Facial Rejuvenation - Val Lambros, M.D., F.A.C.S.

Following are facelifts and necklifts that I have done. Almost never is the facelift the only procedure that is done. Very commonly some fat is used, or other filler for volume. In some, dermabrasion was done around the lips to minimize the wrinkles. None of these patients look odd, alien or scary. They truly look natural, like better looking versions of themselves. There are easy cases, usually youngish people with good definition and good thick skin. These uniformly get good results. In fact, the best results seen with cosmetic surgery are in the patients who need it the least. When you operate on older patients, people with too much fat, or too little fat in their faces it is much more difficult to see a good result. Some of the patients presented here are very difficult facelifts and yet still look natural. Many of these patients have had smaller additional procedures such as fat injection or other volume addition in the face. In some of them the result wouldn’t be nearly as good without them. As people get older they get hollows in their cheeks, hollows just in front of the jowls, hollowed out upper lids and brows. A traditional facelift does not correct problems like these and some fill is necessary. There are many options for filling the face, I have used fat for many years, but equally good if not better results can be obtained with other fillers like Restylane, Radiesse, or Sculptra. Restylane has the advantage of being dissolvable if there is a less than perfect contour, and lasts a year to two years when used in the face other than the lips and nasolabial folds. Click here for Dr. Lambros' thoughts on Facial Aging [click on most images to enlarge]
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She is in her 50's and very attractive. She has excellent skin with some laxity of the face and the neck and a small amount of excess neck fat. Her eyes and forehead are good. This is the kind of person who does the best with a facelift. Her operation was straightforward, with a deep-layer facial support, a small amount of fat removed from the neck, with treatment of the muscle bands in the front of the neck and a small fat injection right in front of the jowls to establish a straight jaw line. Can you see her scar in front of the ear? This is about a year out from surgery.

She’s 54 years old. Very nice skin and very attractive. She had previous jaw surgery which left her with a notch in her right jawline. This is about a year after her surgery. She had a face lift with a deep layer support. The neck was smoothed. She had fat injected to straighten out the jawline, and a small amount in her cheeks to reduce the hollow. Dr Lambros has been doing fat grafts for 17 years. They are very useful for filling in hollows such as these. The fat does not migrate and a percentage of it lasts forever. She is about a year out from surgery and all her fat is expected to last.
	49 years old. A straightforward face and neck lift in a very attractive woman. Her main problem was minor laxity of skin.
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These are people that are older, have more difficult skin and more fat in their faces and necks. A good deal of my practice is patients like these because I don’t like operating on people too early. Notice that they don’t look strange or pulled. Some people like a very stylized Newport Beach look. I don’t.
She is in her late 40’s. Nice skin. An excess of fat in the neck with moderate laxity of the skin. This is more than a year afterwards.
	She is in her late 50’s. She has good skin considering her skin type. She is very attractive. She has had a facelift and a browlift. She looks like a much better version of herself, and completely natural. This is more than a year afterward
In her late 40’s, a facelift with deep layer support , focusing mainly on her neck. In her age range liposucuction of the neck alone would not have given her such a smooth result. This is about 8 months later.
	In her 50’s. Someone else had done a browlift on her previously with an exposed incision. I did her face and neck with a deep layer face support, removing fat from her neck and smoothing her neck muscles.
In her early 50’s, she had a face, necklift and browlift. Note the degree of improvement.
	In her early 50’s. She had a facelift with a deep support, her neck muscles smoothed. She had a small amount of fat injected into the jawline in front of the jowl to straighten out the jawline. More than a year after surgery.
Heavy-set woman in her late 40’s. She had her face and neck done. Note the improvement in the neck.
	She’s 54 years old and had a face and necklift. She is about 6 months post-op.

In her 50’s. She had a face and necklift with smoothing of the neck muscles. She also had some fat placed in the jawline and in the brows to reduce the hollow-eyed look she was getting.
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These are older people with inelastic wrinkled skin. It is very difficult to get a natural looking result in someone like this. Anyone can do a youngish patient with good skin and get a reasonable result. It takes considerably more judgement and technical expertise to get a good result in someone with more difficult material to work with.
	Very difficult and weathered neck skin in this 56 year old seen about 8 months after surgery. In addition to the face and necklift she had a small amount of fat removed from the jowl, and a small amount injected in front of the jowl to straighten the jawline.
72 year old with very thin, delicate skin, jowls and wrinkles. This kind of patient can be made to look very pulled after surgery if great care is not taken. She had a face and necklift, attention paid to the jowl and a chin implant.

Very lovely patient in her 60’s with a difficult neck, wrinkles and pigmentations. She had a face and necklift, her upper and lower lids done and dermabrasion done around the mouth and anterior cheeks. She is greatly improved everywhere. Note the line of color change on her cheeks where the dermabrasion stopped. She could use creams or a light laser to improve this area if she wished. She didn’t mind it.
	Very difficult heavy neck, treated with a face and necklift.
55 year-old woman with difficult skin. 11 months after a face and necklift with some fat injection into her cheeks.
	57 year old after a face, necklift, perioral dermabrasion and browlift.
75 year old with very thin and wrinkled skin. She had a face and necklift. She didn’t want anything done with her eyes. Look how much better she looks without any scary pull lines.
	In her 60’s. Deep wrinkles, fat pads and extra skin of the eyes. Very difficult tissues in general. She had a face and neck lift with a deep layer support along with some fat grafting to her cheeks and jawline. Upper and lower lids were done as well as some dermabrasion around the mouth. She is 6 months after surgery here.
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There are people who have very nice tight faces before surgery and really shouldn’t have their faces operated on. However they have loose necks. The neck can be done alone without doing a facelift. The procedure is basically the back half of a facelift with incisions behind the ear. In younger patients a liposuction alone may be done. Sometimes a chin implant is necessary.


