Miami’s facelift expert, Dr. Sam Gershenbaum, brings state-of-the-art techniques and experience to every facial surgery procedure at the Brickell Riverfront Surgery Center in Miami, Florida. A facelift can improve the most visible signs of aging by sculpting, lifting and tightening the deeper structures and foundation of the face and neck, restoring deficient volume and removing skin excess. As we age, the effects of gravity, sun exposure, weight fluctuations, volume loss, smoking, heredity, and the daily stresses of life begin to reveal themselves in our faces. Facelift surgery can bring youth back to a patient’s face. In youth, the face is firm and smooth due to good skin elasticity and proper positioning and volume of normal facial fat. As we age, skin elasticity and connective tissues weaken, facial fat compartments and underlying bone volume diminish causing prominent skin folds and deep creases. Jowls also become prominent along with fat deposits, loose skin with vertical bands in the neck.
A facelift won’t stop this aging process, but it can “turn back the hands of time.” A facelift (technically referred to as Rhytidectomy) is designed to restore facial volume, tighten and repair lax musculature, sculpt away areas of undesirable fat and reduce the laxity and the heavy wrinkles and folds in the face and neck. It will also improve the contour of the jaw and necklines. A face and neck lift procedure works to restore the “triangle of youth” Generally, as can easily be seen in any fashion magazine, a youthful face ideally has high cheekbones, a full cheek and defined jawline. These three attributes shape what is commonly referred to as the “triangle of youth” with the base of the triangle aligning with the full cheekbones and the point at the chin. As we age, this youthful triangle gradually becomes inverted.
It is now well understood that facial aging, in simple terms, is due to a combination of skin’s loss of collagen and elasticity as well as facial volume loss of bone and fat. Studies have shown that multiple areas of facial skeleton undergo bone resorption and changes in shape as we age. Studies have also revealed that the face has multiple deep fat compartments. These fat compartments, generally full in youth, diminish in volume over time. As facial bone and fat volume diminishes with age, the overlying skin, no longer full and supported, becomes hollow, loose and sags. Analogy can be made of the change in appearance from a grape to a raisin. As the internal volume of a grape diminishes and shrinks, the once firm and plump grape skin shrinks and wrinkles.
Volume restoration, especially fat volume restoration is often a very important step in facial rejuvenation. The idea is to restore that “facial triangle of youth”. Depending on each individuals exam, volume may be restored to hollow and volume depleted areas of the temples, orbits of the eyes, around and under the eyes, the midface, cheeks and lips in conjunction with the facelift procedure. This volume restoration is most often accomplished with one’s own fat.
A facelift will not, however, completely remove every fold, line, and wrinkle. There is limited improvement around the eyes and with fine lines of the facial skin. A facelift alone will not improve “smoker’s” lines around the mouth or a poor and damaged skin complexion. Other options exist to treat these problems, including CO2 Smart Skin Fractional Laser resurfacing treatments, dermabrasion, and chemical peels.
At our new state of the art Brickell Riverfront Surgery Center in Miami, many facelift procedures are combined with a forehead or brow lift, upper and/or lower eyelid surgery, and possibly “cheekbone” (malar) augmentation. Frequently, chin implants are placed to improve the profile proportions of the jaw line and increase the projection of the chin. These additional procedures may be performed at the same time and in combination with facelift and neck lift surgery or as independent procedures at a later date.
Facelift Techniques
It is important to realize that there are numerous facelift techniques. These range from superficial skin re-draping and fat contouring procedures to more extensive procedures of tightening of the deeper connective tissue layer of the muscles known as the SMAS ( superficial muscular aponeurotic system ) along with tightening the muscles in the neck called a platysmaplasty ( repairing the pair of platysma muscles of the neck ). With all of these techniques, the facial skin is elevated, to varying degrees, and the excess removed. Understand that a youthful face is not created by simply elevating and pulling on skin. Correcting and shaping the underlying foundation of muscles, connective tissues and fat compartments to recreate that “triangle of youth” is the key component before removing the excess skin and closing without tension. The SMAS techniques act to correct and contour the underlying foundation. SMAS layer techniques include 1) SMASectomy, where a strip of the SMAS layer is excised and the cut edges of the SMAS are sewn together tightening and lifting the SMAS layer 2) SMAS plication, where the SMAS layer plicated/imbricated with sutures to tighten and lift the SMAS layer 3) SMAS elevation is where dissection separates and elevates the SMAS layer and sutures this layer in a higher position. There are different nuances and variations of these SMAS techniques that vary from surgeon to surgeon, however the aim is to use the SMAS layer as a vehicle to elevate the foundation of deeper connective tissues, fat compartments and overlying skin to more youthful positions. The Deep Plane Facelift is a variation which elevates the more mobile SMAS more anterior to the traditional fixed SMAS layer at a line drawn from the corner of the eye to the angle of the mandible where much of the soft tissues of the face begin to fall. The Deep Plane Facelift also incorporates the release of the osseocutaneous and cutaneous retaining ligaments (bone to skin and deep fascia to skin) to allow tension free elevation of the more ptotic midface. The SMAS and Deep Plane Facelift procedures generally will include procedures to reshape, tighten and contour the neck and jawline. The platysma muscle is contiguous with the SMAS layer on each side of the face and continues into the neck to the collar bone on each side. The vertical bands in the front of the neck, platysmal bands, are the front borders of each of these muscles made more obvious by animation. The neck and jawline are corrected by platysmaplasty, which suture repairs the front borders of these muscles together and, at times elevates and suspends the posterior borders of this muscle before the excess skin is removed. Contour of the neck and jawline may also include removing excess fat from these areas. Some surgeons may recommend removal of portions of the submandibular salivary glands if they are excessively prominent. There are a multitude of other facelift techniques in the literature including short scar face lift, endoscopic facelift, MACS lift, ponytail lift and others. They are essentially variations in techniques to accomplish similar goals, however the SMAS and Deep Plane Facelifts are the most widely accepted and performed techniques. Dr Gershenbaum notes an important conclusion made about results at recent comprehensive plastic surgery meeting, where patient facelift results from different techniques were placed side to side. The general consensus from hundreds of plastic surgeons, as well as the meeting moderator, was that it was not so much due to the technique, but rather the surgeons chosen technique skillfully performed that produced the best outcomes.
