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360 Facelift Procedure
A complete Rejuvenation Face and Necklift with Dr. Moelleken’s signature procedures: USIC Cheeklift, LiveFill™ grafts, Neck-Lace Procedure and many ancillary procedures.
Click Here to see the Neck-Lace Graphic
Click Here to see the USIC (Ultrashort incision cheeklift) Procedure Graphic
Click Here to see the LiveFill™ procedure Graphic (lips and cheeks)
Click Here to see the LiveFill™ procedure Graphic (multiple areas)
Click Here to see the 360 Facelift Procedure Graphic
Click Here to see the Graphic of the Depressor Anguli Oris release (DAO Release)
There are now many options to rejuvenate the face and neck. Here is our common selection.
Radiofrequency Techniques
Minimally invasive devices such as radiofrequency (RF) devices (Thermage, Polaris, Re-Firme) can be used to heat the skin, produce new collagen and tighten the skin minimally. Patients do not require sedation for the Re-Firme procedure and go directly back to work.
Submental liposculpture
When fat reduction is needed, liposuction or liposculpture of the area beneath the chin (submental region) or the jowls can be performed, often under local anesthesia. The incision is a small incision under the chin (about ¼ inch long or less). Healing time is approximately 3 days of wearing a dressing. Patients typically go home with an adult after surgery.
Wide submental liposculpture
Fat reduction and sculpting is performed through a small ¼ inch or less incision below the chin in the submental area, and in the jowl and neck region as well. Recovery is typically 5 days before the patient is back in public, and 7 days for critical events. Patients typically go home with an adult after surgery.
Corset platysmaplasty with liposculpture
This technique, often combined with liposuction or liposculpture, involves suturing together the plastysmal muscles. This smoothens the neck. This technique is stronger than liposuction or liposculpture alone, however is best used in patients who do not have a significant amount of skin laxity. The incison is usually about one inch or less long under the chin. Recovery is typically 5-7 days before the patient is back in public, and 2 weeks before they attend critical events.
Neck-Lace Procedure
For patients with more fat and muscle looseness than can be handled with a corset platysmaplasty alone, the Neck-Lace procedure is performed. This procedure involves extensive tightening of the muscle with NO VOLUME REDUCTION and NO CUTTING of the platysma (Dr. Moelleken believes this to be prematurely aging). Liposculpture is performed on the submental and jowl regions as well. The incision is usually about one inch or less long under the chin. Recovery is typically 5-7 days before the patient is back in public, and 2 weeks before they attend critical events. Patients usually go home with an adult after their procedure.
Corset platysmaplasty with liposculpture plus face and neck lifting.
This is yet more powerful than a treatment for the neck and jawline, achieving smoothening of the neck and jawline. Incisions are behind the tragus (bump in front of the ear), below the earlobe, and behind the ear itself, and then into the hairline. Recovery is typically 7-10 days before the patient is back in public, and 2-3 weeks before they attend critical events. This is currently the gold standard for rejuvenation of the face and neck. Patients typically spend one to two days in Aftercare.
Neck-Lace Procedure with face and necklifting
With the more extensive tightening of the platysma muscle and the tissues above the glands, this procedure is exceptionally powerful at rejuvenating the neck without removing any volume from the platysma muscle. Liposculpture of the submental and jowl region, and the upper neck, is performed before the Neck-Lace Procedure. Dr. Moelleken believes this will be new “platinum standard” with superiority of corset platysmaplasty and face/necklifting alone. Recovery is typically 7-10 days before the patient is back in public, and 2-3 weeks before they attend critical events. Patients spend one to two days in Aftercare.
The 360-Facelift: Neck-Lace Procedure with bidirectional Face and necklift, LiveFill™ and Ancillary procedures (Click Here to see the 360 Facelift Graphic).
