As a head and neck cancer surgeon and as an art historian, the middle face represents the ultimate aesthetic challenge. My patients want to restore their youth. They do not simply want to look slightly refreshed; they want to look great!
The mid face lift has been both an evolutionary as well as a quantum change in my practice. I will begin parenthetically by stating that I regard the “life Style,” “Lunch”, or “Thread Lift” as useless. It is impossible to lift or efface tissue collapse or defect without surgically reaching beyond the area. Simply put “a scar will always be stronger than unoperated tissue, and therefore cannot hold up over time.
The best traditional procedure developed by truly great pioneer surgeon involved lifting the deep supportive covers of facial muscles as well as adding fat to depleted areas; though these are excellent; muscle cover is weak and fat inserts may be impermanent.
I believe all of facial aging is vertical. You can readily see this up by holding skin up across the cheek bones and all tissue lifted vertically. Muscles traditional course from one bone to another, either moving or stabilizing joints. The face has only 1 joint and that is to chew. Therefore, in humans all age, all expression and all affect represent the interplay of muscles pulling facial skin around.
With age (men & women) the face becomes depleted and loses volume as well as descends because of gravity. To re-create the earlier visage (my patients want to be who they were) requires both support and volume. I extend my surgery beyond any pre-existing defect and use the patients already collapsed volume as living filler. This is therefore, not grafts but living flaps of tissue. I repair the entire muscle mass of the mid face with biodegradable sutures with no knots. There is no pull on the skin ever and there is no change in the hairline. Traditional procedures lift or destroy the hairline making it impossible to wear the hair up and creating a mannequin –like look.
My technique has major advantages other than longevity and naturalness. There are no bandages and discomfort requires only Tylenol. Surgery eliminates two thirds of the crows feet around the eyes. Cheek volume is restored and the depression between the lid and cheek is filled. The jowl is now lifted out and is used as the living filler that it is, producing a sweeping jaw line. The corners of the mouth are supported and the lower marionette lines reduced. The fold from the nose to the corner of the mouth is lifted up and out. Lastly, the drooping chin which is barely noticed and is the beginning of the witch’s chin is elevated.
Because of its elegance and complexity, I will only do this operation in hospital using a very light anesthetic. Patients always breathe on their own and are never fully anesthetized.
There are no bandages, as well as minimal bruising and swelling ( I use drains and recheck each side twice). What are the problems? The most major problem I had was an overly enthusiastic plastic surgeon who insisted on leaving the hospital immediately after surgery. He developed some bleeding which had to be controlled in the OR.
This operation requires a rare degree of skill and experience because of its scope. Many of my patients who bring me early pictures state that they are now better than when they were younger. Though they may be hyperbole I believe that we are close to the theoretical limits of what can be achieved.