Often fat is harvested by syringe from a remote area, processed and transferred to volume depleted areas of the face in conjunction with the facelift procedure. In general, a layered technique which restores volume and corrects the foundation placing the tension on the deeper tissues, allowing a gentler re-draping of the skin without tension. This facelift technique results in a natural, more youthful appearance without tell-tale signs of plastic surgery. Understand that no single technique is appropriate for every patient. As each face is unique, the most appropriate facelift technique or combination of techniques must be adequately determined to optimize each individual result.
Dr. Gershenbaum also performs many facelifts on male patients, and although much of the surgery and techniques are similar, there are variations in incisions, hairline considerations and limitations on volume enhancement that must be understood to keep a man looking masculine and un-operated in appearance.
The exact placement of the face and neck lift incisions will vary from patient to patient, male to female, at the discretion of Dr. Gershenbaum. Generally the incisions will extend from above the ear in the hair bearing scalp, extend down into the ear behind the tragus, around the earlobe onto the back of the ear to near the top and then back into the hair bearing scalp. At times, depending on the patient’s hairlines, incisions may be planned around the sideburn to avoid over elevation of the sideburn and tell-tales signs of a facelift. These incisions are planned and made to be as inconspicuous as possible.
Scars are generally not seen even with wearing hair up or in a pony tail. All incisions are closed with small sutures (stitches).
Procedure time for a facelift will vary greatly depending on the surgery, the extent of surgery, and the choice of techniques. A facelift will generally last from four to six hours.
For patients who only exhibit early signs of aging, or those who simply do not desire a complete facelift, Dr. Gershenbaum offers several options to obtain desired goals. Depending on each person’s exam as well as with their requests, goals and expectations there is a whole host of options to entertain. Options include micro fat transfer in combination with an upper or mini facelift, or perhaps just a neck lift, with or without CO2 Smart Skin Fractional Laser resurfacing, dermabrasion or a TCA peel. Another popular option that Dr Gershenbaum routinely performs is a necklift with a mini facelift, often combined with micro fat transfer and perhaps a CO2 laser resurfacing or TCA peel. Other additional procedures may include a brow lift, eyelid surgery / blepharoplasty and /or a chin implant. Dr. Gershenbaum will provide a thorough exam and discuss all options and make recommendations for which combination of procedures will best suit each client’s individual needs and goals.
Dr. Gershenbaum also has extensive experience with revision or secondary facelift surgery procedures. This may be simply a person who was happy with their facelift surgery a number of years ago and with continued aging, simply requests another facelift procedure. However, Dr. Gershenbaum often repairs or revises facelifts and neck lifts on patients who have had poor cosmetic results, complications and / or deformities from their surgery done elsewhere. Dr. Gershenbaum has many years experience with reconstructive surgery and is very creative in his ability to offer and produce repairs and restore harmony for patients who are unhappy with their previous surgery.
THE CONSULTATION
The initial consultation is extremely important to review the patient’s medical history, goals and expectations as well as develop mutual trust and rapport. Numerous before and after photos are reviewed, the procedures and alternatives are discussed. A complete evaluation and physical examination is performed for each individual patient to insure that expectations can be met as well as to determine the best choice of procedures.
Prospective patients are encouraged to speak with previous patients about their surgery and results. Dr. Gershenbaum and his staff are always available for questions. Following the initial consultation and after appropriate time for reflection and decision making, an appointment is scheduled for routine preparation and informed consent. Additional questions and concerns may also be addressed. Routine blood analysis and medical clearance is required prior to surgery.
