Facelift Surgeries

Men of different ages with different issues come to me in consultation to discuss facial rejuvenation. There is no “just right” time to do something, and there is no critical threshold beyond which all of a sudden your tissues need to be lifted. It is all in what you see.

I have great respect for all of the different concerns, impressions, and complaints that more than justify seeking consultation, and I am pleased and privileged to be help you with this issue.

Men have a variety of issues and a variety of different anatomic features that make evaluation and planning for facial rejuvenation a completely personalized and customized process for each patient. There is no one basic intervention that should be promoted to “fit all.” Men notice fine wrinkle lines, sagging eyebrows, folds and furrows between the eyebrows, and folds and furrows at the laugh lines. Bigger issues become loose, hanging skin in the neck (turkey neck) or in the jowls. The complaint of fat in the face and neck associated with hanging skin is often cited. The cheeks may droop and the corners of the mouth may droop and look sad. Others say, “I just look old” or “My face is falling” or “I am beginning to look like my parents and I hate that.” The anatomy of the face that I systematically evaluate with each patient may be thought of in layers. First there is the bony foundation, which gives structure to the cheekbones and determines the width and the height of the face and jaw-line. Second, the overlying muscles and ligaments are above the bony layer. Third, separating these structures from the overlying skin is a fatty layer of variable thickness. Fourth, there is a complex network of ligaments (called the SMAS) that connects the muscle system to the skin to modulate and impart the extremely fine and subtle movements that make our expressions and features so particular. Fifth, there is the skin layer with its dermis (layer containing collagen and elastic fibers) and its inherent elasticity, or lack thereof. Rejuvenation occurs at any of these layers and to various extents. These interrelated areas—as well as your hair, hairline, hairstyle, and ears—are all so intimately associated with each other that there are many different anatomic features which must be analyzed and addressed prior to your surgery. I will coordinate the features of your anatomy with your expectations, formulate a plan with you, and guide you through this process.

There is a well-defined spectrum of specific techniques for facelift surgery that addresses the anatomy and the actions to be taken on each layer mentioned above, and I will explain and illustrate all of the techniques to you. Surgery involves a light general anesthetic and is performed where I do surgery, which is in a hospital setting and using an expert MD anesthesiologist. There is an incision, customized to your features and what we want to achieve, that is just hidden in your temporal hairline and side burn, in and out of the ear, and behind the ear for a tailored length. The surgery is safe and predictable. All of the stitches are small and removed in four to seven days. You can return to work in as little as five to seven days and to some physical exercise in the second week. The spectrum of facial rejuvenation and surgery that I offer in my practice is:

• Facelift Surgery: This is the standard and latest state-of-the-art technique of addressing your bony foundation if needed, removing and repositioning any excess or displaced fat, tightening the muscles and ligaments, and removing excess skin. Fat grafting may occur if needed.
• Mini Facelift Surgery: This is same as the above but less involved and performed through a shorter incision.
• Suture Facelift: This occurs in those patients who need only a certain lift along certain vectors. The only incision is in the hairline, where a special suture is placed down to the sagging tissues in order to lift them.
• Other Facelifts: Depending on your specific anatomy, we may want to consider the Vertical Facelift, the Midface Lift, and the Weekend Lift. These depend on your vectors of laxity and the features involved.

To learn more, you can also review Dr. Romano’s article on facelift surgery in the Educational Articles section of the website.