Transform Your Look: Tips on Facelift & Necklift

Welcome to another enlightening episode of The Beauty Scientists Podcast, where Dr. Roy Kim and Dr. Kristy Hamilton delve into the secrets of facelifts and necklifts for achieving timeless beauty. Discover the transformative power of these procedures as they discuss restoring anti-gravity, lost volume, and eliminating excess skin in the face and neck. 

Gain valuable insights into facial analysis, fat grafting techniques, and the longevity of results. Join the conversation as we explore the rising trend of younger patients seeking facial rejuvenation. 

Don't miss out on this expert advice for unlocking your youthful radiance!

#Facelift #Necklift #FacialRejuvenation #CosmeticSurgery #BeautyPodcast #TheBeautyScientists #staybeautiful #YouthfulRadiance #SkinCare #AntiAging #BeautyTips

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Transcript

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the key is after 10 15 years like you said you're not gonna be back where you were plus as if 10 years of aging it happened you're just gonna slowly continue to age from your new set point for the viewers out there we can actually determine the direction of lift and so why is this important the main consideration is who is doing your face lift and do they do a great face lift this is why it's nice to get both but some patients really don't need the brow they may need mainly the eyelid lift Hi this is Doctor Roy Kim as well as my counterpart and partner Doctor Kristy Hamilton and you're gonna be on The Beauty Scientists so today we will be talking about Facelift Necklift sort of an introduction to it including what is a Facelift what is a Necklift what are some of the procedures some of the risks and finally what can enhance it so Doctor Hamilton what exactly is a Facelift? so Facelift and Necklift these are surgical procedures that we do they are geared towards rejuvenating the face and neck so this is the most powerful option we have in our armamentarium so non surgical or surgical this is the pinnacle of facial rejuvenation and I view the operation as addressing three components so one is restoring or anti gravity so we want to restore where the tissues were originally positioned so getting everything up number two is restoring lost volumes we know our facial skeleton shrinks our fat pads shrink and then on top of it our face and the skin and the tissues get lax or loose and so it's almost like we have we have the balloon gets deflated and then the balloon is saggy on top of it so we wanna restore volume and there's a couple ways to do that but fat grafting or fat transfer is favored right now and then secondly we remove additional the extra skin once we've restored and lifted the structure and some individuals will also include a chemical peel or laser resurfacing to a certain degree at the time of their Facelift as well or afterwards that's a great answer and then we'll be getting into the anatomy more of the face in just a second so what is a Necklift as opposed to a Facelift so this is a good question so you know face clearly you don't need to be in in a medicine to know this but we consider this starts at the jawline and neck is everything beneath that and down Dr. Kim do you do face only or neck only or is this something you tend to combine and why yeah it's hard to do only face and it's hard to do only neck because the face as a plastic surgeon we're thinking of the face but also just above the jawline well most patients have a little loose jowl skin they may need the muscles in their neck tightened they need their neck skin tightened that's impossible unless you go down towards the neck the flip side's also true we could do a neck lift that's very isolated and we can drape the skin behind the ear sometimes though you have loose jaw skin or when we tighten the skin behind the ear you have excess skin that sort of pops up in front of your earlobe well the only way to deal with that skin that pops up in front of the earlobe is to actually make an incision in front of the ear and then by definition that's a Facelift so I think that maybe very young patients in their 30s or 40s might get away with isolated procedures like only a face and only a neck but the vast majority of patients do require both at the same time right and generally speaking when people are coming in they have a real reason to have surgery although there is a trend to having a surgery younger we'll talk about that too but you can imagine you don't wanna look like a bobblehead so we you know it limits us we can't create this really tight really dramatic jawline if we're having significant sagging deep folds because we want we want the results to look harmonious we want it to look natural and people don't age in pieces yes so we don't want to have your face look exactly the same and then the you know the face of a 50 year old in the neck of a 30 year old that doesn't make make sense so I agree most most people end up having at least a component of both and I think there's a lot of branding of these procedures with actual names or people I think often times they like saying that they're having a mini lift a mini Facelift or mini Necklift because it makes it feel like it's not as big of an operation but I when I am counseling patients I remember in training seeing people I was like oh we're gonna do it we're gonna see a mini Facelift today curious about that and then I realized oh that was that surgeons like it was still the full Facelift but the patient cause like I'm having a mini Facelift so I think if you're gonna go in for it if you're gonna have the scars which should be beautiful at the end but if you're gonna go in and undergo the whole procedure the recovery then I think you ought to address everything cause you're gonna be making you're gonna be entering the face and neck anyways so Doctor Kim if when we're looking at the anatomy and the structures of the face what are you looking at when you're doing your facial analysis what are you assessing and what do you what are you mainly addressing in the face and Necklift if you're just looking at someone straight on you're looking classically the upper third middle third and lower third of the face so you concerned about brow position whether the patient needs a forehead lift or not you can keep on going down so you can be concerned does this patient need an eyelid lift or not do they need enhancement to the cheek to actually have it lifted or to go forward with just fat