The aging process of the face is expressed in looseness and sagging of the skin and deep tissues, as well as loss of volume in both the fatty tissues and the bones of the face. Alternatively, fatty tissue sometimes concentrates in the central area underneath the chin, and plays a part in the formation of a double-chin and sagging of the neck.
This aging process contributes to the appearance and exaggeration of existing wrinkles, especially in the area underneath the lower eyelids, the corners of the mouth, and the loss of lines of definition of the lower jaw. The skin itself becomes thinner and the superficial blood vessels expand, compounded by damage from the sun, appearing as dark or reddish spots. Aging of the skin is also accelerated by long-term smoking, various medications, hormonal changes, and emotional tension, as well as individual genetic determinants.
The main purpose of surgery is to return the former structures of the face, and create a younger appearance. Therefore a “face lift” is performed, as opposed to stretching the skin. Additional goals of the surgery include regaining the bulk of the face, primarily in the center of the face, as well as removal of surplus fat from the area of the chin and neck, and removal of excess skin. It is important to note that the procedure improves the appearance of the skin by spreading it over the deep skin layers that have been raised, but does not directly treat the quality of the skin.
The surgical incision is made at the hairline and continues around the ear and into the hair. The length of the incision varies depending on the degree of lifting desired and the amount of excess skin, and can be even shorter, in a procedure called a mini face lift. This incision enables the exposure of the enveloping layer over the muscles of the face, the superficial muscular aponeurotic system (SMAS) which is raised with internal stitches anchored from above. The neck and the chin are treated as necessary by suctioning the excess fat and tightening the superficial muscles of the neck (platysma), which create prominent folds of skin in the center of the aging neck. This tightening of the neck muscles is performed when necessary by way of a small incision beneath the chin.
Rejuvenation of the face is not complete without the restoration of missing volume, by way of injecting the patient’s own fat. Injected fat is suctioned from areas such as the lower abdominal wall, the waist, or the thighs, and injected after being prepared, by way of a special cannula using a technique which increases the chances that the fat cells will be accepted.
The forehead is treated within the framework of the surgery on the face and neck where, in addition to the horizontal wrinkles, it is necessary to lift the eyebrows and treat the expressive wrinkles between the eyebrows. The incision that enables easy access without need for special equipment is at the hairline. The skin of the forehead is separated from the underlying muscle layer, which enables stretching and effacing of expressive wrinkles while raising the eyebrows, and direct work on the expressive muscles of the forehead, and the muscles between the eyebrows. These muscles are weakened or disconnected, preventing the recurrence of expressive wrinkles where the patient is willing to forego movement of the forehead and eyebrows. The surgical incision is made 1-2 millimeters behind the hairline, such that, upon recovery, the hair will grow through the scar and help hide it, without damaging the hair itself. In men whose hairline does not permit such an incision, it is possible to perform a raising of the forehead by use of an endoscopic device or by a direct raising of the forehead and eyebrows, performed by making the incision in one of the horizontal expressive wrinkles.
Dr. Aharon Amir: Face Lift