Facelift San Francisco
Performed by Dr. Maas
San Francisco Facelift Surgeon Dr Corey Maas
The term facelift has become one widely used for all types of aging facial plastic surgery in San Francisco and beyond.
Traditional surgical definitions would describe a facelift as a surgical procedure that elevates sagging tissues from the cheek area down to and including the neck. However, with recent aggressive marketing campaigns that describe a small incision in front of the ear with an inch of skin pulled back to patients who refer to a “full facelift” that include a browlift, upper blepharoplasty, lower blepharoplasty and versions of volume augmentation like fat grafting, it is clear that traditional definitions are inadequate.
The Maas Clinic in San Francisco has developed a simple and thoughtful way of describing facelifts that accurately describe what is done rather than using vague marketing or even proprietary terms like “Lifestyle lift”, “Natural lift”, “Quicklift” and others. These terms while being aggressively marketed, do not clearly describe to the public what or how the procedure is preformed and or the risks and benefits for the procedure. In simple terms, San Francisco Plastic Surgeon Dr. Corey Maas, a recognized leader in cosmetic surgery, has divided the face lift into three basic surgical strategies:
The lower facelift is a plastic surgery procedure that is another way of describing what tradition text books would simply call a facelift. The lower facelift addresses the sagging tissues and skin from the cheekbone down to and including the neck with skin laxity and overgrown (hypertrophic) muscle (platysma) bands in the neck. In contrast to what many refer to as “the L.A. facelift”, with an over-stretched appearance, the San Francisco Bay Area facelift patient is typically looking for a natural restoration of the facial contours enjoyed in the 30’s and early 40’s. A lower facelift employing the SMAS (subcutaneous aponeurotic system) Call The Maas Clinic for more information about facelift surgery San Francisco
Using the SMAS in a lower facelift in allows the “restoration tension” to be applied below the skin surface rather than over-tightening the skin. In extended SMAS facelift technique, in particular, the skin can be gently re-draped in a natural configuration. In a natural facelift particular attention is paid to several important areas by expert facelift surgeons:
- The hairline in above and behind the ear – every patient and different and, while some surgeons “do every patient the same way” it is the opinion of Dr. Maas that the facelift is one that assures the hairline is maintained in the temple area and carefully aligned behind the ear. The incisions for men’s facelift and women’s facelift remain hidden behind the prominent cartilage in front of the ear – the tragus. Any hair hair-bearing skin that is moved into this area can have the hair ablated or removed at the time of surgery or subsequent to the surgery.
- The facelift in men and women never look over-pulled or over stretched. This is the value of the extended SMASplasty facelift technique developed by Dr. Maas at the University of California San Francisco and later refined at The Maas Clinic.
- Finally, the earlobe must rest in a natural position without looking pulled or distorted. This video demonstrates the precision used in placing the lobule (ear lobe)
The mini-facelift is a term that, unfortunately, has been described by various companies with slick marketing terms and advertising campaigns that often over-promise what this procedure can do. The reason for the mismatch between outcomes and the various names applied to the mini-facelift are that for each surgeon or company the procedure may be very different.
Some surgeons or “companies” offer a one hour office procedure with a straight vertical incision in front of the ear, a small amount of skin elevated, removed and sutures placed. Others surgeons offer much longer lasting and more technical procedure that offer more predictable long-term results. However a mini-facelift is performed, the refinement of this centuries old early facelift procedure was driven by patient’s fast-paced lifestyle. Many patients want a facelift that minimally impacts their busy lifestyle with shorter recovery times. Mini-facelifts may not always offer shorter recovery times however.
With that caveat, there are many things a mini-facelift can provide for the right patient. The mini-facelift offered by The Maas Clinic in San Francisco addresses the sagging tissues between temple and the jawline, including the nasolabial fold, cheek and “marionette lines”. This procedure is usually best applied to patients that need a little tuck up some years after a previous facelift or younger patients with a still nice neck line and satisfactory neck tissues that just need a lift in the areas described.
The procedure employs an incision that extends from the temple hair, is hidden behind the ear cartilage in front of the ear and ends just behind the earlobe. Dr. Maas’ approach to the mini-facelift is similar to the lower facelift in that it relies on extensive use of the underlying thick connective tissue SMAS (subcutaneous aponeurotic system) to provide long-lasting contour improvements with gentle and natural skin tightening. The recovery for this procedure is about one week of moderate facial swelling with brusing be the rate limited variable in re
turning to normal social activities. Recovery, in truth, is not significantly different than that of the lower facelift.
A 2007 article in Vogue magazine rated Dr. Maas, The Maas Clinic, San Francisco as one of America’s “top plastic surgeons” for neck lift. How one judges “the best surgeon” is probably beyond the scope of this discussion but is usually based on a legacy or reputation based on many patients over ten or more years with good results.
The endorsement notwithstanding, neck lifting is a unique procedure that involved a sophisticated combination of liposuction, platsymaplasty (bands or cords of muscles in the neck) and subplastysmal flap SMAS elevation in the neck employing small incisions around the ear lobule (lobe) and behind the ear. This carefully sequenced series of surgical maneuvers can substantially change neck skin laxity – bringing a square or near 90 degree angle to neck and chin line, fat under the chin (submental fat) as well as deep wrinkles under neck. The procedure, like all Maas Clinic facelift procedures as an outpatient with a compression dressing that is removed after one night. Very little swelling is expected and quite often bruising is minimal with this technique which, like the mini-facelift, is often reserved for younger patients with premature neck aging and patients that have experienced neck laxity relapse after previous facelift surgery.
