Facelift Surgery in Dallas, TX - Allen, TX - North Dallas Plastic Surgery

Q: How Is Facelift Surgery Performed?

Facelifts come in many forms, and the following is a general overview of techniques and other factors patients commonly have questions about when seeking a facelift. Dr. Pollock approaches this procedure with individualization and precision to achieve your goals, give you a natural look, and avoid complications.

What Causes Facial Aging?
What Is a Facelift?
Am I a Candidate for Facelift Surgery?
How Is Facelift Surgery Performed?
Progressive Tension Sutures (PTS)
Adjunctive Procedures to Facelift
What Is Recovery Like After a Facelift?
What Results Can I Expect From a Facelift?
How Long Will a Facelift Last?
How Much Does a Facelift Cost?
Want to Learn More About Facelift Surgery?

What Causes Facial Aging?

As we age, collagen begins to decrease, resulting in the loss of elasticity of our facial tissues. This loss begins in our mid-30s and progresses with time at various rates in individuals based on our genetics, general health, sun exposure, smoking, and many other factors. It is the elasticity of our skin and the deeper retaining ligaments that support the facial tissues in a youthful position and the loss of elasticity of these tissues that leads to the typical signs of aging such as sagging and wrinkles. These signs of aging are divided into their effects on the skin and the effects on the deeper tissues.

When elasticity is decreased in the skin, we begin to see wrinkles with animation, like smiling or frowning. These are called dynamic wrinkles because they appear only when we animate. As those lines begin to remain without animating, they are known as static wrinkles. Dynamic lines are treated by weakening the muscles that cause them using a product like BOTOX® that temporarily stops the nerves from sending signals to the muscles and stopping or weakening that motion. They can also be treated using skin care regimens that improve the skin health. Static lines are treated with a skin resurfacing procedure like laser or chemical peels. Fillers can also give temporary improvement. Skin wrinkles may be softened by facial tightening, as in a facelift, but not necessarily eliminated.

The deeper facial tissues are supported by various strong attachments that are called retaining ligaments, and, as they lose elasticity, the facial tissues they support begin to sag, producing folds around the mouth, jowls, and laxity of the neck. A facelift repositions these drooping tissues to a more youthful position.

What Is a Facelift?

A facelift rejuvenates your face by repositioning the deeper tissues (using the strong fascial layer called the SMAS) as well as tightening excess facial skin, resulting in a smoother, more youthful appearance. It is important to know that “facelift” is a general term and not a specific operation. There are many technical variations, mostly in if and how the deeper tissues are addressed. Typically, a facelift addresses the lower face from the cheekbones down and the neck. The upper face is addressed through brow lifting and eyelid surgery.
As previously mentioned, the big difference between different facelift techniques is how the deeper tissue is repositioned. These deep tissues can be repositioned by folding the deep tissue on itself, removing a strip of the fascia (SMAS) and sewing it back in a better position, or elevating the deep tissue and moving it as a unit. There are pros and cons for each of these techniques. Facelifts that only tighten skin (often called a “mini” facelift) have very limited and short-term effectiveness.
Facelifts are often done in conjunction with other adjunctive procedures that affect other parts of the face, like brow lifting or eyelid surgery, lip lift and enhancement, and adding or removing fat. Fat grafting has become an important part of facial rejuvenation, as facial fat loss is common with aging. This involves taking fat from one part of your body and adding it where it is needed. This fat “takes” as a graft and is permanent. Fat grafting is believed to have effects beyond just adding fullness, as it has been shown that fat contains stem cells and natural chemical factors that improve skin and tissue elasticity. While current thoughts on these added benefits are promising, many observations are anecdotal and still being studied to understand their effects on tissues and how to best obtain and use them.

Am I a Candidate for Facelift Surgery?

Healthy patients who are concerned about signs of aging, including skin excess on the face and neck, folds, sagging jowls, or areas of fullness or hollows, may benefit from a facelift. Patients who seek facial rejuvenation may be younger and looking to prolong their youthful appearance or older with more advanced signs of aging. The best way to know what is best for your situation is through a consultation with an experienced and qualified (board certified by the American Board of Plastic Surgery) plastic surgeon. You should explain your concerns about your face and allow the surgeon to present you with options to address those concerns. There are a number of options, so don’t be surprised that different surgeons may present varied and diverse opinions.

