In general, Dr. Gordon performs procedures that restore and rejuvenate your appearance. Procedures that alter your appearance include facelifts (rhytidectomy), eyelifts (blepharoplasty), and chin implants (mentoplasty). These procedures can be done individually or combined depending on an individual’s goals. Below are descriptions of our cosmetic surgery procedures and the motivations of many of the patients who seek these services.
Since the facial soft tissue is kept naturally together, bruising and swelling are minimized leading to rapid recovery, without unnecessary medications. The specialized access points allow the procedure to be couture’d or individualized to a person’s specific face-type and aging changes.
Table of Contents
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 21st 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 and neck lifts, produced results that were obvious, unnatural, and changed a person’s 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.”
Dr. Gordon was the first to…..
- Prove the Deep Plane Rhytidectomy was safe and produced predictable, natural results in a series of patients, 1996.
- Create a place for the entire process of facial rejuvenation, The Retreat at Split Rock, 2003.
- First Chairman of the Committee on Patient Safety for American Academy of Facial Plastic and Reconstructive Surgery, 2005.
- Publish a study proving that surgery performed out of a hospital using general anesthesia was safe, 2006.
- Create a research model to prove patterns of facial aging over time, 2014.
- Publish how the facial skeleton changes during the aging process, 2015.
- Publish “The Illusion of Volume Loss”, based on his research that showed facial volume loss is an illusion; and that soft tissue gravity changes are the aging issue, even in younger people, 2015.
- Advance the original Deep-Plane technique to the Vertical Platysma Advancement offering person-specific advances to the technique, 2016.
- Publish and prove that facial fat is not lost in the face during the aging process, 2019.
What Is 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 occur. 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.
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, is lifted, tightened, and repositioned. A facelift is not just one procedure; different techniques have evolved 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 cosmetic surgery procedures such as a brow or eye lift that 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 to wait to look bad 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 be corrected or create an imbalanced result. Under corrections of aging changes and/or imbalances between areas of the face are some of the most common reasons people seek revision facelifts.
The anatomy of youth can be understood using some basic analogies. Your ‘look” is created by your “frame,” the same way the frame of a couch creates the “look” of a couch. The research I have conducted and published shows that your “frame” doesn’t change (until extremes of aging) and explains why using the proper techniques, at the right time, can duplicate your past appearance the same way reupholstering an older couch can restore the couch as new since the frame did not change.
Our frame is fitted with a “garment.” Imagine a quilted comforter that fits our frame like a glove when we are a mature yet youthful adult at our best. So, our 35-year-old appearance is essentially our frame that creates our look, our attractiveness, our uniqueness, and our individuality and is fitted perfectly by a thick garment, allowing everyone to see our unique frame.
While our frame stays similar most of the time, the garment that originally fits it like a glove does not. If we look at the garment separately, it has the same biomechanical behavior as pizza dough. If pizza dough is held in the air, over time, it will predictably stretch and descend toward the ground. Stretched out pizza dough and an aged face have similar principles.
Thus, youth is like wearing a perfectly fitted pair of pants, the garment, on our lower body, our frame. Aging is essentially the pants getting bigger and bigger as time progresses.
Should I Do It Now or Wait?
This is a common question, but the way we think it out today differs from the past.
- Once you notice your aging changes, you will not “unnotice “them.
- As aging changes advance, minimally invasive procedures have less effect, have a long-term recurring expense, do not eliminate the need for surgery, and when overused, look obvious and can have complications.
- Current techniques such as Deep-Plane facelifting and Vertical Galeal Advancements are natural and undetectable, eliminating the past reason to wait because surgery created an unnatural look.
- Certain aging changes such as festoons, facial creases, or neck rings can become irreversible if not corrected earlier. Waiting can only limit the potential result.
- The earlier aging changes are reversed, the better the result and the longer it lasts. Minimally invasive techniques camouflage aging changes rather than reverse them.
