?
The risks of facelift surgery are similar to the risks of other surgical procedures. This can include the risk of infection, facial nerve injuries, fluid or blood collections, numbness, and possible skin loss or healing issues.
How should I prepare for a facelift?
New York City Facial plastic surgeon Dr. Steven Wallach usually tells his patients to eat healthy and exercise regularly, and to avoid medications and herbal supplements that might cause bleeding.
What are the steps of a facelift procedure?
Your facelift procedure is usually performed under sedation or general anesthesia. In some instances, it can also be performed under local anesthesia. Your board-certified plastic surgeon will usually make a small incision underneath the chin and along the sides of the ear and behind the hairline. Fat removal, fat injection, muscle tightening, and skin tightening are other facelift techniques that can then be performed by Dr. Wallach as needed. Sutures are used to close the incision and the patient then goes home with a dressing around their head after the facial plastic surgery.
What should I expect during my facelift recovery?
Recovery after the New York City facelift is often straightforward. Dr. Wallach instructs patients to keep their head elevated and not to bend their head down in order to limit any tension on the incisions. Stitches from a facial plastic surgery are usually removed within seven to fourteen days and patients can go back to light activity within one to two weeks.
What results should I expect after a facelift?
The goal of the facelift is to produce a more youthful look and natural looking results without the tell-tale signs of having the plastic surgery procedure. After your facial plastic surgery, the cheeks should appear fuller, the jowls should be improved, the excess skin should be removed, and the neck should be refined.
Liquid Face Lift
The liquid face lift is a marketing phrase that refers to a non-surgical facial plastic procedure offered in New York incorporating both facial filler material such as Restylane™, Restylane Lyft, Juvederm, Revanesse, Radiesse, and Sculptra along with using the neuromodulators, Botox™ or Dysport. As our knowledge of facial aging has evolved, these products for facial rejuvenation have become more important. The filler materials can be used to fill the depressed cheeks that as a side benefit may improve the nasolabial folds (creases along the sides of the nose and mouth) indirectly. The nasolabial folds can be injected directly as well. Facial wasting along the sides of the mouth can also be treated by filler injections to treat the marionette lines. Jowling can be camouflaged to some extent with filler injections, and jaw line deformities can be improved as well. Areas around the eyes such as the tear trough can be filled to soften the “double-bubble” deformity of the lower lid -cheek attachments that appear with increasing age. In addition, cheek hollows and lines of the upper face can be filled. Temporal hollowing can also be treated in a similar manner. Even brow elevation can be accomplished with fillers by your plastic surgeon. In addition, the neuromodulators such as Botox and Dysport can treat overactive frontalis muscle that causes transverse forehead lines, overactive corrugators that lead to “11” lines, and lateral crow’s feet lines that are caused by the overactive orbicularis muscle. Treating the lateral brow with neuromodulators can create lateral brow elevation. In addition, the neuromodulators can treat some neck bands due to overactive platysma muscles. Lip lines, chin puckering, and overactive depressor anguli oris muscles of the lower lip region can also be treated. The key in using these products for facial rejuvenation is to not over do it. Some patients are over treated by their injector, possibly because the plastic surgeon performing the injection has not been trained properly in aesthetic facial rejuvenation or the injector does not offer other procedures such as face lift, brow lift, or eyelid surgery. Inevitably, some patients look “puffy” or like marshmallows. Too much product can make someone look as unnatural as someone who has had too much facial plastic surgery!
Chemical Peels, Lasers, and Skin Care Products
As stated previously, using the roller coaster analogy, the fine wrinkles and sun damaged skin, like the rust on the roller coaster tracks, can be treated with less invasive treatments like chemical peels, lasers, and skin care products (see the section on Non-Invasive Procedures). This is not treated with a face lift in New York but is an important ancillary procedure to make the face lift or filler procedure results look that much better. There are numerous laser and light based regimens offered in Manhattan that can improve the skin quality. For instance, Erbium laser peels used in New York either performing microlaser peels or deeper peels can be of benefit for some to improve fine lines, skin color, and tone. Thermascan laser treatments for NYC facelift can help with pore size and skin tightening. Intense Pulsed Light (IPL or Sciton laser system BBL) procedures offered in New York can help with tightening the skin, treat sun spots, and general dyschromia. BBL-ST is another light based system used in New York that can tighten the skin. Skin care products are also a great ancillary product to be used as well.
