Face Lift

(Rhytidectomy)

Dr. Bartlett does not agree with the current trend of very invasive procedures in face lifting. His procedure not only tightens the face, it changes the shape of the face and patients are usually able to return to work in one week if there is no fat grafting.

What I frequently hear from my patients is that they want to look better and not different. They say that when they see themselves in their mirror they see a person who looks tired and stern and generally not happy. They feel good and are enjoying life and would like an appearance that reflects this. Most would like to have the procedure with local anesthesia and minimal sedation.

They also do not want a long protracted recovery. They are realistic and do not believe the advertised claims of going back to work the next day after surgery. Most are not independently wealthy and need to have this done in a cost effective manner.

There is a plethora of face lifting procedures. For example the “deep plane” lift, the “Skoog” lift, the “MACS” lift, the “Life Style Lift”, the “S” lift, Platysmaplasty with and without the cheek, the “short scar” lift etc. How are patients able to choose which is the best for them? For that matter how does their physician choose what procedure should be used?

The patient needs to find a surgeon who has experience and intellectual honesty. A physician who has first-hand experience performing multiple different face lifting procedures and can honestly say which procedures give the following:

  • The best results with minimal postoperative morbidity
  • Maintain the longest possible result
  • Minimally interrupts the tissues circulation
  • Gives the patient a natural, rested, pleasant, younger appearance in repose
  • Can even be safely performed on smokers

I did my first face lift independently as a resident in 1969. I have performed hundreds of face lifts over the years. I believe I understand what the patient feels is important and how each piece of the face lifting procedure affects the outcome of the total procedure.

It has been said there is nothing new under the sun, but I do feel there are different ways to arrange the pieces of the puzzle. To the best of my knowledge, there is no other surgeon performing a face lift in the exact manner I do.

Questions Commonly Asked by Patients:

Do your patients have the wind tunnel appearance post-operatively?

No. The wind tunnel or stretched appearance is a result of too much posterior pull and tension on the skin flaps.

Where are my scars?

Unless you have some unusual problems your incision and scar starts at the bottom of the side burn, goes down at the edge of the ear, turns around the earlobe and goes up the back of the ear and usually does not reach the post-auricular hairline.

Will I have a dressing when I leave the facility?

Not usually.

Do you place drainage tubes under the skin flaps?

Yes. I have found that patients have less discomfort if whatever fluid that might form under the flaps is evacuated. If there is any bloody drainage that is not evacuated it will eventually show up later as a bruise. The drains usually can be removed within 48 hours.

Are there any special instructions you give your patients to help them post-operatively?

Because there are no valves in the veins and lymphatics in the head and neck it is important to keep the head above the level of the heart for about 7 days. This means that sleeping in a recliner is very helpful. Also restrict the ingestion of salt and salt containing foods. Arnica Montana is a food substance that has clinically shown to decrease bruising. This can be purchased at a health food store or just eat pineapple which contains high levels of this substance.

Facial aging and its correction (Vertical Face Lift)

To devise a plan to correct changes that happen with facial aging you need to understand the major changes that occur with facial aging. The facial fat disappears, the facial skeleton becomes smaller, and the skin thins, loses elasticity and many times becomes wrinkled.

Also there are changes in the anterior neck which can include wrinkling, excess fat, and bow stringing of the platysma muscle, making bands or turkey gobbler deformity.

What brought attention to the importance of correcting the volume loss, was injectable fillers. Fillers expertly used about the midface can give dramatic temporary changes. These changes do not result in the distortions that many face lifting procedures have had.

Most patients that need a face lift would also have further improvement by facial fat grafting.

My vertical face lift by its basic design moves tissue in a superior direction. This is so effective that some patient’s lower lid fat bulges disappear after having this procedure. This procedure gives dramatic results that are completely natural in appearance and usually have no discernible scar in or at the hairline behind the ear.

I think the basic design of the face lifting procedure as we have been performing it for than 100 years limits any correction to the mid-face area. In the conventional face lift, the tissues are moved either mostly posteriorly or in an up and backward direction. The highest point of the anterior incision is the point that the tissues rotate around.

If you were to draw straight lines downward from that point much like bicycle spokes leaving the axil, the lines diverge as the distance between them becomes greater the farther they travel from the axil or superior point of the incision. This distance is related to how much tissue movement or postoperative change you will attain at different distances from the rotation point. I think it is easy to understand why the conventional face has a very limited effect on the mid-face. I hear from my patients that I don’t want to look like some celebrity because the patient thinks that that celebrity looks artificial and surgical. I explain to the patient that that result was not due to poor surgery but due to a flaw in the design in procedure performed.

To devise a plan to correct changes that happen with facial aging you need to understand the major changes that occur with facial aging. The facial skeleton becomes smaller, the skin thins, loses elasticity and many times becomes wrinkled, and fat is lost from the orbital and midface area.

Also there are changes in the anterior neck which can include wrinkling, excess fat, and bow stringing of the platysma muscle, making bands or turkey gobbler deformity.

What brought attention to the importance of correcting the volume loss, was injectable fillers. Fillers expertly used about the midface can give dramatic temporary changes. These changes do not result in the distortions that many face lifting procedures have had.

I recently attended a large multi-specialty meeting, STATE OF THE ART IN FACIAL AESTHETIC SURGERY & NON SURGICAL AESTHETICS. There is a great deal of interest in fat grafting the mid-face as a separate procedure or combined with a face lift.

There was no face lifting procedure presented at that symposium which simultaneously gave a significant change to the mid-face without combining it with other procedures such as temporal lifts or fat grafting. The net result to patients is that they have more expense and longer recovery time. I let two physicians see some of my results from the vertical face lift and their response was “wow”.

My vertical face lift by its basic design moves tissue in a superior direction. This is so effective that some patient’s lower lid fat bulges disappear after having this procedure. This procedure gives dramatic results that are completely natural in appearance and have no scar in or at the hairline behind the ear.

I think the basic design of the face lifting procedure as we have performing it for than 100 years limits any correction to the mid-face area. In the conventional face lift, the tissues are moved either mostly posteriorly or in an up and backward direction. The highest point of the anterior incision is the point that the tissues rotate around. If you were to draw straight lines downward from that point much like bicycle spokes leaving the axil, the lines diverge as the distance between them becomes greater the farther they travel from the axil or superior point of the incision. This distance is related to how much tissue movement or postoperative change you will attain at different distances from the rotation point. I think it is easy to understand why the conventional face has a very limited effect on the mid-face. I hear from my patients that I don’t want to look like some celebrity because the patient thinks that that celebrity looks artificial and surgical. I explain to the patient that that result was not due to poor surgery but due to a flaw in the design in procedure performed.

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Sylvan Bartlett specializes in face lift services for clients in Odessa, Midland, Andrews, Monahans, San Antonio, Lubbock and surrounding areas.