All of us can take steps to maintain our facial appearance but the fact is, your face and neck change with age. The greatest changes occur from infancy to puberty as your face and head mature into an adult form. The eyes, nose, and mouth features of your face expand to fill a greater area of the surface of the cranium; the relative area occupied by your forehead shrinks as your eyes move up; your eyes become proportionately smaller and your forehead slopes back; your face becomes smaller in respect to the rest of your body; and your chin tends to become larger and more protrusive. Although some of these changes continue into adulthood, other variations begin to occur to mark aging and correspond to the decline of your face. As your face matures, it changes some of its most enduring properties and acquires new attributes that are not necessarily appreciated. Your skin becomes darker, less flexible, and more leathery; lines, wrinkles, folds, pouches, and blemishes or discolorations gradually appear; muscles and connective tissues change their elasticity; and fatty deposits and bone may be lost to produce pouches in your cheeks, bags under your eyes, sagging under your chin, and other changes in the way soft tissues conform to your underlying bony structure.
Most people within a given society agree among themselves about what makes faces attractive and what makes them that way. They may disagree about certain attributes of beauty but much of what is considered attractive is shared universally across cultures.
The common characteristics that contribute to facial beauty include:
Symmetry: There is a significant correlation between a symmetric face and beauty. This means that facial features are mirrored across the vertical midline of your face. With aging, any facial asymmetry becomes more pronounced. Slight imperfections in symmetry are not significant but deviations such as a crooked mouth, twisted nose, or one eye smaller than the other disrupts the perception of beauty. Several studies have shown that the perceived age can be lowered when facial asymmetry is improved.
Good Proportion: Proportion among facial features contributes to beauty. Features such as your mouth or nose should not be too large or small in comparison with your other facial features.
Proper Placement: Proper placement of the features on your face is another factor contributing to beauty. The eyes should not be too close together or too far apart and the eyes and mouth lie approximately upon lines dividing the face into thirds.
Shape: The shape of the face in profile also shows a clear relation to attractiveness.
Some important facial shapes include:
The Ideal Beautiful Cheeks
One of the features of a beautiful face in a woman is a pronounced cheekbone with narrow cheeks. The ideal beautiful cheek has been found to be oval, not round. It is also angled which extends from the angle of the mouth to the base of the helix of the ear.
The Ideal Beautiful Lip
Having fuller lips is considered a desirable trait.
The Ideal Beautiful Brow
Your eyebrows bring attention to your eyes and help frame your face. The beautiful brow is typically arched at the junction of the medial 2/3 and outer 1/3 of the eyebrow. The lateral tip of a beautiful brow should be higher than the medial tip of the brow.
Dr. Brent Moelleken, M.D., F.A.C.S., is a Plastic and Reconstructive surgeon with offices in Beverly Hills and Santa Barbara, California. He is double board certified by the American Board of Surgery and American Board of Plastic Surgery and specializes in cosmetic surgery. He received his premedical, medical and surgical training at Harvard University, Yale University, UCSF and UCLA. Although skin is very important, ultimately a beautiful face is determined by your skeletal structure. Because of this, Dr. Moelleken will spend a considerable amount of time analyzing your bone structure and facial features before discussing any possible improvements you are considering. In the end, you will decide the procedure you want to have but it is important to trust Dr. Moelleken and understand that his advice is based on sound principles.
The ancient Greeks found what they believed to be the “golden ratio”, also known as “phi” or the “divine proportion”. This belief was devised by the Greek mathematician Eudoxus and is still used today in architecture and art. Pythagoras, another Greek mathematician, determined that this formula could also be the basis for the portions of the human figure and Leonardo da Vinci, over 2,000 years later, used this philosophy to show that the face should be divided into three equal horizontal spaces. The famed artist showed how these spaces are further subdivided into spaces occupied by the facial features and how aesthetic balance is achieved when the facial features fall within these parameters. To determine the “thirds,” the face can be divided into three sections by drawing horizontal lines through the forehead hairline, the brow, the base of the nose, and at the lower margin of the chin. On the ideal face, the three sections are equal. The beauty of a face was studied mathematically since the 5th century BC by the Greek sculptor, Polykleitos and through a system of ideal mathematical proportions; he developed a set of aesthetic principles and wrote a treatise called the “canon”.