This procedure is for the patients who want complete rejuvenation of their face and cost is no object. It combines Dr. Moelleken’s signature LiveFill graft insertion into lips, nasolabial folds, marionette lines (and other customized areas); his signature Neck-Lace procedure for additional neck tightening, nasolabial folds, marionette regions; Dr. Moelleken’s signature USIC ultrashort incision superficial cheeklift procedure for the under eyes and the cheeks (using fat preservation or redistribution of lower eyelid fat, or LiveFill grafts in patients with lower eyelid hollowness); a complete bidirectional face and neck-lift procedure with 100% volume retention- no SMAS removed), cheek augmentation with superior vector SMAS transfer, an upper lip lift (gull wing), subcutaneous minimally invasive brow lift, central minimally invasive nerve-sparing brow muscle reduction, upper blepharoplasty, and conservative laser resurfacing when required. Incisions are the same as for the Face and neck lift with Neck-Lace. There are approximately 3 cm incisions in the widow’s peak for the subcutaneous nerve sparing browlift, no additional incisions for the frown muscle reduction. Recovery is identical as for a conventional Face and necklift Procedure: typically 7-10 days before the patient is back in public, and 2-3 weeks before they attend critical events. Dr. Moelleken’s most commoly performed procedure is the 360 facelift. It is important for the surgeon to work expediently and have great experience in order to minimize surgical time. A typical 360 facelift can be accomplished in approximately 6 hours. Patients typically spend 2 days in Aftercare.
Revisional facelift Surgery
A great deal of our practice is devoted to revisional facelift surgery. It is our goal to minimize the appearance of prior surgery. The problems often noted after facelift surgery are pixie ear (ear pulled down), “done look” (pull in nonatomic directions; hairline stepoff (hairline shows scars of previous facelift; “lateral sweep look” resulting from facelift without midfacelift, also called the “Nike swoop sign”; volume maldistribution, or excessive volume in the jowl area; facial fat atrophy—occurs normally with age; exacerbated by some facelift techniques. Often, correction of these problems will involve elevating the midface, redoing the hairlines, redoing the earlobes, restoring reliable volume with redirecting the direction of pull from the previous facelift to a more anatomic direction; restoring lost hairlines and hair, and repair of the deep layers (SMAS) as needed. A primary facelift is completely different from a revisional facelift. The level of complexity and the skill needed for correction is far greater.
Now I’m Really Confused
The many new procedures available for rejuvenation of the face are confusing. Patients may wish to read Dr. Moelleken’s chapter in the 8-Volume internationally published .textbook “Plastic Surgery”, Ed. Mathes, Saunders, 2006 (Click Here to read Dr. Moelleken’s book chapter on rejuvenation of the upper and midface). Considerable additional information written for the lay public is also available under the individual topics on this website (drbrent.com).
The Anesthetic
The facelift is usually performed under a "light" general anesthetic (patient is asleep) or, in select cases, under “twilight” anesthesia in our outpatient surgical center. In any event, the patient's safety and comfort remain uppermost in our concerns. All of the required monitoring, anesthetic delivery and emergency equipment are present at all times. The anesthetic is administered by a board certified anesthesiologist who remains in attendance throughout the operation. The appropriate choice of anesthetic will be explained and discussed fully by our anesthesiologist prior to your surgery.
Preoperative Preparations
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services. It will be required that all this pre-op paperwork is in our office 1-2 weeks prior to surgery.
It is very important that our office is aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 4 weeks prior to surgery, and 4 weeks after surgery. This would impede your healing greatly. Studies have been done showing that the incidence of complications is ten times as high in smokers that it is in non-smokers. The chance of having a complicaton is greatly reduced by eliminating smoking.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.
AFTER CARE
In most all cases, it is required to stay at an after care facility. This will be prearranged during your pre-operative appointment. Our staff will describe the facilities to you. The facility we use provides transportation after surgery, and for follow-up appointments. They also provide for your special diet, and 24 hour nursing care.
Private Duty nursing is another option, and is one on one nursing care. Please ask if you prefer this.
THE SURGICAL PROCEDURE
The length of the operating time varies between two and six hours depending on how much work is done in the various areas of the face, neck and brow.
The incisions come down from the hair in the temple area, curve inside the ear canal so as to be hidden, curve down around the earlobe into the crease behind the ear, and then backwards and upwards into the hair. There is no scar at the base of the hairline so that if the patient prefers to wear the hair swept up they can do so with out fear of the scar showing.
