Facelift Montgomery AL

Deep Plane Facelift (Lower Face & Neck Lift)

The term facelift can be a confusing, as it insinuates the entire face is being addressed. Even more confusing, there are various techniques for face lifting and some surgeons even attempt to name or trademark specific techniques. In general, a facelift focuses the lower face, neck, and to some extent the cheek. More specifically referring to the midface, jowls, jawline, and loose skin and tissue of the neck. Think of this procedure of a continuation of an isolated neck lift (click here for details), however, with the added benefit of addressing the tissue below the lower eyelid to the jawline. 

There is little debate amongst the leading surgeons in the country that deep plane facelifts incorporating deep neck work provide the most natural and long-lasting results. Deep plane techniques have allowed improvement in the midface and cheek region, which typically was not address to a significant extent in the past.  A paradigm shift has also occurred in treatment of the neck. The focus has changed from removal of tissue directly under the skin to removing deeper tissues in the neck and maintaining a layer of fat directly under the skin to provide soft, pleasant, and youthful contours. Aggressive removal of fat directly under the skin leads to thinning of the skin and premature aging in the long term.  This is one of Dr. Nizam’s favorite procedures offered at Alabama Surgical Arts.  In fact, he has published on his techniques for reshaping the deep neck in the American Journal of Cosmetic Surgery. 

Procedure

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. These incisions typically are imperceptible by 6 months and due to their location, they are well hidden during the healing period. The neck is typically addressed first. The deeper neck is then entered underneath the platysma muscle. At this point, depending on your specific anatomy deeper structures are removed including muscle, fat, and glands. This deep neck work is what gives permanence to the neck result. Once this is accomplished the tissues are re draped and suspended.  The excess skin is then laid back over the new contour that was created in the deeper structures. Next 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 providing the lift to the jowl and the cheek. 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 who 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. The deep plane facelift 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.  

Recovery

It is necessary to have someone drive you home and stay with you for the first 24 hours. Social downtime (time to be presentable in public) is typically 7-14 days. If an isolated deep plane is performed it is usually closer to 7 days. If it is combined with other procedures including laser resurfacing, then it can be closer to 14 days. 

A compressive dressing and drains are typically placed for the first 24 hours. You are seen after 24 hours, and the dressing is removed and surgical site examined. Any drains are typically removed at 4-7 days depending on the patient. 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.

Major complications following facelifts are very rare. These include bleeding, skin death leading to scarring, permanent nerve damage (ones that move the face and ones that provide feeling), discoloration of the skin, asymmetry, scarring, and infection. Infection is rare due to the large blood supply to the face. Minor complications such as scabbing around the incision, temporary numbness, temporary weakness, temporary irregularities, and small fluid collections occasionally do happen, however cause no permanent issues. A large part of selecting a surgeon should include your comfort and confidence in your surgeon’s ability to deal with any issues that arise in a timely fashion to ensure that there are no long term complications. For this reason, Dr. Nizam personally calls of his patients post operatively and provides his personal cell phone.  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 quit prior to undergoing the procedure due to the increased risk of complications.

Longevity

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.

Click here for Facelift Before and After pictures