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Surgical skin tightening—when you need significant tightening for sagging skin you need a face lift

For patients with significant sagging of the skin, poor elasticity or who want dramatic results, surgical treatment is necessary. A face lift, or rhytidectomy, surgically rejuvenates the face by tightening the skin, underlying muscles and fat of the face. A face lift is designed to improve signs of aging in the lower face, including the lower cheeks, jaw, and upper neck. A common misconception is that a facelift will dramatically improve the smile lines, lipstick lines, and eyes. They don’t. Surgical treatment of the forehead, brows, and upper eyelids are best treated with a brow/forehead lift or upper eyelid surgery. The middle of the face and lower eyelids are best addressed with a midface lift and/or lower eyelid surgery. There are various incisions, depth and extent of treatment under the skin and surgical techniques used depending on the patients needs and the surgeons preferences.

Commonly, for the best and most natural looking results, the patient will also need other procedures in addition to the face lift. Resurfacing for etched lines and skin texture, especially around the lips, and volume replacement are the two most commonly performed additional facial non-surgical procedures. Liposuction of the fat under the chin may be needed as well.

Natural looking results are achievable. It takes an experienced, and well trained plastic surgeon and it is very technique dependent. You often can recognize a bad facelift. The face is too tight, the classic “wind tunnel” look, the lines have been rearranged from running up and down to being pulled to the side towards the incision line. There has been no volume replacement and the skin is pulled tightly over the skull giving a skeletonized look—and let’s not even get into bad eyelid lifts. The ear lobes are deformed with the “pixie ear” point instead of the rounded lobe attachment to the side of the face, and the angle of the ears has been changed. There is a visible scar in front of and around the ear and the hairline may be pulled backwards. These patients often end up always having to wear their hair down, covering the sides of the face, and wear big earrings to disguise the ear problems. These are the ones you look at and think “wow—bummer”. You want the one that people don’t know you have had done, they just think you look great for your age.

I have seen a lot of both great and horrible facelift results over the past 30 years. I firmly believe that the most important factor in getting the former rather than the latter is the formal training, skill, experience and aesthetic judgment of the surgeon performing the procedure. These are real surgical procedures, with real risks and recovery time. I always refer my patients to a Board Certified Facial Plastic Surgeon for face lift surgery and would strongly suggest that you stick with these surgical sub-specialists. For eyelid lifts I refer to Board Certified Oculo-Plastic Surgeons.

Do other specialties perform these procedures—yes. Are some good—yes. Do I perform these procedures—no, even though I have a lot of experience in rejuvenation treatments and consider myself to be trained in evaluation and treatment of aging. Are some Board Certified Facial Plastic Surgeons not so good—yes. But it is a place to start. That at least tells you that the surgeon has official structured training in facial plastic surgery and has passed an objective exam by a real organization certified by the American Board of Medical Specialties. Check them out at the “Is your doctor board certified by the American Board of Medical Specialties site —although I just checked myself and they have me under my maiden name that I haven’t used professionally in many years, Elaine Remmers, and an address from 15 years ago.

Are “I have developed an interest in cosmetic surgery”, “I have a lot of experience in doing plastic surgery”, “I am certified by the Board of Who-Knows-What” and all of the other things that physicians who are not Board Certified in Plastic Surgery by the American Board of Medical Specialties say an acceptable substitute—no.

And beyond that you need a referral from someone you trust. This can be a friend who has a face lift that is both natural looking with good results (though if it is a really good result you may not know they have had a facelift). Your cosmetic dermatologist is another good source, because we see a lot of post-facelift patients, and know what makes a good result.

You should talk to a couple of surgeons, and don’t shop for a deal or the lowest price. This is your face we are talking about.

How long does a facelift typically last? Face lifts set the clock back, they don’t stop it. You will continue to age, and results do loosen over time but most people see a good 10 years from a properly performed procedure that tightens the underlying muscle. Skin only procedures (see below) last a much shorter period of time anywhere from 6 months to a couple of years.

And what about the L******** L*** that is advertised on infomercials and online?

L******** L*** is not an advance in technique, it is a marketing term. It is a form of a mini-facelift. “Mini-lift” on the whole implies a surgical procedure meant to address mild aging changes seen in the lower third of the face. It uses smaller incisions but does tighten the underlying muscle layer and involves removing skin. L******** L*** is performed through a larger incision and may or may not involved tightening the muscle. It is done under local anesthesia. The chain hires physicians, many who are not trained plastic surgeons, but are other specialties to perform the procedure. They always show patients with results months out from the procedure, not long term. They advertise extensively and have been the subject of much controversy involving results, complications and the legitimacy of those who are portrayed as patients and giving glowing testimonials on the internet. Google them.

The patients I have seen who have had L******** L*** are often initially satisfied, although I consider the scars, earlobe changes and results to be unsatisfactory. As I see them over a couple of years, most of the tightening is gone, and they are left with wide and visible scars. Would I ever, in my professional opinion, recommend it for a patient—no.

This is one area where I really believe, do it right or don’t do it at all.

Next: How do you know which aesthetic skin tightening treatment is right for you?

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