Andrew Jacono, M.D., FACS 630 Park Avenue New York, NY 10065 001 212 570 2500 www.newyorkfacialplasticsurgery.com
A
t some point in their life every woman, and also every man, will tug on the slack skin under their neck and wish it were gone.
DISSECTING THE FACELIFT Andrew Jacono
The most common age for considering surgery is the late 40s all the way through to the 70s. The main factors that compel patients to visit a surgeon’s office are premature aging or a lower tolerance threshold for aging. This tolerance differs and a woman/ man who has had a heavy neck since the age of 60 may wait until she/he is 78 for their first face lift. Although there is no prescribed age when the face needs to be supported by a lifting procedure, the most common age for women is 54 or on average three years post-menopause. After three years without estrogen stimulation, the quality of the skin changes significantly and the facial muscles loosen more in those three years than in the prior 50. In older faces it is not enough to simply fill the face (for example with temporary fillers or fat transfers) because the facial tissues cannot support the additional volume as they have become too loose. The goal of facelift surgery is to re-establish the heart shaped face of youth. As we age, jowls form on either side of the chin, making this horizontal length of the lower face wider, and “marionette lines” or grooves between the corner of the mouth and chin develop (Figure 1). This is accompanied by a “double chin” or “turkey gobbler” with vertical folds or bands developing in the neck. The cheeks deflate and the horizontal distance between them becomes shorter. These drooped cheeks create folding between the nose and mouth called nasolabial folds. In order to restore the natural beauty of youth, a combination of lifting the jowls to reduce the width of the face along the jawline, and repositioning the cheek higher to add height and width to the cheek bones is necessary.
Figure 1 Heart shaped face
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