grafting to the area and then for the lower third I mean we definitely have jowling but what about the nasolabial fold the marionette line the lips and then boom you're at the mandible already finally you're at the neck so we are worried about loose skin or not making it tight but not too tight and muscle banding is very common here we can eliminate that muscle banding the platysma muscles with the pretty short incision directly underneath the chin but you may need it you may not and it just depends and then when you're looking at the face Doctor Hamilton and the neck I know that I just discussed anatomically looking at it from the front but the deeper structures underneath the skin what are you looking at as well as what are you looking to actually tighten to give the best long lasting result that's a great question so we are looking at the so obviously the quality of the skin we see the platysma muscle that you mentioned before so that's the part when you strain that sticks out and the bands that you're talking about so you wanna make sure that that's nice smooth and tight then you know so fat that's underneath the skin we can address that with a minimally invasive procedure like submental liposuction but often times there's fat that's deeper that's below the platysma muscle so we have the opportunity to address that when we do a neck lift because we're directly looking at it and then some patients have there's other structures some people they have prominent muscles that are underneath this chin area here prominent salivary glands called the submandibular gland so for some some patients those are very prominent as well and that be because that can be because they they they're sagging and kind of herniating outward or it can be just because they're they're big so I don't think those should be removed or addressed in every single patient you also don't wanna make a neck that looks skeletonized but for some patients you're not gonna be able to get as nice of a contour if you're not tightening the strength structures and also removing some of these bulky structures and to toot our own horn we wrote an abstract on how to actually eliminate or diminish these salivary glands of submandibular glands without surgery yes and we looked at injecting Dysport or you can use any neuromodulator like Botox and what we found is that this a very very safe way to shrink the salivary glands without having to surgically remove them because there can be complications associated with that procedure it works really really well and the and interestingly enough we see that after one or maybe two treatments that it doesn't seem to get big again which is nice but you still your salivary function still works although some I had one patient that had a little bit of a dry mouth afterwards but it was temporary that's great yes so it works for those people out there and then when you look at a patient for the upper third like forehead or forehead and eyelid lift how do you figure out like which patient needs a forehead lift versus which patient needs an eyelid lift versus a patient who needs both that's a great question so I start with brow position first that's gonna tell me because you can see if I push my eyebrow down well it looks like I need an eye lift there look at all that extra skin but if I pull the brow up and we for women we like the brow to be about a centimeter above the brow bone or the supraorbital rims you can feel that minimum half center ideally one for men we like the eyebrow to be on the brow bones it's different you can see that looking at yours looks like it's right on the brow bone yes so that's something that can that can tell us if you know it's really eyelid surgery we're talking about or if it's we need to start with the brow lift now after you get the brow in the appropriate position if you still have excess eyelid skin then that can be an indication to go ahead and do upper eyelid surgery and lower eyelids it's usually less about extra skin although there's often some there too and more about fat pads and bulges and patients like to just have a nice smooth under eye area so that's you know the quick version of what I'm looking for for the upper third of the face yeah I totally agree with you totally makes sense and this is why it's nice to get both but some patients really don't need the brow they may need mainly the eyelid lift yeah and some patients will say hey I understand what you're talking about that the brow lift would help I'm okay with having a little bit of a longer scar in the eyelid crease and I'm gonna go for that kind of simpler recovery and that's that's fair too I just think it's important to inform the patients and then they can they can choose yeah totally agree and okay let's talk about kinds of face lifts because this is one of you know lots of the techniques that we do are kind of internal like plastic surgeon a plastic surgeon we talk about them so we can communicate about what we're doing when we're talking to colleagues think the SMAS face lift VS the Deep Plane that actually got popularized on social media and patients actually come in knowing about this that they don't think they have necessarily a deep knowledge of it some do what do you think about the different kinds of Facelifts is one superior what do you think I think you know as as background one thing we mentioned is the SMAS S-M-A-S so obviously we all have skin and we're not tightening skin only yes we're tightening this skin we're trimming some skin but if you just did the skin Facelift which is what they did in the 60s and earlier results look great for about a year it will fade so then in the 70s they discovered SMAS Superficial Musculo Aponeurotic System which essentially is the fascia of the facial structures so if you tighten that stuff up I mean you get a much better result as well as a longer lasting result so what Doctor Hamilton is describing and what we'll go into detail of course is okay we can identify the SMAS we need to remove some of it slash tighten it slash suture it onto itself slash go under it and tighten it some more what's the best way to do it and this is where deep plane comes to the social media knowledge because deep plane is from honestly like the late 80s and 90s and then it fell out of favor and now it's coming back in the favor and really all deep plane means is you're going underneath the SMAS in an area that's maybe a little more medial in other words going towards that direction than what a lot of people do and depending