Plastic Surgery Facelift Alternatives, Older Philosophies, and New Alternatives

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Plastic surgery's face lift approach and philosophy of facial rejuvenation in general has been based on a reductive philosophy. The results can be unnatural with these techniques. There are incision less facelift alternatives that can achieve natural and less invasive results.

Plastic Surgery in the past has concentrated on the philosophy of reduction. What this means is that Plastic Surgeons typically approached facial rejuvenation by reducing and taking away tissue. This definitely leads to a tighter look. But sometimes these results have made people who have received plastic surgery look like they had something done. The question is why that occurs.

As you age, the process is really dominated by a volume loss. You lose volume all throughout the face. But what it appears to others though is that you are dropping or sagging. How does this happen? Well, as you lose volume, the skin and tissues are no longer pushed forward away from the facial skeleton. Without this volume support, the only way for the tissues to move is down. So, in the past, plastic surgeons would see this drooping and would try to correct by lifting and cutting away tissue. This is also compounded by the fact that plastic surgeons were surgeons. Meaning that, surgeons have been trained all of these years on the art of cutting and surgical techniques. Naturally, they had a predilection to cutting things away. This is the genesis of the reductive philosophy in plastic surgery.

Why is this approach not natural? There is an easier way to think of the answer to this question. Your aging is analogous to a grape and it's transition to a raisin. This process has a lot of volume changes. The grape is the volumized version of the raisin. Plastic surgery has traditionally approached facial rejuvenation by making this raisin into a smaller raisin. They made incisions in the deepest part of the raisin's wrinkle and the then excised the skin of the grape to make things tighter. As you can start to see, the raisin that has gone through this approach can never really look like the grape it once was without some type of addition to the volume of the raisin.

We are progressing in our understanding of facial rejuvenation and the above ideas are central to this change in thought. Volumizing is playing a major part in this improvement of our approaches. It began with fillers in the 1990's. The nasolabial folds were the first areas to be volumized. Collagen started the trend where Restylane now dominates. This technique then began to be applied to other areas of the face such as the marionette lines (lines inferior to the corner of the mouth), lower eyelid hollows and bags, and the rest of the face. Because of the temporary results that you get from restylane (6 months to a year at best), other options began to surface and resurface. Longer acting fillers include radiesse (a natural bone product made up of calcium hydroxyapatite), artefill (polymethylmethacrylate microspheres), sculptra (poly L lactic acid). Most of the results obtained by the longer acting fillers are like restylane but can last much longer. What has been found, though, is that the longer acting fillers eventually do lose volume over a year but the actual materials can persist for longer. Part of the reason why is due to the carrier.

molecule that becomes absorbed. With this absorption, the results also wane. Silicone has been used as injectable filler, but the results are variable from good to disastrous.

As I mentioned, other options began to resurface as well. With this new idea on facial volumization for more natural results, fat transfer began to make a comeback. The process includes harvesting fat from another part of your body and then it is refined and injected into various parts of the face. The results from fat grafting the face can be amazing. The main issue with fat grafting is finding the most optimal technique to achieve the most reliable fat survival. Consistency has been a major challenge. There are many steps with fat grafting that can play a role on the fat's survival. It has been difficult to study every aspect of those steps. But research is ongoing. The plastic surgery community is doing all that it can to find the best alternatives including fat grafting and volumizing the face. In terms of fat grafting, there are many ways to approach it. Just as many different artists will draw a face in an infinite amount of varying ways, so too will a plastic surgeon volumize a face in a different way. The Young Volumizer is an amazing approach to volumizing the face.

Other alternatives to volumizing the face is the use of facial implants. Facial implants are most commonly placed in the chin, and cheeks. Implants for the rest of the face have been used but with less frequency. Implants, however, require a significant surgical procedure to place them in the face which many people are not excited about. This is one of the reasons that fat grafting has taken such a big part of the stage in natural facial rejuvenation through volumizing.

This article is written by Dr. Philip Young M.D. the recipient of the Sir Harold DelfGillies Award from the American Academy of Facial Plastic and Reconstructive Surgery. He went to Tulane Medical School. He completed his residency in Head and Neck Surgery at the University of Southern California. His fellowship traiing in Facial Plastic and Reconstructive Surgery was done in Shreveport, Louisiana. He currently practices Plastic Surgery in Bellevue, Washington.

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