The Deep-Plane Lift
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. 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 the 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 very elastic skin, 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 mini-lifts 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 to prevent an unnatural tightening of the surface or skin layer that can occur with repeated SMAS procedures.
Taking the Deep-Plane Facelift to the Vertical Platysma Advancement
The Deep –Plane facelift is a superior procedure, but amongst the elite surgeons that can perform the deep-plane facelift, Dr. Gordon stands out.
Dr. Gordon was one of the early pioneers in the technique and the first fellowship-trained, facial plastic and reconstructive surgeon to specialize in the deep-plane facelift in New York City. Throughout his career Dr. Gordon has been recognized as an international expert in deep-plane face lifting as evidenced by his academic appointment as Director, Head and Neck Aesthetic Surgery in the Section of Otolaryngology at Yale School of Medicine, as well as recognition through invitations, to give prestigious academic lectures, contributions to the medical literature and the training of international surgeons.
Beginning in 1996, Dr. Gordon has been annually invited to lecture at both national and international academic conferences on deep-plane facelifting. Specifically, lectures have focused on adaptations, modifications, and nuances of the technique in applying the procedure to different face types for specific goals, and in the techniques’ preferred use in revision or redo-facelifts. These technical modifications have led to the development of his latest advancement, the “Vertical Platysma Advancement”.
Dr. Gordon only utilizes the DEEP PLANE FACELIFT and VERTICAL PLATYSMA ADVANCEMENT technique to revise previously performed facelifts. Because these techniques do not require the skin to be pulled to achieve the desired result, it is the preferred technique to revise any prior facelift, whether the initial outcome was pleasing or suboptimal. The importance here is that having one’s skin pulled is the reason for the unwanted “over-done” or “plastic look” after a facelift. The deep plane or vertical platysma procedure avoids this entirely.
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. That is why it has won the devotion of patients and acclaim from the plastic surgery community.
Because of his expertise in facial rejuvenation procedures that do not create a tight or pulled look by using a unique layer, Dr. Gordon has acquired a national reputation as the expert in not only primary, or first facelifts, but also revision procedures and was featured in “W Magazine” (The Movie Issue, February 2011) and noted as a “revisionist who is widely admired for his ability to restore a soft and natural look to an overstretched face and over pulled brows.
In the majority of revision cases where someone has had a facelift, the procedure was a SMAS procedure that focuses on the surface layers of the face, whether the outcome was pleasing or suboptimal. Since Vertical Platysma Advancements and Deep-Plane Rhytidectomy do not require the skin to be pulled to achieve the desired result, this is the only technique that should be used to revise previously performed facelifts. The importance here is that having one’s skin pulled is the reason for the unwanted “over-done” or “plastic look” after a facelift. Not only does the Deep Plane or Vertical Platysma Advancement procedure avoid this, but often can fully reverse the “done” appearance. In cases where the first procedure was satisfactory, the current problems are due to the unapproached underbelly layer and retightening the surface again (a repeat SMAS lift) would not produce a natural result.
Since the soft tissue of the face has the same anatomy as a sandwich, we use a peanut butter and jelly sandwich as an example. (Understanding The Deep-Plane Facelift Video Here!). A SMAS procedure only moves the top bread of the sandwich, which is why in undesirable outcomes they can have the dichotomy of a tight surface, with obvious scars, yet with jowls and a lax neck needing a facelift. This is because the peanut butter and jelly and bottom bread have not been touched and surface tension is created by tightening the top bread.
The deep-plane procedure takes advantage that a sandwich is a biomechanical unit, it acts as one object, so keeping the sandwich together and only using the bottom bread of the sandwich to move the entire soft tissue unit accomplishes many beneficial things.
- Tension can be removed from the surface, the visible top bread layer, and transferred to the invisible deep bottom bread. Allowing suboptimal scars to be fixed.
