When most people think of facial rejuvenation undertandably the thought a facelift emerges. But contrary to popular perception, a facelift only addresses the lower third of the face. While smoothing out the neck and the jawline provides a youthful improvement, it does not address the middle of the face. Even if it could pulling the middle of the face outward would produce an unnatural distortion and is rarely the answer to midface rejuvenation.
Loss of facial volume and removal of tissue support is a well recognized mechanism of facial aging. Thus volume restoration is a very useful approach to helping to reverse midface deflation. This can be done by either malar/submalar implants or fat injections and there are advocates for each approach. Implants tend to produce a more consistent augmentation method that is stable long-term.
Neither a facelift or the addition of volume restoration to the midface will improve the texture of the skin. Chemical peels and laser resurfacing are the known effective approaches for smoothing out fine wrinkles and improving the look of the skin.
A more complete facial rejuvenation approach would include all of these elements from a facelift, midface augmentation and skin resurfacing. In the September 2014 issue of the American Journal of Cosmetic Surgery, an article appeared entitled ‘Total Face Rejuvenation: Simultaneous 3-Plane Surgical Approach Combined With Ablative Laser Resurfacing’. In this paper, a retrospective review of 21 female patients (age 58 to 71 years old) undergoing combined extended-SMAS facelift, mid-ace augmentation with implants, and full-face ablative laser resurfacing by a single surgeon was done. None of the facelift skin flaps suffered any healing problems. The skin healed (re-epitheliazed) within ten days and makeup was able to be worn again within two weeks. One hematoma occurred as well as one implant infection. This study showed that all three facial procedures can be performed at the same time.
It has been historically thought that combing certain procedures, such as laser resurfacing and a facelift, runs the risk of skin loss and other healing problems. But this study shows what has been known now for some time that combining multiple facial rejuvenation procedures is not only safe but necessary in most cases to have the best results. As long as the laser resurfacing is not done too deep over the raised skin flaps of the facelift, a negative effect of skin and incisional healing does not occur.
Dr. Barry Eppley