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Along the surgical-noninvasive continuum, one expert advocates moderation

Article-Along the surgical-noninvasive continuum, one expert advocates moderation

Key iconKey Points

  • The challenge with effective facelifts is in selecting a procedure that is effective enough to achieve the intended goals of the patient and one that simultaneously justifies the cost and the risk of the surgery without producing an unnatural or 'operated' look.
  • An effective way to make the most of a conservative facelift is to "dress it up" with adjunctive procedures.

GULF SHORES, ALA. It's unlikely that the modern-day facelift was the inspiration for the adage, "All things in moderation and moderation in all things," but as far as E. Gaylon McCollough, M.D., is concerned, it may as well have been. Dr. McCollough, head of the McCollough Plastic Surgery Institute, Gulf Shores, Ala., extols the benefits of a "conservative," facelift, pointing out that this method has been the foundation of his thriving cosmetic surgery practice for 30-plus years — and approximately 5,000 facelifts.

Since the inception of facelift surgery, Dr. McCollough points out, the pendulum has swung from radically invasive to ultra conservative and then back again, but the facelift that he has performed throughout three decades of this evolution falls somewhere in between those extremes.

Dr. McCollough
"It's beyond those minimally invasive procedures that produce very little long-term results, but it's not as aggressive and radical as some that invade the deeper tissues of the face and extend to the point of identifying all the branches of the facial nerves. It's somewhere right in the middle," he says, "and it's very effective." "In recent years," Dr. McCollough points out, "there have been an onslaught of 'trade-named' facelifts, many of which are minimally invasive and, in my opinion, equally minimally effective. Meanwhile, I've maintained my middle of the road position, and it seems to have stood me in good stead. I've been able to build a good practice and a very significant following."

A FACELIFT IS A FACELIFT Dr. McCollough holds that the widespread promotion of these "brand-name techniques" lends confusion not only to the public, but even to some surgeons who are just starting out.

55-year-old patient before and 25 months following facelift of forehead, temporal, cheek and neck; upper and lower blepharoplasty; upper and lower lip augmentation with pre-auricular SMAS grafts and a rhinoplasty. Hair incision shown far right. All photos credit: E. Gaylon McCollough, M.D.
"Technically speaking, any procedure that lifts and tightens the face is a facelift," he explains. "The challenge, and the essence of my facelift philosophy, lies in selecting a procedure that is effective enough to achieve the intended goals of the patient and one that simultaneously justifies the cost and the risk of the surgery without producing an unnatural or 'operated' look."

Moderation, according to Dr. McCollough, never goes out of style, but fads do. This logic has guided his facelift surgery evolution.

"Over the years, there are only a few things that I've modified, and one of those is the type of incision that I make behind the ear and at the temporal tuft of hair," says Dr. McCollough. "We learned from hair transplant surgeons that if you cut tangentially across the hair follicle and then undercut the flap of the skin and lay it across, the hair will grow through the scar," he explains.

Dr. McCollough says he rarely makes incisions into the hairline because this alters the patient's hairline. If a patient has a single facelift in their lifetime, this may be acceptable, but it won't be if they come in for maintenance 10 years later and then perhaps once again after that, he points out.

Having spent a portion of his early training in Beverly Hills, Dr. McCollough saw that many patients who were in the entertainment industry were committed to a lifetime of wig wear because multiple facelifts had left them with an unnaturally high hairline.

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