Through these incisions, the skin is elevated and released from the underlying muscles. Fat may be removed from the area under the jaw. The fascia that is supported by the facial muscles of expression is undermined as a separate layer and pulled in an upward and backwards direction where it is trimmed and sutured. This is all done beneath the skin so that the skin may drape with very little tension over the newly tightened muscular framework and will heal with minimal stretching and avoid the so-called "plastic" appearance. The excess skin is trimmed and the area is closed with fine sutures. Upon the completion of surgery, a large soft compressive bandage is applied to the head to maintain some pressure. The purpose of this is to reduce swelling and protect the wounds.
Ancillary Procedures
One of the best materials for filling areas in facial areas is Livefill™. At the time of surgery, many patients choose to have their lips or nasolabial folds, (smile lines) augmented.
Earlobe Reduction
The earlobes can be reduced and made more attractive during facelift surgery. Ears that have been pulled down can be corrected.
Brow Surgery
There is a tendency away from aggressive, old-style browlifts as they can alter the hairline and prematurely cause an aged hair pattern. Newer brow techniques are customized and targeted for individual "trouble spots".
Laser
Often laser around the mouth area results in reduction of the fine wrinkles around the mouth. During the facelift is a perfect time to consider this procedure. We do believe it is safe to perform fullface laser with a face and necklift.
The Done Look
This is a result of inexpert plastic surgery where excessive pull is placed on the skin, causing deformity forces on the tragus (bump in front of the ear), the earlobes, the hairline and the face in general. This look is no longer considered acceptable. Dr. Moelleken can discuss with you how to reverse this (if you have already had a face lift and are having a re-do) or to avoid it in the first place.
The facelift operation is frequently combined with eyelid (blepharoplasty) surgery or other types of facial procedures. If you have any questions about these procedures please ask.
Risks and Complications
In any surgical procedure, there is risk. Certainly the administration of any medication of any sort can have an unpredictable and in extreme cases fatal outcome. Every precaution is taken to prevent possible drug sensitivity, and if it should occur, to treat it properly and avoid any dire consequences.
The risks of facelift surgery specifically are limited and usually quite rare as well. The most common complication (which is still exceedingly rare) is a collection of blood or blood clot under the skin called a hematoma. If the hematoma is large enough, it will need to be removed by suction aspiration or by opening a small portion of the incision. This will not affect the final result.
In very rare cases there is some breakdown of the skin where it has been undermined, usually in the area immediately in front of the ear. This will heal with a scar, which may be permanent but usually is not significant, and can be improved if needed.
Hair loss may occur to a very slight degree around the scars. In rare instances, it may be permanent. Keloid scar formation is very rare in the face but occasionally may occur behind the ears. This is usually of a minimal degree and can be treated appropriately with excellent results. Nerve damage can occur to one of the small branches of the facial nerve causing weakness of an area of facial musculature, which may be permanent, but is very rare.
WHAT TO EXPECT AFTER SURGERY
Activity: Post-operatively the patient is encouraged to ambulate soon after surgery, with frequent periods of resting.
Pain: There is a minimal to moderate amount of pain associated with this type of surgery. Medication is available to control any discomfort experienced while in an after-care facility or at home. Coughing, laughing, sneezing or other anything that exerts pressure will produce discomfort post-operatively.
Dressings: A very large dressing with drains will be applied for the first 24 hours, and then removed the day after surgery.
Scars: The scars left by this procedure are generally predictable and although they fade with time, they are permanent. Occasionally, a scar revision procedure is necessary to attain the best cosmetic result. These procedures are minor and can be carried out in the office under local anesthesia.
It is not unusual for a patient to experience a period of the "blues" during the convalescence. This is temporary. It's helpful to remember that it is impossible to judge the final result of your surgery until all of the swelling has subsided and the operative area has smoothed out.
Swelling: Swelling is mostly resolved in two to three weeks, but some swelling will persist to a slight degree for several months. To a large extent, only you will notice this.
