I have been in practice long enough now that I have seen quite a few plastic surgery fads come and go. On the other hand, there are some very beneficial surgical innovations that have occurred. In fact, there are very few procedures that I perform the same way I did when I started practice in 1996! I am excited to say that I feel the greatest improvements have been in the area of facial rejuvenation, which is one of my favorite things to do, especially facelifts. While there have been many positive developments that have allowed plastic surgeons to create better, and more long-lasting results, there are a few things that have come along of which I am not a fan.

It is easy to start this topic off with the obvious: If it sounds too good to be true, it probably is. In this category I place all facial rejuvenation procedures that promise long results with short surgeries and short recoveries. It is just not possible, period. Also in this category is the contention that lasers lift anything. If they do, they do so minimally and for a fleeting period of time. So I don’t recommend “lunch-time lifts,” or fancy machines that are supposed to transform you during a one hour treatment in an office.

I think it is best to start thinking about your philosophy about rejuvenation before you decide what you want to do about aging. My philosophy is and has always been, if I can’t make the patient look natural, I am not going to do the procedure. That rules out quite a few procedures for me. Believe it or not, there are a fair number of patients that WANT to look operated. I am not a good match for them, but there are plenty of surgeons who specialize in this type of rejuvenation who can assist these patients. Most of the patients I end up seeing want to look like a refreshed version of themselves, not like a different person. I think it is imperative to study pictures of patients from younger stages in their lives to determine exactly how the aging process has affected their face. People age differently, and if as a surgeon, you don’t study and recognize this fact, you can end up creating some unusual looking individuals. So let’s assume that you can accept all of the above information and you really want your face to look better. What good options do you have?

I often am asked about facial fat injections. They are definitely popular with many plastic surgeons and certainly with the lay press. My lack of enthusiasm for this technique of rejuvenation is multi-factorial. First of all, most of the patients I see in the land of plenty have plenty of fat in their faces. It may no longer reside in the most favorable and attractive areas of the face, but nonetheless, there is plenty available. In these patients, injecting more fat does not result in aesthetically appealing outcomes in my opinion. Secondly, fat injections are a bit unpredictable. We have not yet determined the best techniques to harvest, process, or re-inject the fat so that the “take rate” is nowhere near one-hundred percent. Sometimes the fat takes well and sometimes it doesn’t take at all.  Sometimes the fat takes well in some areas and poorly in others. Sometimes it resorbs unevenly and leaves contour problems. Occasionally it takes too well, or the patient gains weight and there is way too much fat that remains or develops. I like predictable results with low revision rates. Even the most prolific and talented plastic surgeons who perform fat-grafting state that up to fifty percent of their patients have “touch-ups” or secondary fat grafting sessions. Finally, I just don’t like the look of it. When I am at plastic surgery conferences and fat grafting zealots show their best results, the patient’s faces look doughy to me. While fat injections do tend to smooth out wrinkles, I don’t think a round, overly full face without any angularity or definition is a great trade-off.

I much prefer to utilize the tissues that already exist in the face and reposition them to the area they lived in at an earlier stage of a patient’s life. One reason fat grafting is popular is that it is technically simple, whereas rejuvenation by mobilizing and re-positioning the deeper tissues in the face is demanding, time consuming and requires a great deal of skill and experience. I find most things in life that are worthwhile are not easy to come by! When I recruit the existing tissues in the face back into more favorable and youthful positions during a facelift, I am replacing like with like. I do not have to guess and hope that the tissue will survive and thrive, and I am restoring what use to be. It fits perfectly with my desire to create natural results. The recovery from this procedure comes with limited and minor discomfort, and most people feel presentable to friends within three weeks.

While I would never claim my favored techniques of facial rejuvenation are the only way, or the best way, I can say the results look natural, and I have many happy patients who say their friends and families marvel at how good they look following these procedures. They never say how different they look, but how refreshed they look. That’s a win in my book.


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