- Soft tissue redundancy, evidenced by the fact that jowls and neck changes exist despite a previous facelift, is isolated to the underbelly layer which wasn’t touched but now can be utilized, redoing the facelift
- Avoidance of retightening the same superficial layer twice, which occurs when a SMAS procedure is used to revise a past SMAS procedure, regardless of whether the initial procedure was satisfactory or not. If a SMAS is used to revise a past SMAS facelift either a done facelift appearance can be created or the procedure will fail to produce a result, since it is the bottom virgin layer that is causing the aging appearance
- The ability to see and treat suboptimal fat or filler injections, string-facelifts or other past treatments.
These are some of the reasons why Dr. Gordon is considered a world expert in revision rhytidectomy and has published in the medical literature, lectured internationally and even had a TV show based created,“Botched”, on his work.
As a recognized international expert on the nuances of deep-plane facelifting, Dr. Gordon was invited to be a contributing author in multiple academic books and published the modifications of the deep-plane technique for the treatment of the neck in the publication Clinics of Facial Plastic Surgery, modifications for treatment of the mid-face in Clinics of Plastic Surgery, and wrote the content for deep-plane technique in a special monograph edition on Facelifting published by the European Academy for Facial Plastic and Reconstructive Surgery. He recently wrote the chapter on deep-plane rhytidectomy for the upcoming book series, Expert Techniques In Facial Plastic Surgery in the book An Analytical Approach to Facelifts and Neck Lifts.
Based on his research, Dr. Gordon was invited to author the contrarian chapter in a book on Volume Loss and was recognized for his work titled, “The Illusion of Volume Loss”, where he definitively shows how the majority of facial aging is not due to volume loss and how deep-plane facelifting and now vertical platysma advancements reverses facial aging changes in an anatomically correct manner, safely creating natural-appearing and long-lasting results.
In addition to his role as Coordinator of Residency Education in Facial Plastic and Reconstructive Surgery in the training of surgical residents at Yale School of Medicine (Dr. Gordon always performs all procedures), surgeons from 5 continents have traveled to observed Dr. Gordon perform deep-plane facelifts and vertical platysma advancements and he is credited with the expansion of the technique in the United States, Europe, and Australia.
The Vertical Platysma Advancement
The goals of facial rejuvenation are simple, “reverse my changes, don’t change me”, “if it looks like I had it, I don’t want it” and “I have to be back in my life within 2 weeks”. Since facial aesthetic procedures are all elective they must be achieved in a consistent, predictable, and safe manner. Developed by Dr. Gordon, the Vertical Platysma Advancement is the first anatomically correct procedure that reproduces someone’s past appearance, can be couture’d and individualized to the nuances of their look, while accomplished predictably, safely with minimal recovery.
Developed over the last two decades, Dr. Gordon presented his advanced technique as the key-note speaker at the Annual Symposium on Facial Rejuvenation and Facelifts by the Australian Academy of Facial Plastic Surgery in November 2016 to the international physician attendants and media. Since gravity is the cause of the majority of facial aging changes by slowly stretching out the elastic facial soft tissue, reversing their effects is consummate in restoring someone’s past appearance. A falling object only travels vertically down, so optimal gravity reversal must advance stretched out soft tissue vertically upward. Through defined access points, the Vertical Platysma Advancement allows the gravity-affected, droopy facial soft tissue to remain intact as it naturally exists, and only the underbelly layer (the platysma) is utilized to advance, reversing gravity’s effects without ever producing any surface tension. Visible tightness is no longer part of the procedure or necessary to reverse aging effects.
Since the facial soft tissue is kept naturally together, bruising and swelling are minimized leading to rapid recovery, without unnecessary medications. The specialized access points allow the procedure to be couture’d or individualized to a person’s specific face-type and aging changes. Areas such as jowls, nasolabial folds, and extreme neck laxity can be treated effectively on a variety of face types. Since a natural outcome is guaranteed, younger patients don’t have to wait to look bad to rejuvenate their past appearance. Without any skin tension, incision lines quickly become unapparent, even on difficult skin types. Because the underbelly layer is not elastic, outcomes last for extended periods, eliminating the need for additional procedures or the use of facial fillers or fat injections. Vital structures can be avoided, creating safe, duplications of one’s past appearance in a consistent, predictable manner
Although our concepts are “One and Done” in facial rejuvenation surgery, the most common issue limiting people from pursuing a procedure is recovery time. Essentially the majority of people have to be able to be back in their professional and social life between 9- 14 days.
