Facial Rejuvenation Surgery
With aging there are two physical effects that occur—deflation and sagging. Deflation and sagging give the look of tiredness and an aged appearance. In addition, they alter one’s original facial form.
As patients notice areas of deflation, some may consider fillers or fat grafting. Fillers are temporary and need to be injected throughout one’s life. Fat grafts can be maintained within the grafted site without being significantly resorbed, but as the aging process continues, the grafted fat descends. This leads to a heavy, full, and unnaturally descended face. Furthermore, fillers and fat grafting do not correct the descended region of the face and therefore do not correct the aged facial shape.
About Facial Rejuvenation Surgery
- Asians faces tend to be wider than faces of other ethnicities
- Asian skin and connective tissues tend to be thicker
- Asians are prone to scarring
- Wider facial appearance due to lateral (outer) pulling
- Insufficient correction of the descended region because skin and connective tissues are thicker and more resistant to lifting
- Noticeable scarring due to tension placed on the incision site
After surgery, the original facial form is regained to achieve a youthful, beautiful face that appears natural.
Muscle pull vs. Muscle relocation
Typical facelift procedures utilize some sort of muscle pull. This is done by putting threads or some sort of fixation device such as Endotine. These results last a year or so as the muscle of the face, Superficial Muscular Aponeurotic System (SMAS), is not dissected and released. The next kind of muscle pull is facial muscle (SMAS) pull. SMAS muscle dissection and muscle pull lasts longer than thread lift or Endotine fixation but still does not last more than a few years.
The reason for these facelift procedures not lasting a long time is that the muscle is not fully released.
This may be beneficial for some Caucasian faces with narrow faces, but for Asians with wide faces, this will lead to wider faces. Furthermore, SMAS facelift does not effectively correct the jowl and, therefore, does not create a smooth, slender, V-shape jawline.
SMAS lift pulls the jowl backward toward the incision at the ear. This can improve the jowl but gives a wider jaw line as the skin, fat, and the muscle is pulled toward the incision (laterally/outward) which is along the ear. Lastly, because the SMAS muscle pull facelift does not correct the neck muscle (platysma), a separate incision is sometimes made on the chin to correct the neck wrinkles and bands. However, the neck muscle (platysma) and the SMAS muscle is the same continuous layer. They are joined in this same plane at the jawline region.
Muscle release facelift surgery is fundamentally different, in that the muscle is not simply dissected, but the facial muscles are fully released.
An Expert on Facial Rejuvenation Surgery
My understanding of the minor retaining ligaments came about from my studies at different parts of the world and racial differences and inter-racial patients.
My training in Northwestern University in Chicago had significant Scandinavian decent patients living in the Midwest where their minor retaining ligaments were weak. Therefore, the release of the major retaining ligaments effectively corrected their aging faces. Yet while I was doing research in Switzerland for a year studying engineering and tissue force-strain, I noticed that the Swiss and Germans had slightly firmer minor retaining ligaments than pure Scandinavians. My time in Korea with Korean surgeons performing facelift confirmed that full release of the major retaining ligaments described in text books and peer-reviewed journals does not effectively lift firm dense faces.
It was when I went to Brazil (A country with most mix races) where I was able to study mix races of Caucasians, Indigenous Brazilians, Asians, and Blacks mixed in various ways. By studying their tissue firmness and their non-major retaining ligament strengths, I was able to discover the key minor retaining ligaments holding the facial muscle from being fully released.
We cannot correct what we do not know. By knowing these key minor retaining ligaments, facial muscle release and relocation technique became possible.
The release of the minor retaining ligaments requires supreme precision. This type of uber precision requires that the tissue separation occurs split second before the surgeon dissects the tissue. This can only happen when surgery is performed in the perfect natural tissue plane. Because our tissues are formed in layers, by following this tissue plane will allow the surgeon to naturally elevate the tissue without tissue damage or much bleeding.
Using an analogy, an airplane will stay within a jet stream during a flight. If the airplane goes in and out of the jet stream, then turbulence (or in this case, trauma) will occur. This clean dissection avoids damage to motor nerves that control muscle movement and allows for a faster recovery.
You can see the precision by minimal facial bleeding postoperatively in our facelift videos.
There is no tension distally that is holding the face.
Facial muscle relocation facelift is fundamentally different than any facial muscle pulling technique.
After surgery, patients return home or to the hotel (for out-of-town patients) without experiencing much discomfort. Most patients do not take any pain medications after surgery. Few patients may take Tylenol. The patient may resume light activity (no strenuous exercise) the following day. The sutures are removed after 1 week and the patient can expect to return to work 1 week after surgery. Swelling and bruising are minimized by performing the surgery at a minimally vascular surgical plane in a hydrated state so that the tissue is in a physiologic moist condition.
Identifying and operating at this surgical tissue plane optimizes recovery and the aesthetic effect.