Deep Plane Facelift (lower face and neck lift)| Montgomery
A cervicofacial rhytidectomy is the medical term for a facelift. A facelift typically addresses the lower face and neck. More specifically referring to the jowls, jawline, and loose skin and tissue of the neck. Modern advances in techniques have also allowed improvement in the midface and cheek region as well. The anterior of the face is more mobile than the side of the face, which has extensive strong retaining ligaments that stabilize the tissue. As we age the forces of gravity cause the mobile tissue in the anterior face and neck to sag inferiorly. Volume loss also occurs in many and much like letting the air out of a balloon causes even more loose redundant tissue. This is one of Dr. Nizam’s favorite procedures offered at Alabama Surgical Arts. In fact, he has recently published on his techniques for reshaping the neck in the American Journal of Cosmetic Surgery.
The procedure itself consists of incisions that start in the hairline on the side of the face, track downward and slightly inside the ear, then around the earlobe, back behind the ear, and into the posterior hairline. An additional incision is placed hidden underneath the chin to gain access to the neck in some. These incisions typically are imperceptible by 6 months and due to their location they are well hidden during the healing period. For patients whom require entry into the neck, the neck skin is raised initially. Excess tissue is removed if present from the deeper structures of the neck. Once this is accomplished the tissues are resuspended to recontour the neck and provide a more acute angle. The excess skin is then laid back over the new contour that was created in the deeper structures. The skin is then lifted off the deeper tissue lateral in the face until the strong retaining ligaments are encountered. At this point the retaining ligaments are separated and the dissection is shifted to the deep plane. This is a natural area of cleavage around the face and allows unrestricted movement of the sagging tissues posterior and vertically once division of the retaining ligaments has occurred. The deep tissues are then suspended with dissolving sutures. The excess skin then lays passively and is removed without placing any tension. This avoids relapse (skin is elastic) and poor healing incision lines. For patients whom have lost volume of the face fat transfer is often used to restore the contours of youth. Deep plane facelifts are performed under general anesthesia and take approximately 4 hours. Click here to see actual surgical footage of the procedure.
The above described procedure is the most powerful, natural, and long lasting way to rejuvenate the lower face and neck. Deep plane facelifting is only performed by select surgeons with an in depth understanding of anatomy of the face. It can be combined with other procedures to rejuvenate the upper face. The goal is to turn back the clock 10 years without looking overdone or artificial.
It is necessary to have someone drive you home and stay with you for the first 24 hours. Social downtime is typically 7-10 days. A compressive dressing and drains are typically placed for the first 24 hours. You are seen after 24 hours and these dressings and drains are removed and the surgical site is examined. An elastic head wrap is worn all day for the first week. The face and neck may initially feel tight. At 1 week sutures are removed and a majority of any bruising that has occurred has usually abated. Make up can be worn. The following week an elastic head wrap is worn only at night. Minor contour irregularities can be present in the initial few weeks and gradually disappear as swelling and edema subsides over the first 1-2 months.
Complications following facelifts are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Infection is rare due to the large blood supply to the face. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease, and smokers. Dr. Nizam requires smokers to quite prior to undergoing the procedure due to the increased risk of complications.
An often asked question is how long does the procedure last? The goal as mentioned earlier is to turn back the clock 10 years. The face continues to age from the date of surgery onward. Additionally, minimally invasive maintenance procedures may be recommended to maintain the result.