Facial Procedures

In general, Dr. Gordon performs procedures that restore and rejuvenate your appearance, such as facelifts (rhytidectomy) and eyelifts (blepharoplasty) and procedures that alter your appearance such as nose reshaping (rhinoplasty) and chin implants (mentoplasty). These procedures can be done individually or combined depending on an individual's goals. Below are descriptions of procedures and the motivations of many of the patients who seek these services.

Facial Rejuvenation

The type of results achieved in facial rejuvenation is a product of the facial plastic surgeon's techniques, aesthetic judgment and artistic skill.

Although the aesthetic judgment of an individual may vary, in the 21^st century the majority of people seeking facial rejuvenation have similar motivation and goals.

In contrast to facial plastic surgery of the past, where facial rejuvenation procedures, such as facelifts, produced results that were obvious, unnatural and changed a persons appearance, advancements in techniques and procedures, today, offer completely different outcomes.

Most people like their faces, it is their aging changes that they do not like. "Reverse my changes but do not make me look different." "If it looks like I had it done, I don't want it."

Facial aging

Changes in our facial appearance over time are due to two main factors: gravity's effect on the soft tissue of our face, which both stretches out our face and causes it to droop, and changes in the quality of the surface or skin such as fine lines and hyperpigmentation.

The soft tissues constituting the face are in layers, with the skin on the surface, then a layer consisting of fat, mixed with a layer of connective tissue, and then the SMAS layer (subcutaneous musculoaponeurotic system). The SMAS layer of the face, a strong fibrous sheet of tissue, separates the deeper facial structures such as facial movement muscles, nerves and other structures that are not as affected by aging as the soft tissue.

As we age, all these facial layers begin to sag due to gravity's effects. The fat pads in our cheeks slide downward, our cheeks become hollow, and we develop jowls, creases and eventually a loose neck. Changes to our facial shape, from a tapered shape with a defined jawline, when we are young, to a square, elongated shape with folds and laxity as we age are the major signs of gravity's effects.

The specific 'look' that reflects each decade of our lives (what makes a fifty year old look fifty, a sixty year old look sixty, etc) is predominately created by our gravity changes, with drooping of the neck and jowls, as one of the last gravity changes that occurs. Even before we look 'old' gravity affects our face and creates illusions of tiredness (bags under our eyes), sadness (a down turned mouth) and anger (furrows between our eyes). Since all the facial tissue layers are affected by gravity, only procedures that reposition all the drooping tissue layers effectively reverse our aging facial changes. No significant or long-term result can be achieved without utilizing procedures that are directed at reversing our facial gravity changes.

Below is a summary of the most common facial procedures. For more information on a specific procedure or to schedule a consultation, please call us and our attentive staff will assist you.

A facelift, known as a rhytidectomy in medical terms, is a procedure in which the loose skin on the cheeks and neck, along with the underlying, sagging facial soft tissue, are lifted, tightened and repositioned. A facelift is not just one procedure; different techniques have evolved over time that produce different results from past techniques. The deep-plane facelift today produces incredibly natural and longer lasting results than older skin only procedures. Often a facelift, is combined with other procedures such as a brow or eyelift offers a balanced, complete and more natural facial rejuvenation.

The type and degree of facial rejuvenation should match the degree or stage of aging changes. Since today's procedures can always appear natural, a person does not have need to wait to look bad in order to return to their optimal stage of appearance. When approached earlier, facial rejuvenation will produce a subtle refreshing of our look. Similarly, if a person has significant aging changes throughout their face choosing substandard techniques or having isolated procedures will either undercorrect or create an imbalanced result. Undercorrection of aging changes and/or imbalances between areas of the face are some of the most common reasons people seek revision facelifts.

Understanding the limitations of skin-only and SMAS facelifts, research in facial anatomy showed that procedures accomplished one layer deeper, below the SMAS sheet instead of above it, created better, more natural results and longevity not capable in the past.

As a modification and advancement of the standard facelift, the deep-plane facelift involves repositioning all the drooping facial soft tissues that are involved in facial aging. Since only the deeper SMAS layer is utilized to reposition all the drooping facial tissue, no tension or tightness is ever needed or placed on the skin. If the skin is never pulled in doing the facelift the result will never produce a pulled, tight or plastic appearance.

This facelift is the most effective in restoring the midface and nasolabial folds (creases from our nose to our mouth) because the fat pads in the cheeks are lifted and repositioned removing facial hollows and restoring our cheekbone shape. In addition, since the SMAS layer is connected to the loose muscles of our neck, a deep-plane facelift is also the most effective in recreating our smooth neckline.

Unlike the SMAS procedure where the skin is separated from the deeper tissues, the deep-plane technique repositions the entire loose saggy soft tissue of face as a unit causing less tissue trauma and faster healing. Since the deep-plane technique is accomplished in the plane or layer that naturally exists in our face (instead of an unnatural plane or level that is produced in other facelifts), there is minimal bruising and minimal pain after this procedure.

Areas such as loose buccal cheek fat (the part of the face that produces jowls) can be assessed and treated during the procedure addressing aging changes that were not accessible before.

Since the deeper layer that is utilized is fibrous and inelastic, unlike the skin which is very elastic, the procedure produces the most long lasting results of any facelift technique.

The deep-plane technique can be modified to include only the midface, from under the eyes to the jawbone, accomplishing a significant result in a limited region. Replacing old fashioned minilifts, this can be an option if you are younger and do not have signs of aging in your neck.

Since most facelifts previously performed have been SMAS procedures, the deep-plane facelift is the preferred technique in revision or secondary facelifts in order to prevent an unnatural tightening of the surface or skin layer that can occur with repeated SMAS procedures.

Most important, because this technique focuses on the deeper facial structure, there is never any unnatural tightening or pulling of the facial skin that typifies older and obsolete facelift techniques. The Deep-Plane Facelift is the most sophisticated procedure available today and studies have shown that it is the most effective procedure available for repositioning sagging soft tissue. This is why it has won the devotion of patients and acclaim from the plastic surgery community.

Are You a Candidate for a Deep-Plane Facelift?

In general, any candidate for a standard facelift is also a candidate for a deep-plane facelift. Many scientists believe that a deep-plane facelift is a better choice for smokers than a standard facelift, since the deep-plane region has a more ample blood supply and is more resistant to smoking complications. This is the preferred technique for secondary or revision facelifts. Since a greater level of facial plastic surgical training is often associated with doctors who perform deep-plane facelifts, make sure your surgeon has in depth experience in this technique to ensure the proper outcome.

As the name states, a midface lift affects the midface region (from under the eyes to the jawbone). Replacing the out-dated minilift, this procedure uses a more limited version of the deep-plane technique and is aimed at people with earlier, more isolated facial aging changes. Patients are typically in their late 30's to 40's.

Since a smaller region is being treated shorter incisions lines are needed. But similar to the standard deep-plane technique, only the deeper layer is repositioned and tightened, avoiding any pulling on the skin layer. Natural results are ensured.

This technique is effective in restoring the fat pads on the cheekbone, producing a more "mounded," youthful cheek. This lift also diminishes the nasolabial fold and facial hollows more than the SMAS facelift does. The midface lift does not affect the jowls or neck; nor does it involve the removal of loose skin in the neck, which is done with a full deep-plane facelift. Since a smaller region of the face is affected, recovery can be quicker, often less than two weeks.