Contact us if you’d like to schedule a consultation with Dr. Pollock to gain a deeper understanding of your facial aging and determine which technique will best meet your needs. Dr. Pollock will listen to your concerns, carefully examine you, and offer an individualized treatment plan. He will spend time to help you understand the procedure, help you understand what you can expect (and what cannot be expected) from the procedure, risks, and typical recovery. He will review before and after pictures as they relate to you and your situation as a means to assure your expectations are appropriate.

Pollock will listen to your concerns, carefully examine you, and offer an individualized treatment plan. He will spend time to help you understand the procedure, help you understand what you can expect (and what cannot be expected) from the procedure, risks, and typical recovery. He will review before and after pictures as they relate to you and your situation as a means to assure your expectations are appropriate.

How Is Facelift Surgery Performed?

As previously mentioned, facelifts come in many forms, and the following is a general overview of techniques and other factors patients commonly have questions about when seeking a facelift. Dr. Pollock approaches this procedure with individualization and precision to achieve your goals, give you a natural look, and avoid complications.
The procedure is done under either intravenous sedation (also known as twilight sleep or conscious sedation) or general anesthesia. The incisions are made along the hairline at the temples and extend around the contours of the ears and for a variable distance behind the ears. This leaves a well-hidden and fine scar that is typically hard to see in the long run.
These incisions allow access for Dr. Pollock to reposition the underlying deep tissues, remove excess skin, and redrape the remaining skin over the new facial contours.

The main technique options for restructuring the deeper tissues are:

Folding the superficial musculoaponeurotic system (SMAS), which is beneficial for those with a thinner muscular frame.
- This approach brings fullness to the cheek area and adds volume to the face.
Excising a portion of the SMAS and then sewing it back together to tighten and reposition the drooping tissues, known as a SMASectomy.
- This approach removes the excess tissue and is ideal for those with a naturally fuller facial structure.
Elevating the SMAS widely and moving the tissues to a new position where they are sutured into place.
- This approach has been the standard for a long time, but, due to its higher risk of nerve and salivary gland injury, it has been challenged more recently by the above techniques that are considered to be safer.

Short-Scar Facelift

The short-scar facelift uses an incision that is mostly just in front of the ear. It is used for patients with primarily facial changes like jowling and drooping cheeks but limited neck sagging. The incisions are shorter than a regular facelift and are typically only made near the ears. This limited incision allows access for the surgeon to tighten the deeper tissues in the way mentioned above. This procedure is sometimes referred to as a “mini facelift,” and the patient should be clear that it includes tightening of the deep tissues and not just the skin.

Progressive Tension Sutures (PTS)

Dr. Pollock is the innovator of a unique procedural method that is now used worldwide in tummy tuck surgery to avoid fluid collections and drains. He has adapted it for use in a variety of procedures including facelift and eyebrow lift. The progressive tension suture (PTS) approach anchors the redraped skin to the underlying tissues with fine, dissolving stitches placed on the underside of the skin.

This technique helps to:

Eliminate the space under the skin flap to minimize any fluid or blood collections, resulting in decreased swelling and a quicker return to a normal appearance and social activities.
Securely anchor the skin to the underlying tissues, evenly distributing tension over a broad area for better blood flow and minimizing tension on the skin closure, resulting in better scarring.

Adjunctive Procedures to Facelift

Eyelid Surgery

This procedure removes excess skin and fat from the upper and/or lower eyelids to give the eyes a more youthful appearance. The upper eyelids frequently need skin removed, but this must be assessed in conjunction with brow position (see below). Lower lid lifts involve some removal or repositioning of fat with skin and muscle tightening. Careful evaluation of lower eyelid tone is important to prevent complications that result in poor eyelid shape and even dry eyes.

Brow Lift

Drooping of the eyebrows, giving the eyes a heavier and tired look, is common with aging. This heavy feeling and, in more advanced cases, limited vision in the upper gaze causes people to lift up their brows, resulting in forehead wrinkles. Lifting the eyebrows opens the eyes, minimizes involuntary forehead muscle contraction, reduces or eliminates forehead wrinkles, and reduces upper eyelid skin excess, giving a more youthful appearance. Incisions can be deep in the scalp at the hairline or small incisions in the scalp if an endoscopic approach is used. The pros and cons of each approach should be discussed with your surgeon.