Bruising: Bruising is usually localized to the area immediately beneath the eyes and the area on either side of the neck. It is usually gone within one week but on occasion may persist longer. Areas begin to discolor, and skin has a sight yellow/brown tinge that travels to the neck area.
The day after surgery: Your initial bulky head dressing and drains are removed, and all the wounds are checked. A new dressing will be applied which is lighter and smaller than the previous one. You will be given a chinstrap to wear after your first shampoo.
Three days after surgery: the second head dressing can be removed, discarded, and hair can be washed. Start by applying hair conditioner all over dried crusty areas in the hair around the ears, and top of scalp. Leave conditioner on for about 10 minutes, and then step into the shower. Gently shampoo and condition hair, letting everything get wet. Let hair air dry, and comb through with a large comb, avoiding areas around the ears. Do not use a blow dryer to dry, as you can easily burn areas that may be numb. After hair is dry, apply the chinstrap as shown in package, and continue to wear it for at least 1-2 weeks. This significantly reduces swelling as it supports swollen cheek/neck areas.
(IF STAYING AT AN AFTERCARE FACILITY FOR A SECOND NIGHT, A NURSE MAY WASH YOUR HAIR ON SECOND DAY)
Five to six days after surgery: all sutures and staples are removed from the area in front of the ear, and behind the ear. If eyelid surgery has been done as well, these sutures will be removed at that time. From this time forward, no further bandages are needed, only the chin strap.
Depending on the degree of the surgery, most patients are quite "presentable" within 2-3 weeks after surgery.
AS WITH ANY FACIAL SURGERY, AVOID BENDING FORWARD, AS THIS CREATES STRAIN ON ALL INCISIONS THAT ARE HEALING.
THE RECOVERY
Make sure you have plenty of liquids and soft foods available for your convalescence. Fruit juices, carbonated beverages, and yogurt are particularity useful.
There is some degree of swelling and possibly bruising in most patients but usually very little in the way of pain or discomfort. It is also not unusual for a patient to experience a day or two of "blues" one to three weeks after surgery. After the initial excitement of the operation has worn off, but before you look as good as you would like to, this mild depression might be experienced. It is not unusual and no cause for alarm and should pass quickly.
There is always some numbness in front of the ears and sometimes along the front of the neck. This is normal, and although feeling will return gradually, some numbness may persist for several months. Men are cautioned to use extra care in shaving during this period, perhaps to use an electric razor for safety. Also, the use of heat (compresses, hair dryers etc.) must be carefully controlled lest the skin be burnt without knowledge.
For the first week you should plan on remaining relatively at rest at home. You may be up and about the house but not outside except for your office visits. The second and third week is a time where gradual resumption of physical activity takes place. No sports or exercise is allowed at this period of time but, if you feel up to it, your may go out to a movie, for an easy walk, a casual dinner, etc. After three weeks gradual resumption of any athletic activity you are comfortable with is allowed.
Hair treatments or coloring should not be done for at least three weeks after your surgery. Driving is permitted after one week as is sexual activity (within reasonable limits).
As you probably know, the sun is very injurious to your face. Particularly after having facial surgery, you should be exceedingly careful of the sun, avoiding exposure when possible and using liberal quantities of sun-block. Hats and sunglasses are also helpful. Besides having a direct, deleterious effect on your facial skin, the sun will cause recent scars to redden and become thicker. This is something you will want to avoid.
RESUMPTION OF PHYSICAL ACTIVITIES GENERAL RULES OF THUMB:
TWO, FOUR, SIX RULE
First weekend: TAKE IT EASY!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks: take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks: light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks: resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
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BEFORE
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AFTER
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Face-Necklift, Superficial cheeklift, Livefill to upper-lower lips, naso
labial folds, marionette,
upper lip lift, upper blepharoplasty, CO2 laser resurfacing, lateral browlift.
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BEFORE
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AFTER
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Face-Necklift, Superficial cheeklift, Livefill to upper-lower lips, naso
labial folds, marionette,
upper lip lift, upper blepharoplasty, CO2 laser resurfacing, lateral browlift.
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