In fairly young patients like this a liposuction of the neck is all that is required.
	In her 30’s she had a neck liposuction and a chin implant.
In her 50’s with an open necklift.
	Just a chin implant.

Facelift surgery in men is similar in design to facelifts in women but different in execution. Men have thicker skin than women, which is a mixed blessing. On one hand it shows irregularities more, it also bleeds more, and the control of bleeding can be a very tedious in a male facelift. Because the use of cosmetics and using hair to cover incisions in men is less common in men the surgeon needs to pay very close attention to the detail work of incision placement and closure. For cultural reasons men have less tolerance to surgical manipulation than women do. In other words it’s very easy to make men look odd and strange after cosmetic surgery, particularly around the eyes. One cannot approach a male in terms of doing whatever operations are possible. If for example you take away too much upper lid skin in a male the eyes can look smaller. If the brows are elevated they can look distinctly alien.
	58 year old male chiefly concerned by his neck after considerable weight loss. Seen here a year after a face and necklift. It was necessary on him to remove neck fat both above and below the neck-muscles.

65 year old wanted improvement of the face and neck. He had a face and necklift, still looks like himself and does not look strange. This is about 6 months after surgery. Note the lack of jowls and straight jawline.
55 year old male, wanted to be cleaned up along the jawline and neck. This is 4 months after a face and necklift. I wanted to put some fat into his cheek hollow but he was so thin that I couldn’t find any.
	A 65 year old male who had a face and necklift. These procedures are generally longer and more tedious than facelifts in women as they have more bleeding.
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The care of the face has been my main, but not exclusive, focus since entering practice in 1984. From the beginning I noticed that what conventional medical wisdom said about the face was not what it really did and the treatments sometimes made people look worse than before. In the late 1980’s I began having patients and others bring in old photographs. When going to someone’s house for a visit I would immediately go the mantle where the old pictures were and see what I could learn. In time I began a very close photographic comparison of the same old and young faces which has broken new ground in understanding how the face ages. Amazingly this had never been done before with such close tolerances, probably because it is a difficult technique. I have presented this work at national and International plastic surgery meetings and in peer reviewed Journals over the last 15 years. [Click here to see aging face animations. NYT article]. The common concept of the aging face is that it falls down. While true around the lips and brow, the rest of the face is remarkably stable in position. What people perceive as “falling” is usually thinning of the tissues and expansions and indentations, for example around the lower cheeks and jowls. Generations of plastic surgeons have operated on the face without knowing the basic principles of aging. What surgery does very well and what surgeons do on a daily basis is to take things out and make things tight. This is why overdone surgery makes people look strange, it pulls the skin in an unnatural way and makes a thin face into a bony hard and older looking face. From trial and error certain techniques developed which looked satisfactory in the right person. Unfortunately surgeons tend to use the same technique on everyone...all right if you have the right face, but not all right if you have wrinkles, old skin, hollows and have a thin face. If someone understands the face then treatment of it is not simply a matter of pulling on the skin and taking things out. The aging of the face is complex and generally there is very little descent involved, there is loss of fat in some areas, increasing fat in others, and appearance of wrinkles with the declining quality of the skin and repetitive muscle motion. Have you noticed all the strange looking people around, both in real life and in the media? People who have had an abundance of obvious plastic surgery. The tight faces, the oversized lips? There is no shortage of plastic surgeons out there, either very fresh and inexperienced or without any eye at all for what looks good on the face. Many are ambitious and have persuasive web sites. It seems that the worst somehow get on TV. They are good at marketing but not necessarily good at their jobs. The rhetoric is always the same: they make people look natural. If that were true you wouldn’t see all the odd looking people out there. In fact, it takes years to learn how to read the face, to know what differences truly make a difference in the way other people perceive it. It takes longer, much longer to learn how to operate on the face and learn what modifications in what place make for a harmonious face and not simply a pulled one. No website or textbook could begin to explain the analysis and subtle judgment calls in understanding a particular face as well as treating it. It takes a good eye, the ability to do many surgical techniques, some major, some minor and some restraint to be able to give results that don’t look pulled, odd, or alien. Most importantly one needs to know what not to do to a face to make it look better without making it look operated. There currently is some backlash to facelift procedures because people who have been overdone or done too many times are highly visible and look highly odd. Incredibly, some people like this look. I am not one of them. There is no shortage of celebrities who have had excessive plastic surgery by very expensive and fashionable surgeons. Though some people would like to claim so, cosmetic surgery procedures aren’t art forms. Putting a nose on the side of a face is an artistic decision, recountouring a face is a craft and it needs to be done in a craftsmanlike way. Tiny stitches, treating the tissues with respect, having the experience to know what will look good in 6 months when the swelling is complete.