Fat Grafting

Dr. Pollock implements fat grafting by adding volume into the face rather than taking it away. This approach creates a more youthful appearance in a multitude of ways, as the fat restores lost volume, fills wrinkles, and also contains growth factors and stem cells to improve your tissue elasticity and skin quality.

Lip Lift and Enhancement

With age, the visibility of the red part of the lip decreases with lengthening of the upper lip and atrophy of the lip itself. By removing a small strip of skin just under the nose, the upper lip is lifted to give more show of the red part of the lip, making the lip look fuller. This can be combined with fat or filler to give more fullness to the lips. Trying to achieve lip fullness through fillers alone in a patient with a longer upper lip is difficult, if not impossible, and this results in overfilling and strange-looking lips or “duck lips” look we all too often see today.

Skin Resurfacing

As mentioned previously, a facelift will not eliminate fine lines. To address these lines, a skin resurfacing procedure is needed and can be done through mechanical abrasion, various chemical or acid peels (TCA, Phenol, etc.), or with a laser.

What Is Recovery Like After a Facelift?

The facelift technique used and other facial procedures combined with the facelift (like an eyebrow lift, eyelid lift, fat grafting, or resurfacing) can impact the overall recovery time.

Generally speaking, early postoperative changes include visibility of the incisions, swelling, and bruising. Return to “normal” is mostly related to resolution of these signs of surgery in order to be more socially presentable. This is typically about two weeks depending on what procedures were performed and the individual patient’s desire to hide the surgery from others. Exercise and vigorous activity are limited for about four weeks.

Patients are provided specific postoperative instructions to follow in order to reduce swelling, minimize potential problems, and achieve the quickest recovery. Instructions include incision care, use of compression, cool packs, head elevation, and later, scar treatments. It is important to follow these instructions carefully.

You will be seen back for a follow-up appointment during the first week and, if all is well, at about six to eight weeks and a year. More frequent visits are individualized as needed. Pictures are taken before surgery, at six to eight weeks, and at a year. These photographs document the changes, and patients enjoy seeing their transformation.

What Results Can I Expect From a Facelift?

When your facelift is performed by a skilled, experienced, quality plastic surgeon, you should still look like yourself but more refreshed and youthful. You should not look over tightened or have an obvious operated look. Nothing can prevent the normal aging process, but after undergoing a facelift, you should look like yourself, just more youthful, rested, and fresher.

Preventative actions can help maintain your results, such as adopting a healthy lifestyle, starting a quality skin care regimen, wearing daily sunscreen, and taking other sun exposure precautions.

How Long Will a Facelift Last?

This is one of the most common questions we get. How long a facelift lasts is directly related to the quality (read: elasticity) of your tissues. As mentioned above, the tissue quality and the speed of aging varies from one person to another based on genetics, health, sun exposure, etc., and, therefore, the longevity of the surgery also varies by individual. In general though, since elasticity lessens with age, the younger you are, the longer a facelift will last, and the older you are, the shorter. So an advantage of having a facelift younger is that it will last longer. But understand that while a facelift lifts the tissues to a more youthful position, they will continue to settle over time. On the plus side, a long-term study on facelift longevity did show that at 10 years, all patients looked better than their pre-op pictures despite showing some degree of recurrence of signs of aging. The best analogy is that a facelift will set back the clock but doesn’t stop the clock.

How Much Does a Facelift Cost?

The cost of a facelift can vary greatly and depends on the technique, adjunctive procedures done, length of the surgery, and experience of the surgeon. Also included are anesthesia, facility, overnight stay (if needed), and other fees. After a consultation, Dr. Pollock can give you an exact price for your facelift surgery. Financing options are available to help pay for your plastic surgery procedure.

Want to Learn More About Facelift Surgery?

Dr. Pollock performs facelifts in Dallas and Allen, TX, and he serves many nearby areas, including Plano, Richardson, and McKinney as well as the larger Dallas-Fort Worth-Arlington metropolitan area.
If you are experiencing signs of facial aging in the form of unpleasant wrinkles and drooping tissues, contact Dr. Pollock to set up a consultation by calling (214) 363-2575.

Facelift Surgery in Dallas and Allen, TX

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