on how it's accessed and how it's tightened you can start arguing about whether it's true deep plane or not so there you have it so there's a lot of lingo and these things tend to be very very circular we see that a lot we see it with like threads in this case Facelifting so a lot of these concept you know human facial anatomy hasn't changed right decade to decade so sometimes it's almost like we're as a community like rediscovering things or different techniques so if you go back far enough it's worth taking a look because you'll find that some of our predecessors may have already answered these questions for us so there have been studies perform Doctor Rohrich likes to site this one where they you know they look at both techniques and you can have a great long lasting outcomes with both the main consideration is who is doing your Facelift and do they do a great Facelift so I would say mainly surgeon dependent rather than technique dependent I think jury still out on what the ultimate best technique is so we'll see we'll see if we go full circle again yes and then for the viewers out there we can actually determine the direction of lift and so why is this important we can actually yes we wanna go up but if you go 100% vertical it looks a little odd we want to tighten the skin to the side but again if you go 100% horizontal you have that beautiful wind swept tunnel look which nobody wants it has to be at an angled vector you know at an angle not 100% up not 100% sideways what's that angle as Doctor Rohrich says the anatomy is always the same every patient's different so what's best for you I can't tell you what the angle is because I have to do it in the operating room and figure out the best angle for you to tighten up the SMAS underneath the skin so that you look rejuvenated but you don't look odd do you have any opinions as to like the best angle or the best way to do it or anything like that well I agree as I get even when you look at people's faces like you'll see like one side is different than the other so it's not uncommon to even have slightly different vectors usually not widely different vectors but slightly different vectors on either side of the face because we all have a shorter wider side and a taller thinner side and if you take a a true front facing image and cut that picture in half and then transpose it and you can see what you look like with two left sides of your face kind of flipped and two right sides of your face flipped and you'll see you look like two completely different people so that's a that's a really good point so I think we're always we're tailoring it and I'm looking at it in real time in the operating room and also following the marks that I make on the patient's face before I start to try to create as much symmetry as as we possibly can what are the main risks of Facelift and Necklift yeah I think the biggest things we're concerned about are bleeding and the nerve so interestingly I don't think infection is a big concern because the bleeding so good if there's good blood flow there's less risk of infection well the problem is the face is such awesome blood flow that this is what we worry about we wanna control your blood pressure make sure you're not on any blood thinners make sure as surgeons when we're operating everything is dried up there's no bleeding at all before closing it and that way you don't have a hematoma after surgery the other big risk of course is that we have the facial nerve the nerve that gives us animation or emotion it's sort of rare to have very difficult to actually ding the actual facial nerve it's more concern of dinging or potentially damaging branches of the facial nerve which is why knowledge of anatomy is so important and avoiding the branches or where they are is the best way to prevent this from happening yes so you can have weakness afterwards it's it's it's rare to have like complete paralysis after but sometimes people feel like their mouth feels a little bit funny afterwards or they're smiling a little bit broader on one side versus the other and most of the time it's just that the nerve maybe it's been like stretched or something like that and so just needs a little bit of time to come back to life but rarely you can have paralysis and that of course is a major complication and a little bit higher risk with the deep plane cause you're closer to that nerve so you need to really be you can absolutely do the surgery safely you can do both both styles safely but you just you need to know your anatomy you need to know where you are so very common question we get asked about every surgery we do but how long does a good Facelift last I think weirdly enough we're finding out that it depends on your body how much you take care of your skin and how much you take care of yourself but I think it should last about 10 to 15 years and this also assumes that you don't gain 75 pounds and lose 75 pounds you actually protect your skin from the sun you have not decided to pack you know smoke two packs a day after surgery of cigarettes or whatever assuming you do all the good things it will last a pretty long time it's actually one of the more cost effective procedures amazingly enough in aesthetic surgery so do you have any hints for patients on how to maintain their Facelift yeah so I completely agree so beyond the genetic results are the gene component just like your own like tissue qualities which if you're blessed to have that that's great I completely agree with lifestyles with no sugar, high sugar consumption is terrible for skin drinking is terrible for your skin your size is great for your skin and healthy living so eating a rich balanced diet wearing sunscreen everyday not going out too much in the sun all those things are gonna help and then I would be doing procedures like we talked about there are so many things that you can do afterwards to enhance and maintain your surgical results so whether that's resurfacing resurfacing lasers micro needling doing like chemical peels to get rid of the sun damage Botox and then you know as volume loss continues conservative filler injections those are all a great ways to keep your face looking youthful in balance because it's not that aging won't continue right we always they were resetting the clock with your face lift or your breast lift or whatever it may be but it time will march on the key is after 10 15 years like you said you're not gonna be back where you were plus as if 10 years of aging had happened you're just gonna slowly