“I always wanted to be a physician because I wanted to help people. Plastic surgery gives me the ability to help people in very positive ways.”
Facelift Surgical Incisions
Otherwise known as a “short scar” approach, this incision is usually confined to the region from the base of the earlobe to the sideburn region. This is most commonly used by a plastic surgeon for short scar facelift techniques or mini facelifts in Manhattan in which a SMASectomy, SMAS plication, or a MACS face lift (see below) is performed. This incision does not permit adequate re-draping of loose neck skin, and so it is not a good incision to use for patients that require an extensive lower facelift or neck lift. It is a good choice for those patients in New York that need some jowl and cheek elevation with minimal need for neck work. In addition, it is a quicker facial plastic surgery procedure, so it may be better for patients who are not candidates for longer facial plastic procedures.
Full Face Lift Incision
The traditional facelift incision extends from the temporal hairline, then goes in a pretragal incision (in a skin crease in front of the ear notch), and then follows around the earlobe along the ear sulcus behind the ear and then extends transversely into the hairline. If patients have very loose neck skin or upper cheek and face skin, then these incisions may leave the patient with a “wind-blown” look with loss of hair behind the ear and along the temple. Not uncommonly, female patients will lose their sideburn in this situation.
Dr. Wallach often uses modifications of these traditional facelift techniques to camouflage the incision and preserve the hairline so patients look more natural. This often includes a side-burn type of incision, an incision hidden behind the tragus or ear notch called a retrotragal incision, and then in patients with skin laxity in the neck area he will place the posterior incision along the hairline. Dr. Wallach, a Manhattan NY Cosmetic Surgeon, applies these same techniques in men to preserve their natural hairline with the facial plastic surgery procedure.
Face Lift Techniques
Composite Face Lift
The composite face lift is a face lift procedure in which the tissues are dissected below the Superficial Musculo-Aponeurotic System (SMAS), the connective tissue layer over the muscles. This is a deeper dissection plane than a SMAS face lift or skin face lift that is used in New York. This procedure moves the cheek fat as one unit with the overlying skin. This facial plastic surgery procedure is probably safer in smokers than more traditional facelift techniques.
Deep Plane Face Lift
The deep plane face lift is a subperiosteal (just above the bone) lift that is performed at a deeper plane than the more traditional face lift techniques offered to New York NY patients (SMAS or composite lift). This form of face lift treats mainly the upper two-thirds of the face and is commonly performed in conjunction with a brow lift, often using an endoscopic approach. This facial rejuvenation procedure provides correction of facial aging mainly in the brow and the mid-face region for New York patients.
Extended High SMAS Face Lift
The SMAS refers to the Superficial Musculo-Aponeurotic System, a connective tissue layer below the skin and above the facial muscles. This facelift procedure offered to New York City patients is a variation of the SMAS facelift (see below) but the incision into the SMAS is made higher in the cheek, usually at or above the level of the cheek bone. This higher incision allows for better elevation of the cheek soft tissues than the lower incision SMAS. It can be used to also accomplish a mid-face lift. The SMAS itself is a facial plastic procedure that can be used to augment the cheeks as well and improve the neck contours in New York City patients. It can provide for a fuller cheek appearance, but because the incision is higher on the cheek, there is a slightly higher potential for a facial nerve injury.
MACS Face Lift
MACS is a Minimal Access Cranial Suspension lift. This is a limited incision facelift procedure offered to New York NY patients. An incision is made in the area hidden in the front of the ear. During this facial plastic surgery procedure, limited undermining is performed and then sutures are placed to suspend the soft tissue and elevate the cheek an improve the jaw line by using suspension sutures.
