Facelift in Atlanta, GA

When you think about having a facelift, you want to have a facelift that has natural results. You want to have no or very little scarring. You want to have minimal downtime and long-lasting results. And in my opinion, to get that combination, if you do it from the InsideOut™ approach, you're going to have essentially no scars that are visible. You're going to have a relatively quick recovery. You're going to have a long-lasting result because I free all the attachment areas and recontour before it's reset. I think the best result, the longest lasting, most natural, is an InsideOut™ approach using an endoscope and using areas to access the face that are not visible after you recover from surgery.

The recovery from an endoscopic facelift is less time than a traditional facelift because you're not disrupting a large vascular area and you're keeping the tissues intact. So if you go through a small incision with an endoscope and you're working on that tissue, but the skin is not disrupted, that's where the supply of blood comes from, the skin and the fatty layer that does not get disrupted with an endoscopic approach. So I tell people that the minimum to get back full steam ahead is about two weeks and I prefer for people to take three weeks for endoscopic facelift recovery.

When we talk about scars, what we mean is it's something visible or kind of distorted. Technically, when you have an incision, you always have a scar. But if a tissue has tension on it, it's going to give a noticeable scar. So you can see facelift scars if you know where to look for them. The area that's the most distorted is right in front of the ear. And a lot of people know that if you look in front of the ear or in back of the ear or even at the temple hairline or posterior neck hairline, you might see a facelift scar.

Scars will improve over time, but the scar will always be present. It goes through some color changes. In the beginning, it's a little red because it has extra blood flow. And then it starts to fade out. And at the end, hopefully you'll have pigmentation that matches the other pigmentation. If there's a little faded area because of loss of pigmentation, it's going to be more noticeable. That's why if you can avoid a scar, it's always the best.

A traditional facelift involves an incision right by the sideburn area, in front of the ear, around the ear, and back in the hairline around the ear. I recently did a presentation where it's shown that that's about 70 centimeters. If you do a non-traditional facelift, what I call a no-scar technique, then you can hide incisions and it's only about 7 centimeters. So it highly depends on the type of facelift that you have as to where the scars are going to actually be.

After a facelift, the wound will go through predictable stages of wound healing. And whether you have a one inch incision or a 10 inch incision, you still go through the different stages of wound healing. The wound will be a little pink in the beginning, and then it will start to fade, and it will actually look its best at about a year. The reason that most doctors don't recommend any further enhancements or touch-ups or adjustments for at least six months is because of the scar maturation process. So everything does look better with time. If you have an unsightly scar, that's a different situation that could actually look worse over time. So the real key is a facelift that has either good scars or has hidden scars. Obviously, a hidden scar in the hairline or in the hair is always better than a visible scar.

The goal of an excellent facelift is to be able to put your hair up and wear it so you cannot see the scars. Unfortunately, with a traditional facelift, you have distortion of the earlobe and you have scars in front and behind your ears. So you want to try to find a surgeon that does an advanced approach where you can wear your hair up and not see any scars. That's not typical, but it is available.

A deep plane facelift is a facelift that goes right to where the attention is causing all the aging. It's like that old joke, I think it might have been Willie Sutton's, why do you rob banks? And he's like, well, that's where all the money is. It's the same thing with a deep plane facelift. Back around the ear is skin, but in the front of the face is where all the action is. So a deep plane facelift goes to the angle of the jaw and then dives under the deep area. The only challenge with it is you have to really know the advanced anatomy and have a lot of skill, because technically it's more difficult. If you look at the statistics, about 97 to 98 percent of facelifts done by surgeons in the U.S. is what's called a SMAS, S-M-A-S facelift, which is not a deep plane facelift. So a deep plane facelift gives the smoothest, best results. And the reason it does is the skin and the fatty layer underneath don't get separated. With the traditional facelift and a SMAS tightening, you separate the skin from the fatty layer. And so you disrupt that vascular plexus. So if you disrupt the vascular area, you're going to have more trouble healing. So deep plane is definitely the way to go. And that's what I would certainly do if I was operating on a family member.

A deep plane approach traditionally involves making an incision in front of the ear and going over in the skin area and then going deep into the facial tissues. With newer more advanced techniques, you can actually do all of that endoscopically and through an InsideOut™ approach, you can loosen the ligaments through the mouth area so that there's no scar and I can come in through the hair area where again there's no scar. So you literally have no scar in front of your ear and no scar in the back of your ear at the posterior hairline.

The most natural looking facelift is where you take your tissues that have changed primarily because of gravity and we put your own tissues back where they belong. To do that, we have to release some facial ligaments, then we have to re-contour the face, and then we have to anchor it and set it in place. So the best thing to do is to release the tissues, to re-contour, and to reset. And you want to do that with the least amount of incision sites. If you approach things from the InsideOut™, you can do 85% of the work from the inside tissues so you do not have a scar. And in my opinion, that's the best way to do a facelift.

The facelift of today is not the facelift that your mom and your grandmother did. People are having it done younger and younger because we've been able to see with anatomy the younger that you have a procedure, the more natural it looks and the longer it lasts. It used to be facelifts lasted five, eight, maybe ten years. Now they can last 20 years, 25 years because people are doing it younger. It's kind of what we have termed prejuvenation instead of rejuvenation. Sometimes you don't wait and have this one big facelift and it's noticeable and we've all seen people where you kind of say, wow, do they look different and hopefully they look better, but a lot of times they only look different. If you have it done earlier, it looks more natural, it lasts longer. So I have people that are having facelifts routinely in their 40s and that's actually an ideal age to do it, 40s and 50s.