Starting young

TORONTO, CANADA — Younger patients can benefit from maintenance facelift surgery that will postpone the effects of aging later in life, says a San Francisco-based plastic surgeon. Speaking at the 37th annual Toronto Aesthetic Surgery Symposium, Timothy J. Marten, M.D., F.A.C.S., explained that younger patients achieve a superior outcome by undergoing a complete facelift than by undergoing individual procedures to improve their appearance.

"It's like painting one wall in a room and not painting the other walls," Dr. Marten tells Cosmetic Surgery Times. "If they undergo procedures in a piecemeal fashion, it takes more time to recover from procedures individually than to undergo a facelift."

That said, there isn't a consensus on how to manage younger patients who are seeking facial rejuvenation, according to Dr. Marten.

FAILED FAD Dr. Marten also points out that removing fat can make patients in their 30s and 40s look tired, haggard and even ill. Patients who sought the extraction of buccal fat to achieve the prevailing aesthetic trend of the 1990s are now looking for cosmetic assistance to restore fullness to their face. "Young women had the buccal fat or fat pads in their cheeks taken out to achieve the 'heroin chic' look with sunken cheeks," he says. "Buccal fat is still being removed by dermatologists and surgeons, but there is a trend away from it. I think it creates an objectionable appearance, and it has backfired. Many of us are now putting fat back into the face."

String suture lifts have also been offered to young patients, but the initial improvement does not last beyond a year or two, and patients relapse to their original appearance, says Dr. Marten. "It's another technique that has failed younger patients," he says, adding the use of lasers and surface treatments to the list of procedures that fails to turn back the clock for younger patients. "It's appealing to have a few small procedures recommended because they sound simple with a quick recovery, but that is an illusion. Most fail to address the problems that young patients have. It's easier to take two weeks off and be done with the complete procedure rather than taking days off here and there for individual procedures." By the time individuals enter their late 30s, there are some signs of aging that can be corrected such as sagging of deep facial tissue and loss of facial contour, jowl formation, loss of jawline, infraorbital hollowing, and cheek fattening. In addition, varying degrees of forehead ptosis and loss of neck contour can be present, as well as skin wrinkling and skin laxity.

"Younger women usually have a microform of the same problems that older women have," explains Dr. Marten. "Their whole face ages, and not just part of their face. My contention is that they should be treated by a very skillful and informed surgeon who would perform procedures that would address an older patient's problems such as an early facelift and formal neck lift," he stresses. "We need to address all aspects of aging."

SMAS SOLUTION In contrast to older patients who seek a facelift, younger patients have more facial fat, more elastic skin, less skin wrinkling, less skin redundancy, less eyelid redundancy, less perioral wrinkling, better dentition and less lip involution.

As such, the superficial musculoaponeurotic system (SMAS) facelift is ideal for the younger patient, according to Dr. Marten. The elevation of the SMAS results in restored cheek and jowl contour, increased infraorbital fullness, and takes tension away from the skin to deeper layers of the face. One of the advantages is the avoidance of scars.