His findings include:
An appreciation of what constitutes balance and harmony among facial features is the first step when Dr. Moelleken analyzes your face. He will also measure for full-face symmetry and while symmetry in the human face is rarely perfect, midline points should lie along a vertical line that splits your face. By dividing your face into halves and then fifths, Dr. Moelleken can assess balance and symmetry. The ideal face should be “five eyes wide,” that is, five times the width of one eye. The space between the two eyes should be the width of one eye. In addition, the width of your nose should not extend beyond the lines drawn down from the inner corners of your eyes. Among the factors to consider are the nasofrontal angle, the brow in relation to your nose and the eyes, the distances between your eyes and between the pupils of your eyes, the tip projection of your nose, and the length of your chin.
The three scientific steps developed to determine the perfect face-shape are:
There are many methods used by Plastic Surgeons to evaluate a patient’s face from complex mathematical calculations using profile and full-face photographs of the patient to the use of instrumentation to assess the proper angles and projections. The evaluation will vary according to the surgeon’s own aesthetic sense and Dr. Moelleken says it is important that you take some time in trying to identify the artistic style of a doctor. Doctors are very different in their approach to facelifts and over the decades, especially in the 1980s, the “pulled look” was very common. Dr. Moelleken is dedicated to completely natural changes and he believes that art and perspective comprise 30% of the surgical equation while the other 70% come from unhurried, compassionate surgical judgment, knowledge, and technique. Dr. Moelleken believes that art and biology combine to form the most harmonious, safe surgery possible.
People from all walks of life seek out Dr. Moelleken and his patients include many celebrities, business professionals, and broadcasters. During your first consultation, you will receive a personalized surgical plan customized to your needs and expectations. From a mole removal to a 360 facelift®, all of Dr. Moelleken’s patients receive his individual attention and he encourages you to research a physicians’ credentials thoroughly before deciding on the surgeon to perform the procedures you desire. In his opinion, he advises that you seek a surgeon certified by the American Board of Plastic Surgery or a Facial Plastic Surgeon to perform any cosmetic procedure. He explains that no other specialties are trained in the anatomy of all the deep layers of the face to the extent of these two specialties. Deep facelifts require knowledge of the nerves of the face in order to avoid damaging them. Well-trained plastic surgeons are trained in microsurgery to actually operate on the nerves when they are cut, damaged, or missing and they are therefore very familiar with where the nerves are. That is why Dr. Moelleken recommends finding a doctor with these two specialties as a starting point because “cosmetic surgery” is a basket term for anyone who wants to consider themselves a “plastic surgeon” without the six to ten years of plastic surgery residency training required after medical school.
Dr. Moelleken has invented several trademarked procedures including the USIC® and LUSIC® Ultrashort incision Cheeklift procedures, the 360 Facelift® a natural 3-D facelift procedure, the Hybrid tummy tuck®, a short incision, full tightening tummy tuck procedure, the LiveFill® lip and facial augmentation, all natural facial fillers using natural fat, and the Neck-Lace®, an interlacing technique to rejuvenate the neck. He is one of three surgeons in the world to complete the yearlong Aesthetic Surgery Fellowship at UCLA. He is a Fellow of the American College of Surgeons (FACS) and a member of the American Society of Plastic Surgeons (ASPS), The American Society for Aesthetic Plastic Surgery (ASAPS), Who’s Who in America, Who’s Who in the World and numerous medical and scientific organizations. He has been selected by Who’s Who in America’s Top Plastic Surgeons, Top Doctors in Los Angeles, America’s Top Surgeons, and by Vogue Magazine as one of the Top 10 Plastic Surgeons in America.
