Facial rejuvenation surgery has come a long way since its inception in the 1920’s. Today we are able to return patients the looks they had twenty years earlier without looking tight stretched or strange. What many people do not understand is that ALL of the stigmata of facelift surgery can be avoided if the surgeon knows what he is doing. The early facelifts were nothing but mini-lifts, which are inadequate operations irrespective of what catch-phrase name they may be advertised under. An important principle to remember is the younger you go, the longer it will last. This has been shown over and over again. Also important to remember is that the skin should not bear the tension, otherwise one may look funny like so many of our aging celebrities who have had horrible facelifts. So what is the answer?
There is a zone in the facelift procedure which I call the “release zone.” This zone can only be accessed in the deep-plane approach. This means a careful disssection beneath the parotid fascia in the cheek and beyond the anterior border of this gland. Certain ligaments in this area, once divided will allow the surgeon to advance the deep plane and secure it. One can then remove all the skin necessary, and the skin is not under tension, hence the patients do not look funny as the result of a poorly performed facelift. Why don’t all plastic/cosmetic surgeons perform this particular operation? The answer is found in a number of explanations. First of all in the deep plane approach, the surgeon is dissecting very close to the facial nerve branches. If he were to cut one of the branches, the patient’s facial muscles would show paralysis from the damage.
If a surgeon wants to perform this operation, he needs to return to the laboratory and dissect the human cadaver so that he knows anatomically where he is all the time. Most surgeons are unwilling to do this, and furthermore they may be unwilling to take the time required to perform this complex operation. The results are there to achieve; however there are NO shortcuts, and plowing in with big scissors without knowing what plane they are in is a recipe for disaster. The deep-plane facelift into the “release zone” is the ultimate form of facial rejuvenation available today. It can be performed safely and provide the patient much in the way of personal satisfaction.
The advantages of this operation are maximum rejuvenation, optimal results, predictable results, and a longer lasting result. The cons are that this is lengthy surgery; there is danger to adjacent structures (facial nerves); and there is a limited margin of error. A frequent cop-out is when a surgeon says “but my patients don’t want to look that young” which means that he cannot do the procedure. In our practice with over one thousand deep-plane facelifts we have not had any facial nerve loss, and we can safely say that there is no surgical procedure that can bring greater satisfaction and happiness to a patient than to achieve this degree of youthfulness in our youth oriented culture.