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Elevate Interview Elevate Magazine Q&A

Q. What procedure did you perform for your patient?

A. My patient came to see me for for facial rejuvenation. Like many of my patients, she is an exceptionally prolific and high-functioning professional who sought a significant and long-lasting result. She is incredibly active and sought a facial profile that would fit the way she feels. Our patients travel across the world to see us and for each on of them, we develop a tailored plan to address the different subunits of the face. The goal is to create a balanced and harmonious outcome. One that appears more youthful and refreshed, but never pulled, stretched, or artificial in any manner.

To produce an effective result our plan included a deep-plane facelift and neck lift, upper and lower eyelid surgery, brow lift, and facial fat grafting. The skin was treated with a TCA Peel. While some of my patients undergo a facelift alone, the majority will combine procedures that will address the forehead, eyes, and skin at the same time to minimize their downtime.

Q. What does this procedure entail?

A. As we age, the upper third of the face is characterized by a lower and heavier brow position, while the eyes appear crowded due to excess skin, loose muscle and protrusion of fat. This is addressed with a brow lift and upper blepharoplasty to alleviate heaviness above the eyes and lower blepharoplasty for correction of the puffiness of the lower lids. The middle third of the face is improved with a combination of a deep-plane facelift (which elevates and tightens the support structure of the face) with facial fat grafting (which adds volume back to hollowed out regions under the eyes and around the mouth). The lower face was treated with a neck lift which tightens the jowls as well as the loose skin and muscle under the chin.

Q. Why was your patient X a good candidate?

A. My patient was an ideal candidate for the procedure as she was ready for a significant improvement. Her facial aging was fairly consistent throughout her face, and the combined procedure that we developed for her allowed for a balanced correction. She understood that while non-surgical options such as Botox and fillers would be excellent complementary procedures, they would never be able to produce the dramatic improvement that she sought.

Q. How has this procedure changed in terms of technique and effectiveness over time? What about the recovery time?

A. Facelift surgery has changed dramatically over recent years. That being said, 90% of surgeons still rely a superficial type of facelift. While this may be appropriate for patients who are earlier in the aging spectrum, when we want to create long-lasting and natural results, a sub-SMAS or deep-plane facelift is critical. The more minimal facelift techniques would leave a patient like this very disappointed in only a few months time. The more advanced technique that I use allows for repositioning of the soft-tissues rather than pulling or stretching them. Additionally, the use of facial fat grafting (injecting microscopic particles of fat) in combination with facelift surgery has revolutionized our ability to create a smooth and natural appearance. Recovery time varies slightly from patient to patient, but by the second week most will look reasonable to resume social activities. I advise my patients not to plan any major social events for three weeks after surgery in order for the majority of swelling and bruising to resolve.

Q. What changes can patients expect thanks to newer procedural developments?

A. With the new and advanced techniques that we use, we are able to deliver much more natural and long-lasting results for our patients. By replacing fat around the eyes, rather than removing it, the eyes look more youthful and refreshed rather than hollowed out. The cheek position is higher and fuller, rather than pulled or flattened. Facial volume replacement with fat grafting address the volumetric changes that our face undergoes over time. It is not simply about "tightening" the face, but is much more about replacing and augmenting lost volume. 
Q. What is the biggest concern patients have regarding this procedure?

A. By far and away, patients' biggest fears relate to looking unnatural or over-done. We have all seen individuals who have undergone facelift surgery and the pulled/stretched look is simply disturbing. This should never, ever be the case. When done well, no one should see any signs of surgery, yet the appearance should look noticeably improved and last for years.

On the opposite side of the spectrum, I see many patients who have had surgery elsewhere who are disappointed with lack of a result. If you are investing in the cost and downtime of facelift and eyelid surgery, you certainly want to see a noticeable result.

Q. What advice would you give other patients considering this procedure?

A. I would encourage patients to explore the most advanced options in facial rejuvenation surgery that are available to them today. We can do a lot with non-surgical options, but to create a result that is worth the time and effort, surgery is often the best option. Choose a specialist who focuses on the face. Many surgeons are able to do a basic blepharoplasty or facelift, but you need to make sure you are selecting someone who can deliver the best possible results using the most advanced techniques.
