William Truswell, MD, is a facial plastic surgeon and the founder and director of the Aesthetic Laser and Cosmetic Surgery Center. He is a coauthor of The Non-Surgical Facelift Book. He lives in Northampton, Massachusetts. Neil Gordon, MD, is a facial plastic surgeon and a clinical faculty member in the department of surgery at Yale University School of Medicine. He lives in Greenwich, Connecticut. Jon Mendelson, MD, is a facial plastic surgeon and coauthor of The Non-Surgical Facelift Book. He lives in Cincinnati, Ohio. David A. F. Ellis, MD, is is a Professor at the Department of Otolaryngology at the University of Toronto and the president of the Canadian Academy of Facial Plastic Surgery. He lives in Toronto, Ontario. Harrison C. Putman, III, MD, is an expert in the fields of both cosmetic and reconstructive facial surgery. He lives in Peoria, Illinois.

Your Complete Guide to Facial Rejuvenation

By William Truswell, Neil A. Gordon, Jon Mendelsohn, David A.F. Ellis, Harrison C. Putman III, Jack Kusler

Addicus Books, Inc.

Copyright © 2007 William Truswell, M.D.; Jon Mendelsohn, M.D.; Harrison C. Putman III, M.D.; David A. F. Ellis, M.D.; and Neil A. Gordon, M.D.
All rights reserved.
ISBN: 978-1-886039-20-9

Contents

Acknowledgments,
Introduction,
1 A Change of Face: How We Age,
2 Choosing a Cosmetic Surgeon,
3 Preparing for Facelift Surgery,
4 The Standard Facelift,
5 The Deep-plane Lift,
6 The Midface Lift,
7 The Thread Lift,
8 The Mini Facelift,
9 Lip Augmentation and Facial Implants,
10 Eyelid Lifts and Brow Lifts,
11 Skin Rejuvenation,
Glossary,
Resources,
Index,
About the Authors,

CHAPTER 1

A Change of Face: How We Age

When you look into a mirror, do you like what you see? If you don't, give yourself an "instant facelift." Place your fingers beneath your jaw or at the hairline and give your face a gentle tug. For a moment, your younger self will peer back at you. Frown lines will be smoothed away, crow's-feet will have taken flight, and your cheeks will look higher and firmer.

What happens when you release your fingers? Do you see the effects of gravity — some sag in the skin, some wrinkles, or folds, a bit of a tired look? The corners of your mouth may have turned down, eliminating your former natural, youthful smile. The years may have etched lines on your face, making you look older than you actually feel.

Don't despair. Like thousands of individuals who have experienced the same feelings, you may be able to reclaim your younger beauty by seeking facial rejuvenation. Every year more than 100,000 people, 85 percent of them women, choose to have facelifts and other techniques to counter the effects of aging. If the instant facelift made you look and feel younger even momentarily, then you, too, may want to consider a facelift.

Signs of Facial Aging

Eyelids

The eyelids are often the first harbingers of aging. Extra skin in upper and lower lids and bagginess under the eyes may become noticeable. We start to notice wrinkles, crow's-feet, at the corners of the eyes. We will also see wrinkles starting to develop across the forehead and between the eyes.

The area just below the lower lid may become discolored, turning a light gray, green, or brown. In very fair-skinned people, the thinning skin's transparency reveals vascular and muscle tissue beneath. This coloration isn't fixed by surgery, but it can be disguised with cosmetics.

Cheeks and Midface

Some of the earliest signs of aging occur in the midface region when the malar fat pads — the pads of fat that cover our cheekbones — begin to slide downward. When we are young, these fat pads sit on the upper cheekbones, creating a fullness to the cheeks and the regions under the eyes. However, as these pads begin to sag with age, they produce a number of changes in the face. We notice a hollowing under the eyes and in the upper cheeks; the nasolabial folds deepen (these are the creases that run from each side of the nose to the corners of the mouth); and the corners of the mouth start to turn downward. These changes typically create a tired look.

Jawline

As we get older, the skin and soft tissue along the jawline sags, becoming loose and thin. Sooner or later we develop jowls, excess fat and skin below the jawline, which "washes" away the middle third of the jawline.

Neck

As we age, loose skin droops between the thin muscles, the platysma muscles, of the neck. These muscles also droop with the skin, often appearing as bands or chords of loose skin. These bands are masked by fat in individuals with heavy necks.

Surface Changes in Skin

The outermost layer of our skin, composed of dead cells, is called the stratum corneum. As we age, the composition of this layer of surface skin changes. In our teens and twenties, every time we wash, this outermost layer comes off, leaving a fresh new surface. However, around age thirty, the stratum corneum becomes "sticky" and those dead cells begin to adhere. Pores open wider and look larger; wrinkles and discolorations appear. The skin dries and becomes thinner. Facial skin loses its youthful, translucent depth and glow and takes on a flat, matted look.

Why Your Face Ages

There are extrinsic and intrinsic reasons why skin ages, and the distinction between them is important. The intrinsic causes relate to gravity and your genes, things that cannot be controlled. The extrinsic causes, which can be controlled, include such things as sun exposure, tobacco use, weight fluctuations, stress, chronic illness, exposure to harsh climates, alcohol consumption, and poor nutrition.

What You Can't Change

Genes

The rate at which our skin and soft tissue ages is affected by our genes. You've probably noticed some people seem to have fewer wrinkles and firmer-looking skin than other people their age. This may be partly due to their genetics. Sometimes an entire family will retain an unusually youthful appearance. In other cases, the "family face" might keep pace right along with the calendar.

Cell Breakdown

As we grow older, connective tissues in the dermis, a layer of tissues below the skin, begin to break down, and cells aren't able to repair themselves as quickly as they did when we were younger. The connections between our bone structure and the soft tissue loosen and cause the facial tissue to droop. The production of both collagen, the main protein of skin tissue, and elastin, a stretchable protein, diminishes. As collagen production diminishes, our skin begins to droop and wrinkle.

There are two types of wrinkles. Static wrinkles are visible when the face is at rest. Dynamic wrinkles are those we see only when the face moves, such as smile lines that aren't deeply carved. We also lose muscle volume and tone as we age, which contributes to sagging.

What You Can Change

Exposure to Sun

Excessive sun exposure is the number one cause of premature aging. Early wrinkling and "age spots," known as photoaging and solar lentigos, are signs that skin has not been adequately protected from the sun. You can't undo damage that occurred in your younger years, but you can start now to protect your skin from further damage by the regular use of sunscreen and other protection from the sun's UVA rays. These rays penetrate most deeply and are most closely associated with premature aging.

Every day, year-round, apply full-spectrum sunscreen (SPF 15 or higher), and avoid exposure during the midday hours when the sun's rays reach Earth most directly. For about ten minutes a day, however, do let sunlight reach unprotected skin, because sun on skin triggers the body's production of vitamin D, which is crucial for bone growth.

Remember that, in addition to the sun, harsh weather such as wind and cold can also age skin that is not well protected and regularly moisturized.

Smoking

Smoking is harmful to every organ in your body, including your skin — the body's largest organ. Smoking causes lung cancer, heart disease, and other ailments. It also decreases the flow of blood and oxygen to your entire body, including your facial skin, thus starving your skin of nutrients. For...