Age affects every part of the body but nowhere are the consequences on such open display as they are on your face and neck. Normally people are able to determine age from the face with surprising accuracy and nearly every woman recalls the first time she looked in a mirror and noticed a line at the corner of her mouth or near her eyes. No matter how self-assured or determined you are not to allow the external signs of aging to control your life, at the same time you always remember how disappointed you were at the sight of that first wrinkle. Men often have the same reaction when they realize that their hairline is receding or that they are developing bags under their eyes. Fine wrinkles around the corners of the mouth are one of the first signs that you are getting older and while the aging process itself cannot be changed, facial cosmetic surgery is a way to reverse some of its effects.
One of Dr. Moelleken’s signature procedures, the 360 Facelift® is for the patient who wants a complete rejuvenation of their face. Dr. Moelleken performs the 360 Facelift® with the concept in mind that the face does not just age in one or two areas: It ages overall. The 360 Facelift is designed to fix many areas the best he can. He starts with the Neck-Lace procedure, which is an incision underneath your neck. He tightens the neck muscles more aggressively than techniques used in the past when the muscles were merely tied. From the side of the face, he performs a bidirectional lift, which allows him to reach the deep, Superficial Musculoaponeurotic System (SMAS) tissues. Many people think the SMAS tissues are muscles but they are not and Dr. Moelleken lifts them up. He raises the SMAS tissue gracefully, not super-high on the edges so the pull of the face will not be obvious. By allowing the skin to go back in a more gentle direction, the “swoop” look of the past will be avoided. This gives more volume in the upper face and less volume in the jowl area. Unlike the procedures of the past, where the SMAS tissues were removed, Dr. Moelleken does not take away any volume because he understands that people need volume as they age.
LiveFill® is a new method of augmenting wrinkled or “deflated” areas in the face. LiveFill® is a better concept than fat injection because LiveFill® is tissue taken from the patient while they are fully alive. It involves grafts from the patient’s own tissues and the material is obtained as a customized fine graft with blood vessels intact. LiveFill® is basically little strips of tissue taken from areas in a patient where there is a lot of fibrous tissue, usually from the lower abdomen. This differs from traditional fat injection because this method means the tissue is not processed. Processed tissue involves sucking (aspirating) fat into a syringe, purifying it (usually through centrifugation), and then injecting it through a needle. Of course this procedure highly damages the living network of cells but with LiveFill®, Dr. Moelleken fashions completely untraumatized tissue from the patient into small, delicate grafts, resembling strings of pearls, that have structural integrity and blood supply. This technique is different from any rendition of grafted material developed thus far and because the survival of LiveFill® is better for fat injection, it is the method Dr. Moelleken uses for all areas that need extra volume. Since the face does not age in lines but in areas, it is better to fill in complete areas rather than placing filler underneath a single line. LiveFill® is placed beneath the areas that need filling such as your lips, smile lines, the area below your eyes, and in hollow portions of the face that develop with age. LiveFill® can be used for a number of different techniques and almost anywhere in the face. Since LiveFill® is a graft material similar to a skin graft, once the skin graft survives the patient will have it permanently. Dr. Moelleken says, “Once the blood supply of the body has grown into that graft, it is yours to keep forever.”
When Dr. Moelleken works on the upper eyelids, he does not take fat away. Instead, he repositions the fat or actually adds fat to the upper eyelids with LiveFill® to restore the volume. Dr. Moelleken says if you look at young people, you will notice the fullness around their eyes and in their face. They may have a beautiful contour between the cheekbone and the cheek but they also have nice fullness. When looking at older people, that fullness often needs to be replaced. Volume can be lost in the lips, marionette lines, in the temporal zone, the smile lines, and in the eyebrows themselves where the eyebrows actually start to deflate. Part of the 360 Facelift® concept is to restore natural fullness and rejuvenate your face comprehensively.