continue to age from your new set point yeah one of the things we should talk about is the increasing use or pretty much all the time of fat so fat grating through the face is a newer concept let's say past five or 10 years but now I I'm doing all the time I know you are as well any hints on where to place the fat or how the fat is prepared or all that good stuff when you're doing facial and neck rejuvenation I like to take the fat from the inner thigh it's got a really high stem cell concentration other areas like the lower abdomen also one of the higher adipose stem cell concentrations on the body I think the inner thigh fat is kind of mimics like facial fat in a lot of ways it's soft and malleable not doesn't have a lot of fibrous tissues I like it there and then where I graft is very dependent on again the face so I like to see nice full but not overly full cheeks I'll do the entire jawline if the patient has a smaller chin I'll put it there temples are a big area that's one of those places that patients don't necessarily notice but by themselves but if you have a little bit of a peanut shape volume loss there that's one of those areas that makes you look older even though you may not realize it if you have volume loss around the eyes I'll put a little bit in the tear trough even in the eye socket area nasolabial folds I put it basically everywhere across the face except for the lips yeah that I reserve reserve lip fillers for patients want a fuller lips or maybe a lip lift if it's appropriate yeah so essentially we're you're giving it the same place as I'm giving it everywhere in the face because it actually yes it gives you volume but stem cells just in case of for those of you out there stem cells turn into other types of cells so if you put stem cells into an area where there's usually fat the stem cell should turn into more youthful fat cells and it seems to not just give volume it actually rejuvenates the skin it actually makes your skin glow and look better after fat grafting and that's what we want right because that's another component of this so we talk about is okay so the face lift is going to restore like the structural component of the face we want it to look right but we also want everything to look very harmonious right so we want the quality of the skin also to match the structure of your horribly sun damaged skin from a lifetime of sun worshipping and then you have now this like nice taut jawline that doesn't necessarily make sense either so it's nice to have the fat grafting to help with the quality of the skin and then also for patients like that not on the sides of the face but certainly centrally and in the forehead I'll do laser resurfacing at the same time yeah and the final touch of course is we can tighten skin we can do a lot of things for the structures underneath the face but we actually sadly cannot improve skin quality of the face after we're done with all this stuff so I know that I use chemical peels I have used laser what do you like to do after the final end of the procedure or maybe just focus on surgery and then do facial resurfacing in the future in the near future I love to do central laser resurfacing so eyelids nose central face I kind of feather it out to the sides I don't go aggressively on the sides I'll do the forehead aggressively especially for not doing the lift at the same time and so I think that's a great opportunity you're gonna be at home recovering from this anyway so great time to do the laser as well and if patients choose not to or even if they do do it during surgery then we can do a more aggressive one three months later or when the patients ready including the entire face and the sides and the neck as well and I think that is a beautiful way like cherry on top to complete your facial rejuvenation yeah and for the viewers and listeners out there the reason why we're not giving it all the way to the skin edge or to the sides is because we're concerned about blood flow and healing after surgery so I don't think anybody really does hey let's blast it with a maximum amount of power right at the skin edge to rejuvenate the skin we don't do that because we're worried about blood flow and healing right and you have to think about if you're lifting up that area you're cutting underneath it then you're gonna blast it from the outer service in the skin for some patients really really thin so you have to know your patient know what also like their skin type and quality and then adjust their laser treatments and where you're treating whether it's a laser or chemical peel yeah good point and this is what we were concerned about with all of our patients yes always yes blood supply well I don't have any other topics or questions do you have any other topics you wanna bring up with the Facelift Necklift no I think it's just it's a very powerful operation it is the epitome of facial rejuvenation the final comment I would say is that patients are starting to do these surgeries a little bit younger I think we'll see more of that especially with the weight loss that we're seeing secondary to Ozempic and Munjaro and all these other other drugs so we're seeing younger people that have lost a lot of weight and then now have significant laxity in their face same concept you know the balloon has popped and so you can't exercise skin away so I think we'll be doing more and more of that and then I think there's also a trend towards just earlier intervention if even if you're not a massive weight loss patient just so that you're not unveiling this dramatic change you're just looking like those Hollywood stars that just seem to stay the same always and in fact kind of get better yes aging like a fine wine and then we all know at least you and I know that if you get a smaller procedure you're gonna have a less noticeable difference which is what a lot of people want a lot faster recovery actually probably a little less pain if you're older and you need a much bigger procedure well it's gonna take longer you can have more swelling more potential bruising and it will just be a lot more noticeable in a good way but it will definitely be more noticeable to your family and friends yeah so there will no hiding it then right then clearly happen haha well as always a great topic a fun filled discussion and thanks so much for joining me Doctor Hamilton for The Beauty Scientists and as always for all the viewers and listeners out there if you have any questions let us know and definitely stay beautiful stay beautiful