“My recommendations are to ask the following questions while having a consultation with surgeon about facelift surgery in San Francisco.” Dr. Maas
- How many facelifts have you performed in the last month as the surgeon in charge or primary surgeon?
- How many facelifts have you performed in the last year as the surgeon in charge or primary surgeon?
- Are you Board certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery?
- Have you ever had a complication with facelift surgery? … if the surgeon responds no – be suspicious while significant complications are quite rare any surgeon having done enough facelift procedures to be an expert will have experienced at least some complication and this should be discussed.
- What is the worst complication you have experienced with facelift and how did you manage this complication?
- Ask to speak with patients that have had a face lift in San Francisco with the surgeon in the last month or two. They can give a first hand account of their experience and whether their expectations were met.
- Ask to see before and after pictures and make sure that the pictures are of patients that your consultation surgeon was the primary surgeon.
- Finally, corporate facelifts or trademarked procedures are considered unethical in many states and illegal in some. I discourage patients from seeking these types of procedures without carefully credentialing the surgeons.
Post Operative Care
Q- Am I Too Young for a Facelift?
A- “No” The conditions, really, are what dictate the need for the procedure that we are doing. Many young patients have premature aging particularly those who are smokers or have been smokers or patients that have had a lot of sun exposure. The biggest factor, which none of us control, is really genetics. If you gave a genetic predisposition to hanging skin, and there’s even a number of medical conditions that can cause extreme skin laxity, and people who suffer from these are very good candidates for doing facelifts at the age of 40.The average age now is coming down with lifting, people are feeling youthful and energetic and very productive in their early 50′s, even late 40′s, and have a face that doesn’t match what they feel like inside. As long as the conditions of the face warrant a lift, it’s a total appropriate procedure.
Q- Are There Alternatives to a Facelift?
A- I think a lot of people, like this patient who wrote in to me, would like to find a non-surgical options rather than getting a facelift and I think the question is “What do most doctors say or is the best alternative?” I will say in summary that a facelift does a specific thing. It helps to improve the contours of the face, the neck and the jawline specifically and also can help with the cheek area so there really is no non-surgical substitute that will do exactly what a facelift can do. However there are number of people who come in with fine lines and wrinkles on their face and even volume loss, that really don’t need a facelift at all. So to give the simple answer to this, I would say there’s no easy substitute for facelift. There are some alternatives than can be used, including judicious use of facial fillers and volume, particularly through the cheek area, around the lips and marionette lines and the jawline, which can disguise things and make it look like a facelift.
Q- How Long Does it Take To Recover from a Facelift
A- Facelift recovery is at the most about a 10-day to 2 week process for most patients. The first week, people are pretty swollen, and sort of, in many cases, pumpkin head swollen, so you got to be prepared and not be doing any social activities for the first week. The rate limiting thing in terms of returning back to your normal social activities is bruising, and for most people bruising is pretty much limited to just focal areas within about 10 days, which can easily be disguised with make-up since the incisions are hidden in the hairline and other areas. That’s not really a worry because there’s light red, but bruising really is where the rubber meets the road in terms of getting back into the normal social activities.
Q- Is the Ribbon Lift a Facelift
A- There’s a new mattressing type of suture called the eye guide that goes underneath the neck, crisscrossing a lot like a mattress. There’s an endotine which looks like a ribbon and I suspect that the ribbon lift is probably a good marketing way of describing the endotine device, which is a device that’s made of polylactic acid, it’s basically a small flat device with several holes in it, polylactic acid is what vicryl suture is made and over time dissolves so that’s a benefit but it shaped and formed like a ribbon and at the end of it there’s a small spike catch device that is engaged into the soft tissues. This technique is used to a very commonly for elevating the mid-face region. A small incision is made in a temporal hairline and under the lip. The device is inserted underneath the skin, engages the fatty tissues of the cheek and is elevated and sutured into place. That device dissolves over time. There’s a much better way, in my opinion of doing mid-face lifting with the technique that we’ve developed called the endoscopic midface lift, or the percutaneous mid facelift, more specifically.
Q- Non-Surgical Facelift – Does it Actually Exist?
A- First of all, everybody should be aware that there’s no magic cream that does a facelift because facelifts by definition, by our surgical and medical definitions, are actually improving the contour of the lower face and or the neck and that’s really, by definition, what facelifts do.
Facelifts, by definition, should be improving contouring. Well, then we get into some of these procedures or technologies where people are claiming facelifts and I’m not sure that that’s really what you’re getting. The first of them were really lasers. When lasers skin resurfacing first came out, a lot of people were claiming that it lifted the face. Well, in fact, what resurfacing does is tighten the skin a little bit. It makes the surface texture smoother, it makes wrinkles much less perceptible, in fact, in many cases it can make them go away, but it is not physically or substantially changing the contour to the skin.