The mid-face lift is a facial plastic surgery procedure that focuses on the cheek and lower lid junction. The goal is to elevate the cheek fat pad and treat the lower lid region in New York NY patients. This can be done as an isolated procedure using only a lower lid incision. The soft tissue around the cheek is freed and secured to the temporal fascia of the face. A canthopexy or a support procedure for the lower lid is also performed at the same time. Commonly, mid-face treatment is performed during other face lift procedures such as in a deep plane face lift, a composite face lift, and a SMAS face lift.
A facelift or neck lift in New York, NY refers to the treatment specifically of the neck itself. Access to the neck as an isolated procedure can be performed through incisions behind the ear, and in the submental (under the chin) crease. Neck lifts are commonly treated in conjunction with a face lift. There are multiple structures in the neck that may warrant treatment.
They are muscles that can impact the contour of the submental region and may require partial excision.
Neck Fat Removal
There may be fat above and below the platysma muscle (muscle found just under the neck skin). Fat above the muscle can be removed either directly or by suction assisted lipectomy (SAL). If liposuction is the only procedure, Dr. Wallach can perform this through small incisions behind the ear and under the chin. Removing fat under the platysma muscle will require the exposure obtained during a neck lift procedure in New York NY patients.
Commonly patients in New York city complain of a “turkey gobbler” neck as they age. This is often due to skin laxity in the neck area. Removal of the excess skin can be performed after neck skin undermining, and the incisions can be hidden within or along the hairline.
They form the vertical bands of muscle that originate from the lower neck and extend to the chin region. These can cause dynamic bands (seen with motion) or static (seen when at rest). They can be treated by imbrication or plication of the muscles in the midline or by partial or complete transection to allow the muscles to re-drape.
They can be prominent in the area under the mandible (jaw). Some board certified plastic surgeons in New York City will partially excise them to improve the neck contour. However, some risks of removing the glands include bleeding and dry mouth.
Skin Only Facelift
A skin excision only face lift is sometimes performed in New York City. This will only treat skin laxity. It is best for patients with loose skin, and for patients whose health limits the amount of facial plastic surgery that they can have. It is a quick facial plastic surgery with less downtime than some other procedures, and with a lower risk of complications. A major disadvantage is that it is not good for patients with significant soft tissue atrophy or facial soft tissue descent.
This is another variation of the SMAS procedure offered in New York City, but instead of incising the SMAS and lifting it, an ellipse of SMAS is excised (cut-out) along the line perpendicular to the pull vector. This is usually an oblique ellipse. The risk of injury to the facial nerve is lower than with some of the other facial plastic surgery techniques described, but it may not give the same elevation as those procedures that use an elevation of the SMAS. This is also a shorter facial plastic surgery as compared to that during the elevation techniques.
The SMAS refers to the Superficial Musculo-Aponeurotic System, a connective tissue layer below the skin and above the facial muscles. After the skin is elevated, the SMAS is treated. Treatment of this layer can be done in several different ways. Commonly it is incised, elevated, and pulled back in a superomedial direction. The level at which it is cut will determine what area will be best treated. A low incision will primarily treat the lower face and jowl region. Board certified plastic surgeons may also use this facial rejuvenation procedure to improve the neck contour. This low incision is usually made close to the inferior border of the cheekbone or just above the superior border of the parotid gland. The underlying facial nerve, which activates the facial muscles, is protected in this region by the parotid capsule.
SMAS plication refers to the facelift surgery technique used when the SMAS is not elevated or incised and is just imbricated (or overlapped). This facial plastic surgery is performed more commonly in patients who do not have a well-defined, thick SMAS. This facelift surgery procedure like the SMASectomy shortens the surgical time and board certified plastic surgeons sometimes reserve it for patients with higher medical risks, or for patients whose facial aging is not as severe as others.
Stem Cell Face Lift
This is a marketing ploy phrase. There is actually no such thing as a stem cell face lift, but some surgeons market this phrase as fat grafting to the face either separately or in conjunction with a face lift. Stem cells are found within fat graft harvest specimens. So technically there are stem cells, but there is no scientific evidence that stem cells offer any benefit.
If you would like more information about Dr. Wallach and his success with New York City Facelift surgery procedures, we invite you to contact us at our Manhattan office at (212) 257-3263 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details. For more information regarding facelifts or other facial plastic surgery procedures, visit our blog.