THE OPERATION
The surgical procedure is performed in our state-of-the-art outpatient facility Brickell
Riverfront Surgery Center in Miami, Florida. Depending on the extent of the procedures, local anesthesia with sedation may be used. General anesthesia is used for most cases. This surgical procedure generally takes approximately four to six hours to perform and will vary depending on many factors including the number of ancillary procedures. In the holding area, the surgical plan is reviewed with the patient prior to surgery and all skin markings made. For general anesthetic cases, after speaking with the anesthetist/anesthesiologist, the patient is brought back to the operating room. After asleep, local anesthesia is injected into the incisional areas and into the areas to be worked on which also and shrinks blood vessels and capillaries to reduce bleeding. If micro fat transfer is to be performed, the fat is harvested from a remote area and processed to remove fluids and oils. Using micro cannulas, fat is injected in micro droplets into the volume depleted areas generally from deep on top of bone to more superficial layers. It is important to avoid putting fat simply under thin skin, like in the eyelids, so as to avoid any lumps or nodules. If upper or lower eyelid surgery (blepharoplasty) is to be performed, Dr Gershenbaum completes that next before the facelift procedure. With this complete, the facelift skin incisions are made and skin elevated to expose the areas to be worked on. Depending of the patient’s exam, the chosen technique to correct, shape and elevate the foundation and cheek, whether SMAS vs. Deep Plane, is performed. The opposite side completed as well. Next, any excess fat in the jowls and neck area under the chin is sculpted away. The platysma muscles of the neck are tightened and repaired. The skin is then redraped with the extra skin removed and closure completed without tension. Any ancillary procedures, such as brow lift, CO2 Smart Skin Laser resurfacing, chemical peels, dermabrasion, chin implant, etc may lastly be completed. A thin drain generally exits from scalp behind the ear to accumulate any minor and normal drainage. The face is wrapped with a cotton and gauze bandage. The patient, after awake, is transferred to the recovery area, where they will generally spend one hour in preparation for discharge.
THE RECOVERY PERIOD ( POST OPERATIVELY )
Following the surgery patients generally report minimal to mild discomfort which is easily controlled with medication. Most face and neck lift surgery patients really do not complain of pain. Varying degrees of swelling and bruising, generally mild, depending on the extent of the procedures subside over the first few days and the remainder over the next week or two. The patient is seen for their first follow up appointment the next day after surgery in which the dressing is changed. The second visit is generally a couple days after to remove the drain and place a lighter dressing wrap. The dressing wrap is generally removed completely in four to five days. Sutures are removed in one week after surgery. Depending on the extent of the procedure, routine activities may resume ten days to two weeks after surgery and light exercise started at four to six weeks after surgery. Dr Gershenbaum informs his patients that it will generally take them somewhere between two and three weeks to feel comfortable back in a social setting after facelift surgery. Recovery and healing will vary from patient to patient. It must be remembered that complete healing takes time and patience, taking several months before realizing the final results of surgery. Dr. Gershenbaum takes a lot of pride in his surgery and results and takes that extra time to hide the scars as best as possible. After complete healing, it is generally very difficult to find any scars unless deliberately looking closely for them.
What does a facelift cost in Miami?
The cost of a facelift in Miami will vary greatly depending on many factors including the practice, the surgeon, the surgery center and the anesthesia provider whether physician or nurse anesthetist. The price of a face lift will also vary greatly depending on the type of facelift and the technique being performed. Does the facelift, include the neck lift ? Is it a simple skin lift, a SMAS type lift, a deep plane facelift ? Are there ancillary procedures being performed such as eyelid surgery, brow lift, fat augmentations, chemical peel, etc ? Please check out the article on my website under patient education, What’s In A Surgical Fee to help better understand why prices vary. In general, the full cost of a facelift in Miami, Florida range from $8500 to $20,000. For more information on a facelift, or to schedule your appointment, click here to our Contact Form, or simply call 305-933-1838…….. Because YOU deserve the best!
COMPLICATIONS
As with most cosmetic surgical procedures, complications are unlikely when performed by a skilled and competent surgeon. Be wary of plastic surgery “mills” and business owned and managed high volume surgery centers. Prices may be greatly reduced, but often also reduced, is the time allotted for your surgery. Understand that much of your results in cosmetic surgery depends on taking that time needed to produce wonderful results. Following the post operative instructions are critical helping to avoid post-operative complications
Complications include, but are not limited to anesthesia risks, bleeding, infection, asymmetry, poor healing with obvious or raised scars, skin and soft tissue loss, under or over correction, motor or sensory nerve loss which can be permanent and need for revisional surgery. Also very rare, but possible are blood clots or emboli (blood clots which dislodge and travel in the bloodstream to distant sites). Other potential risks or complications will depend on any additional complementary procedure performed as well.
Rest assured that Dr. Gershenbaum will do everything he can to make your procedure(s) and experience truly rewarding. In the unlikely event of a complication or result that is less than desirable, we will do all within our power to work toward a result that you can be proud of. Venodyne calf compression devices are used for every surgery. Venodynes are pressure cuffs that fit over each lower leg from the ankle to the knee circulating every one to two minutes to reduce pooling of blood in the lower extremities and further reduce the possibility of blood clots or emboli. In addition, smokers must stop smoking well in advance of surgery. Smoking seriously decreases blood circulation in the skin which increases the risks of complications and poor healing.