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More and more people are staying healthy, exercising, feeling more youthful and often opting to stay in the work force longer. So, it is easy to understand why more and more individuals want to have a cosmetic surgical procedure to “turn back the clock of time” and restore a more youthful yet natural look, particularly in the lower face and neck line. People want to look the way they feel. Many are just tired of “looking tired” and choose to seek rejuvenation surgery to make them look more refreshed.

Facial aging occurs inevitably and most commonly because of the hereditary tendency to develop laxity of the skin, wrinkles, fatty deposits, waddles and loose skin under the chin and into the neck. Sometimes the onset of the aging appearance affects the welfare of many men and women. Most individuals feel vigorous and energetic, thus younger than they look. Looking older than you feel can create some psychological stress. In fact, it can also have a social and economic impact, as many potential patients are competing against more youthful appearing co-workers. Mostly, people just want to look like a more youthful version of themselves and just turn the “timeclock” back a few years and look like natural but refreshed versions of themselves. A facelift can make a person look as vital, vibrant and competent as they truly are.

The Facial Aging Process

The aging process actually begins in the mid-to-late 20s, and one starts to look older as they enter into their 30s. Besides heredity, significant sun exposure and sometimes smoking or other external factors will speed up the natural aging process. The aging process of the skin causes loss of elasticity, forming folds and wrinkles. The skin, fat, muscles and bones all change with time and age. The fatty soft tissues often atrophy or collect in undesired areas. This, in combination with the relentless pull of gravity and the fact that the skull becomes thinner and smaller, causes the formation of sagging facial tissues as well as loose, flappy skin on the neck. The facial soft tissue truly sags or descends with loss of recoil or elasticity. The face “deflates” or loses volume. This causes one to look more “gaunt” and develop “hollows”. The loss of elasticity to the skin, along with degenerative changes in the collagen, create deepening lines and furrows brought on by years of facial movement and expression. Everyone ages differently, based upon heredity, so the procedure(s) required to reverse the aging process will vary.

What Is a Facelift?

A facelift is surgery that repositions sagging facial skin along the jawline and neckline in order to provide a natural, more youthful appearance. Rhytidoplasty and rhytidectomy are the medical terms used to describe the facelift operation. Rhytid means wrinkle. It is really not the excision of wrinkles but is the tightening of the deeper soft tissues and re-draping of the skin that makes the wrinkles look less noticeable. Facelift is accomplished by lifting and tightening the lax muscles and fatty tissues of the face and neck under the surface of the skin and then removing some loose and excess sagging skin. The deep-plane portion of the facelift tightens the “weak neck muscles” that create banding in the neck. The connective tissue layer in front of the ear and underneath the surface of the skin is firmly tightened as well. When this is tightened in the cheeks, the jowls go away, the jawline becomes more defined and the sagging tissues help re-volumize the mid-cheek. The skin itself is then smoothed out noticeably – and the excess is trimmed – leaving one looking completely natural.

Facelift Components: Cheek-Jowl Lift and Neck Lift

The facelift procedure is actually divided into two components: the cheek-jowl lift and the neck lift. Most patients require a lifting of both components in a standard lower facelift because the movement of these tissues go hand-in-hand with each other in an upward and slightly backward fashion. In selected patients, only one of the two procedures may be recommended, but this is less common. And, some patients may require a forehead or brow lift in conjunction with their facelift to accomplish their overall personal goals and balance the upper and lower face. This is very true with rejuvenation of the eyelids that is often done at the same time as lower face rejuvenation. The facelift itself is a cheek-jawline and neck lift. It is not a “complete facelift”, meaning lifting the whole face, including the brows, eyes and cheeks at the same time. These are three different component procedures, although they are often done together.

Deflation or loss of volume in the face usually occurs in the midface but also occurs in the temple region and can be treated with injectable fillers to give more volume back. Or, in combination with a facelift, fat grafting can add volume and make the skin look more youthful. Repositioning does a great deal to improve the volume loss or reposition what has fallen, but adding volume with fat transfer from the abdominal area to the mid-cheeks, around the mouth and the temple area often enhances the results of the facelift procedure.

Dr. Perkins discusses this individually with each patient during their personal consultation. The amount of improvement will depend on the amount of tissue sagging and wrinkling that is present before surgery. If the operation is completed earlier in the aging process, a patient can anticipate an energetic, refreshed look. A person who has waited longer can expect even more dramatic results, especially if there is significant wrinkling and sagging of skin in the neck.

During the consultation, Dr. Perkins examines every patient in front of a three-way mirror. He can use his hands to show each patient exactly what a lower facelift does and does not do. Most importantly, he shows each patient how they will look totally natural and just like themselves – like they looked several years previously.

Computerized Video Imaging

Dr. Perkins utilizes computerized video imaging to show patients what their result will potentially look like prior to having their surgery – in comparison to their “pre-surgery” photos. This enables Dr. Perkins to engage in a good dialogue with patients to understand their desires, likes and dislikes and alleviate many natural fears. People feel that they would not look like themselves or would look “funny”, and they do not want this. Looking natural is paramount to each patient, and Dr. Perkins has the same philosophy. He knows how to leave patients looking natural, yet rejuvenated.

The computer imaging shows the patient how they really will look normal and natural. Dr. Perkins’ patients tell him that their friends and colleagues often notice something appears different about them (i.e., a new hairstyle, new make-up, and also that they have lost weight), but can never tell that they have had plastic surgery.

The Aging Neck: What Is a Neck Lift?

One of the most common and bothersome aging face issues that both men and women develop is one of the unfortunate hereditary signs of facial aging. This is developing a sagging neck or ill-defined neck and jawline. Sometimes people call this a “waddle” under the chin, or even refer to it as a “turkey neck”. It is often hereditary. If your mom or dad were faced with this similar challenge, chances are good that you might well develop this, either early or later, too. Surgical procedures we utilize to fix these problems are a combination of work under the chin (called a submentoplasty) or under-the-chin plastic surgical procedure which may or may not involve tightening of the skin from behind the ear. This is called a neck lift.

A neck lift tightens and repositions the tissues after liposuction is performed and tightens the underlying neck muscle. Liposuction removes the excess fat. The outcome of a true neck lift is a tighter neck and jawline and a refreshed or more youthful appearance that can take years of aging off your face. This, however, does not improve laxity to the cheek and jowl area. Sometimes the problem is only in the submental (or under the chin) area and a combination of liposuction, muscle tightening and a little bit of skin trimming can be just enough to give an improved appearance but often this does not solve the significant laxity to the skin.

As mentioned previously, the neck lift itself is actually one of the components we perform during a facelift procedure. A facelift always involves a neck lift. Sometimes a minimum face procedure is a cheek lift only that improves the neck but does not directly involve the neck. Most people need both the cheek, jawline and neck lift at the same time, which is a lower facelift. A neck lift does remove fat, tightens the neck muscles and repositions the skin of the neck and jawline, giving a much more defined and beautiful look to the neckline. A sharper neckline is generally a more youthful neckline or, at least, the sharpness of the neckline that you were born with and that your underlying anatomy allows. A neck lift can be performed on its own but this is less common than when it is done in conjunction with a cheek lift, better known as a lower facelift.

During the consultation, Dr. Perkins can determine with you whether or not a neck lift only can achieve your desired results. He uses computer imaging to show you what the results of a neck lift can likely give you. And, you can see your expected result prior to having surgery. This is extremely helpful in determining the extent of surgery required to give you your neckline back and take care of the waddle of skin or looseness of skin and fat under the chin.