Chicago — Every facelift should be different because every face is different.
"Surgeons tend to become comfortable with one technique and then that's all they do. But we have to get away from that and move on to a more individualized approach to facelift," Dr. Rohrich says.Dr. Rohrich is chairman of the department of plastic surgery at the University of Texas, Southwestern Medical Center, Dallas. He addressed total facial rejuvenation here at the American Society of Plastic Surgeons' Plastic Surgery 2005.
The keys to today's facelift, according to Dr. Rohrich, are having a solid knowledge of facial anatomy to minimize the chance of damaging the facial nerves and operating on only healthy non-smokers.
"The risk of complications is five-fold in smokers," Dr. Rohrich points out, "so patient selection plays a big role in this."
"Many times a facelift leaves a person with a tight face and wrinkled lips that still look like they're 70 years old," Dr. Rohrich says. "That's a telltale sign of incomplete facial rejuvenation."
Sometimes facial rejuvenation should include rhinoplasty as well, Dr. Rohrich tells Cosmetic Surgery Times.
"If you've done this beautiful facelift and rejuvenated the eyes and the mouth and you leave the droopy nose, the patient will still look like an old person. So you have to consider rejuvenating the entire face if you really want to make a difference in those patients, and that's where preoperative facial analysis is so critical."
The single surgical pearl that Dr. Rohrich recommends to surgeons who are moving away from traditional facelift and toward total facial rejuvenation is the use of a combination SMASectomy and SMAS plication in combination with selective facial augmentation in the cheek and nasal labial fold area.
"These are safe, effective deep layer techniques that add longevity but also restore facial shape," Dr. Rohrich says. "So you're not only restoring facial shape, you're lifting and you're filling."
"You can do all of these things at once in four to five hours with a recovery of about two weeks, or you can do them in stages," he says. It depends on the patient.
Total facial rejuvenation requires upkeep. "You can turn the clock back, but you can't stop it," Dr. Rohrich notes. "Obviously these fillers last months and not years — which is what you want in the lips," he says. So the patient eventually will require preventative maintenance.
But, he adds, his patients don't mind (repeat procedures) because in America today people simply want to look younger than they actually are.
"A decade ago, the average age of a person requesting a facelift was in the 60s. Today the typical patient is in their 50s or late 40s," Dr. Rohrich says. "People want to look as good as they feel, and they don't want to age gracefully."