Can you be too old for a facelift?
Throughout my training and much of my
career I considered the facelift in conjunction with eyelid surgery to be
the ultimate solution for facial rejuvenation in my practice I developed
my own techniques and systems to achieve optimal results with local anesthesia
and LITE IV sedation with quicker recovery than traditional surgery my
facelift patients have ranged from age 37 to age 87 when I’m asked the question
can you be too old for a facelift makes me think first about whether a facelift
is the best option for what the patient wants and would the results be worth the
investment in time money and recovery I’ll discuss how I consider the option
of facelift for my patients in my practice and how age is factored into
this discussion I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years I perform all types of phases of procedures in my practice from
short scar mini lifts to deep plane facelift if we look into the past of the
options to address facial aging where the skin and soft-tissue sagged
resulting in gels and loose neck skin it makes sense to operate in order to lift
and reposition the sagging tissue it should also be recognized that there has
been a wide range of proposed best facelift surgery options from minimally
aggressive to highly aggressive in our field attending medical conferences has
been unintentionally amusing for me as colleagues passionately advocate
procedures at one time and then years later they abandoned the same procedures
they advocated for so passionately so what happened what happened was that
regardless of technique there have always been challenges with face lifting
in terms of complications and long-term benefit the ideal procedure is one that
is safe and predictable with minimal complications interestingly I’ve
observed several of my senior colleagues evolved their surgical approaches such
that they look very similar to what I advocated for years ago I think it’s
reasonable to conclude that they came to the same conclusion I did about safety
and predictability in my opinion one of the core limitations of any face of
procedure is the bone volume loss associated with facial aging the pillars
of the face which define the facial structure include the cheekbones the
chin, jawline, and jaw angle in a facelift operation the more defined these
structures are preoperatively the better the facelift results are this means that
for people whose facial structure are not as strong preoperatively within a
relatively short period of time they often look like they still need a
facelift being aware of this variable I often advocated for the placement of
cheek and chin implants at the same time I performed face of surgery but many
patients were not comfortable with having facial implants many were okay
with getting a chin implant another variable is the quality of the
skin the fatty layer under the skin and the SMAS or the superficial musculoaponeurotic system which is often referred to as the muscle and needs to
be addressed to do a proper facelift the SMAS is actually a layer of tissue
connecting the underlying facial muscles to the skin if these tissues are thin or
fragile the face of procedure may not come out as well as the patient would
like I make a point to communicate with my patients about these issues so they
can make an informed decision when considering a facelift patients often
come in for a facelift surgery because they feel that their face is drooping
when they look at the mirror and when they pushed their face upwards with
their hands they conclude that they look better others come in to have a facelift
because they don’t want to have fillers and just want to get that one procedure
that’ll keep them looking good forever I look at my patient during consultation
to determine what aspect of facial aging is dominating in their situation is
their facial aging issues caused more by bone volume loss or by facial soft
tissue sagging or is it a combination of both I look at facial aging from the
inside outward which means I look at the bone structure as the foundation if
there is no significant sagging I recommend volumizing the bone structure
but instead of facial implants I recommend long lasting hyaluronic acid
fillers such as Juvederm Ultra Plus or Juvederm Voluma instead of performing
surgery I use blunt cannulas to place volume at the bone structure level in my
exam room within a few minutes they appear to look as if they had a facelift
this is not the overused and inaccurate term liquid facelift I’m using the
principles I know from performing facial implant surgery for the placement of
thicker hyaluronic acid fillers at the bone level typically with no bruising
and minimal swelling if the soft tissue sagging is so advanced that the filler
placement would not have a significant impact I
recommend facelift surgery but I explained to the patient that they will
still need structural volumizing to address their bone loss after they’ve
healed to get the best results I do in some situations perform a combination of
facelift with structural volumizing at the same time a facelift is part of an
overall facial rejuvenation plan and is not the definitive final step this
awareness of the challenges of lifting sagging tissue over diminished bone
structure makes me particularly disheartened by the claims made by
advocates of threads and thermal energy devices I make more of an impact with
Structural Volumizing in a matter of minutes than any thermal energy device
or thread lifting procedure where patients are told to wait four months to
see the benefit of their treatment which still don’t come close to being
comparable to what I do in evaluating a candidate for face of surgery I look at
age as a variable from a perspective of physical health bone structure and
tissue quality I mentioned earlier my oldest facelift patient being 87 years
old when I did her surgery she was physically strong had no medical issues
no medications and she was healthier than people decades younger than her her
bone structure and tissue quality was great as I do for any patient I look at
the face as a whole and provide my patient with a detailed understanding of
all the aspects of the face contributing to them looking not as good as they can
this includes their eyebrows upper eyelids lower eyelids cheekbones chin
jawline and jaw angle as well as the lips in the area around the mouth of
course I look for the presence of jowls and sagging
neck skin can I suggest a strategy based on what I feel will be the most impactful
for their situation I find that it’s often the case that people focus on
something they don’t like such as their neck skin sagging and then they lose
perspective of the areas of the face that are more significant during social
interaction I call this area of social interaction the beauty triangle which
includes the brows eyes cheekbones lips and chin it’s by no accident that the
cosmetic industry creates countless products to enhance these areas in
summary age is a factor for a facelift in the context of health bone structure
and tissue quality most important is to determine what is the best approach to
help you look your best with the lowest risk minimal downtime and the most
benefit I hope you found this information helpful thank you for your