- Early-aging deformity is characterized by subtle but distinct sagging of deep facial tissue, loss of facial contour
- Early-maintenance facelifts include SMAS repositioning of the midface, cheek and jowl; minimal or no skin tension; some form of forehead, neck and eyelid surgery
Patients who desire the benefits of an early-maintenance facelift want to stop the clock at a time when they feel they look their best, says Timothy J. Marten, M.D.
"It's also a common misconception that all patients seeking surgical facial rejuvenation want to look as young as possible," says Dr. Marten, director and chief of the Marten Clinic of Plastic Surgery in San Francisco. "In fact, many patients think they look their best in the third and fourth decade of their lives."
Traditionally, facelifts were reserved for older patients and regarded as a way to "repair" an advanced aging deformity, Dr. Marten says. But today, many patients are requesting procedures to rejuvenate the face at a younger age, all with the goal of maintaining — not regaining — a youthful appearance. Early-aging deformity is characterized chiefly by a subtle but distinct sagging of the deep facial tissue and loss of facial contour that is typically evident as perioral laxity, jowl formation and cheek flattening, Dr. Marten says. Varying degrees of forehead ptosis and loss of neck contour are also usually present, but skin wrinkling, skin laxity and skin redundancy are usually minimal.
"Although the early-aging deformity of the face has been overlooked and underappreciated by all but the most observant and artistically sensitive plastic surgeons, it has been recognized by and has been a cause of concern for many of our patients for some time," he says.
A NEW PARADIGM Early-maintenance facelifts typically include SMAS repositioning of the midface, cheek and jowl; minimal or no skin tension; a precise incision plan and meticulous execution of skin excision closure; and some form of forehead, neck and eyelid surgery, Dr. Marten says. Skin resurfacing is not usually needed and fat injections are generally not indicated, although they are sometimes helpful because "the younger patient typically has minimal skin wrinkling and facial atrophy," he says.
A 32-year-old female patient before (left images) and three years, eight months after early maintenance facial surgery performed by Timothy J. Marten, M.D. The patient had a facelift, foreheadplasty, upper and lower blepharoplasty, necklift and partial facial fat injections. Note improved transition from the lower eyelid to the cheek and improved contour in the cheek and jawline areas, Dr. Marten says. (Photos credit: Timothy Marten, M.D.)
The early-maintenance facelift approach is based on the concept that aging is a continuum and that younger patients have a microform of the same problems older patients have. Thus, they should be treated by more or less the same means, but the procedures must be performed less aggressively and in a very meticulous fashion.
"Patients with forehead ptosis are often best served with a forehead lift even if the ptosis is modest; patients with sagging of the cheek and jowl and loss of a smooth jawline need a facelift that includes SMAS support to correct these problems if a meaningful and sustained improvement free of secondary deformities is to be obtained; and patients with neck problems often are not adequately or attractively rejuvenated with liposuction or by limited surgical or nonsurgical means," Dr. Marten says. "Skin resurfacing, 'skin shrinking' and facial filling may be of help but don't actually address these problems."
Dr. Marten says it can be difficult to define exactly what constitutes an "early" facelift because some patients in their 40s are already "emergencies," while other patients in their 50s could arguably be defined as undergoing early procedures.
"As a general rule, I would say most surgeons regard a patient to traditionally be ready for a facelift and related procedures in their 50s or 60s, and that an 'early' facelift would be one performed in one's 30s or 40s," Dr. Marten says. "We don't track numbers specifically, but the average age of facelift patients in our practice is early-to-mid 40s."