Ready For A Face Lift?

(From "Your Image," a publication of The American Society for Aesthetic Plastic Surgery.)

Facial rejuvenation isn't just for patients past "a certain age" In fact, it is your appearance, rather than your actual age, that determines whether you are a good candidate for a facelift or other rejuvenative procedures.

The "age" of your face is determined by many factors including genetics, sun exposure, stress, nutrition, smoking and alcohol consumption.

It is not unusual for people in their early 40s or younger to notice an accumulation of fatty tissue or loose, sagging skin under their chin. They may begin developing jowls that give their lower face a squarish shape. Or sometimes the first signs of aging may occur primarily in the mid face where the cheek tissues have started to slide downward, giving the face a tired and drawn appearance.

Patients seeking facial rejuvenation may complain about one or more of these problems. They may have additional areas, such as the forehead and eyelids, that exhibit sagging, wrinkling and excess skin. The possibility for various patterns of facial aging has led to the customization of facial rejuvenation surgery and the introduction of "mini" procedures to address isolated problem areas.

The Traditional Facelift Versus "Mini"Lifts. The traditional facelift incision starts in the temple area, extends downward in a natural line in front of the ear, or just inside the cartilage at the front of the ear, and continues behind the earlobe to the lower scalp. This technique, which varies somewhat from surgeon to surgeon, is still the most effective way to treat many patients who show significant facial aging.

But let's say that you are concerned only about the fullness under your chin or the appearance of early neck cords. Excess fat in this area often can be removed through a small incision underneath your chin. Working through the same incision, the muscles in your neck can be tightened, restoring a smoother, more youthful neck contour. The small incision will be barely visible when healed.

If your main concern is the slackness of your jaw line, a "mini lift" requiring only an incision behind your ear-and no incision in front of the ear - may do the trick. If a lift to your cheek area is what you need, this may sometimes be accomplished with only half of the traditional facelift incision-the part that extends from the temple down the natural line in front of, or just within, the ear. In some cases, a cheek lift may be performed through incisions placed in the lower eyelid.

Remember, though, that none of these mini procedures will address aging changes of the upper third of your face, including your brows and eyelids. Separate procedures can be combined with a facelift or "mini lift" if you want to see improvement in these related areas. Treatment of fine wrinkles and improvement in the skin's texture may require resurfacing techniques such as a chemical peel or laser treatment.

Mini procedures to correct aging changes in the lower or mid face can reduce cost and shorten recovery time compared to a traditional facelift. But they are not for everyone. If your facial aging is more generalized, then a mini procedure may not achieve the results you want. Although you can always go back later and have more work done, you may regret not addressing all the problem areas at once.

How do you know what's right for you? The first thing is to study your face in the mirror and decide what, if anything, bothers you. If you are looking for improvement in only one area of your face, then a mini procedure may be all you really need. Such a procedure can be effective in postponing more extensive facial rejuvenation surgery. On the other hand, if you are bothered by signs of aging in multiple areas of your face, a full facelift - perhaps in combination with other procedures to address problems of the brows and eyelids - may be the best alternative.

Ultimately, whether to have less or more done at a particular time depends on a number of factors. Board-certified plastic surgeons are trained to expertly evaluate the physical characteristics that influence the results of facial rejuvenation surgery, such as your bone structure and the condition of your skin and underlying tissues.

Your surgeon can advise you on whether performing an isolated mini procedure will improve your facial appearance or whether multiple procedures are needed in order to maintain your overall facial harmony. Thoroughly discussing your goals and expectations with your plastic surgeon can help you make the right decision about facial rejuvenation.