Our methodology and the Retreat at Split Rock combine to optimize recovery time in ways unique ways:
- Dr. Gordon limits the schedule, often to one per day; this not only ensures consistency and predictability in his outcomes but allows him to be gentle with the tissue. This minimizes swelling and bruising, which minimizes recovery and cannot be accomplished when operating on multiple cases in a day
- Dr. Gordon does all his own surgery completely without a fellow or physician assistant
- The Retreat at Split Rock provides a seamless process. The adjacency of the Inn at Split Rock to New England Surgical Center eliminates any travel, stress, and the commotion associated with recovery at a separate hotel or travel back to home. In other environments immediate travel after surgery is necessary and can be traumatic. The Retreat at Split Rock eliminates travel and directly leads to an easier, more comfortable, and importantly, a more rapid recovery process.
- This creates security, peace of mind, and intellectual certainty. This eliminates uncertainty and anxiety, allowing all your body energies to be utilized in the healing process and directly equates to a rapid recovery
- Although not a medical recovery facility, the adjacency of the Inn at Split Rock allows for unique proprietary modalities such as oxygen therapy and lymphatic massage, combined with individualized nutritional support as examples of the unparalleled advantages offered at The Retreat at Split Rock. This cannot be accomplished in a separate hotel or home environment.
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.
VIEW THE PROCESS
Besides the actual procedure, the consult is probably the most important part of the process. Since Dr. Gordon can perform uncommon procedures that require specialized training, the main goal of the consult is to educate the consumer on the aging process, how to evaluate their aging changes and what options they can consider to meet their goals. We also offer virtual consultations through Zoom and Facetime to discuss your goals and next steps.
This will be the opportunity for you to communicate what your thoughts, desires and concerns are about your face and approaching the facial rejuvenation process.
Understanding how facial regions relate and influence one another is an important part of the consult process. Often these concepts are not intuitive but will easily be communicated during the consult visit. Dr. Gordon will usually manipulate your facial features in front of the mirror to illustrate how to reverse your specific aging changes, how different regions influence one another and allow you to view your “after” result on your own face. The process for all potential procedures will also be discussed.
Overall, a detailed understanding of how to view your face over time and will make you feel comfortable with Dr. Gordon as a physician and a person. You should not feel rushed during this process.
BEFORE AND AFTER PHOTOS
It is extremely important to view before and after photos of the outcomes from any surgeon you are considering.
Often patterns will emerge, such as all the noses appear the same, or operated upon, or the opposite, different faces have different cosmetic results and all the noses appear natural regardless of the initial appearance. A surgeon who does rhinoplasties regularly should be able to show you many different outcomes that are similar to your cosmetic issues; as well as outcomes that may not be your situation, but illustrate their ability to do many types of noses.
This will form a basis of communication between you and surgeon and provide valuable information.
Our practice does not publish before and after photographs on the internet for a number of reasons.
The main reason is privacy. Photographs on the internet can be used by people for other non-authorized purposes and no one can control this behavior. We cater to the high-end consumer and appreciate that many allow us to use their photographs, so in respect for that privilege, we will not publish photographs when we cannot control who has access to them and their ultimate use. In addition, sophisticated rhinoplasty is individually designed and before and after results shown on most web sites are not necessarily reflective of your specific type of nose or the outcome you could expect. The consult environment is best to view other patients’ results in direct relation to your specific anatomy, goals and desires.
We chose not to use computer imaging because it is not real. It does not predict how your face will behave or that you will receive the image as a real outcome. We always want to focus on what actually occurs and viewing your surgeon’s cosmetic outcomes is the most predictive of what result you can expect.