Often, the first sign of aging in the face occurs in the eye and cheek region. Dr. Moelleken uses LiveFill® for augmenting the cheek area and because it is a soft tissue, recovery is very quick since he does not have to operate all the way to the bone. Dr. Moelleken innovated the USI® & USCI® Cheeklift procedures and this superficial Cheeklift is a new technique. It involves raising the midface up underneath the eye and the unique feature of this operation is that the cheek pad is tied with invisible stitches to very tough tissue beside the eye instead of relying on the weak lower eyelid. The superficial Cheeklift uses an incision hidden just below the lower eyelashes and all the remaining stitches are buried underneath the skin. No implants or plastic are used and through the 360 Facelift®, if deep tissue restructuring is performed (not the conventional SMAS procedure), cheek tissue can be elevated. The Cheeklift is one of the most difficult procedures and every Cheeklift is tailored to the patient’s needs and anatomy. The superficial Cheeklift elevates the cheek pads and rejuvenates the lower eyes. This differs from a conventional facelift, which only pulls the tissues to the side. The midfacial area and lower eyelids cannot be rejuvenated through a conventional facelift incision because a windswept, unnatural appearance may result if that is attempted. When performed at the same time as a facelift, the superficial Cheeklift avoids this by elevating the cheeks, rather than by pulling them to the side and the result is a more natural rejuvenation.
When people have their eyes worked on, they frequently end up with a frightened, “deer in the headlights” look. This may result from the fact that the lower eyelid is very weak and cannot support weight so if the doctor attempts to remove skin from below the eye, the lower eyelid can pull down or develop a rounded appearance. Patients of conventional lower eyelid surgery often complain that their eyes “don’t look the same”. Dr. Moelleken has found that the superficial Cheeklift can correct this problem on patients who have already had eye surgery and noticed that their eyes were pulled down with a somewhat hollow appearance. Some asymmetries can be corrected while others cannot, however. Sometimes, one globe (eyeball) is more deeply set than the other. This means that it sits more deeply in the bone of the eye (orbital socket) and this in turn will cause many other asymmetries. The deeper eye will have more laxity (looseness) of the overlying skin, causing the upper eyelids to appear different. There is often on the same side as the deeper set eye a flattening of the cheekbone, again causing the eye area to look different. Orbital dystopia may also be present, where the eye bones are actually at different levels.
Brows can be at different levels, or have different strengths of muscles functioning to cause the brow to appear different and is this case, the whole anatomy of every bone and muscle in the face comes into play. Differences in the set of a globe cannot, for practical purposes, be corrected. However, when Dr. Moelleken carefully analyzes the asymmetries of the face, he can come up with a plan that minimizes the imperfections. No person is completely symmetrical and Dr. Moelleken will point out which asymmetries cannot be fixed. During your consultation, you will appreciate that he pointed out your asymmetries, recognized them, and presented a plan that included how to correct the fixable asymmetries.
The brow lift is a surgical procedure whose purpose is to improve your appearance and tightening the brow skin and elevating the brow achieves this improvement. The degree of correction varies and is influenced by the physical traits of your skin, the structure of your brow, and the procedure performed. Previously, there was only one brow lift procedure used known as the Coronal Brow Lift. This technique involved a long incision at the top of the head, through which the muscles of the forehead were modified and the brows, usually central and lateral, were elevated. Dr. Moelleken does not offer this procedure in his practice because of the length of the scar and the possibility that it will damage the sensation to the top of the head. There are many other options available today and the newer options reflect the knowledge of the importance of the hairline and preserving its natural contours. Minimally invasive brow lifts are performed through very small incisions next to the brow itself. This brow lift aims at reducing the angry or overly concerned appearance of the central brow, particularly the “frown lines”. The Brow Lift can be totally overdone and again this is where Dr. Moelleken’s artistry comes in. While some patients are very happy with Botox injections (Botulinum toxin A) every three to four months, others desire a more permanent solution and a brow lift is a good option. Also, Botox injections cannot elevate tissues the way brow lifts do because they just relieve the wrinkles in the skin caused by the muscles below.
Endoscopic brow lifts are also available and during this procedure, surgery is performed through endoscopes that enter above the hairline modifying the frown muscles and elevating the lateral brow. The brow is fixed in an up position with screws. This approach avoids the long incision at the top of the head but its results are generally less effective than other methods and prone to relapse. For selected patients, especially a patient whose hairline is already high due to previous plastic surgery or genetics, hairline brow lifts can restore a lost hairline while elevating brow tissues to a more youthful look. No brow lift is right for every patient and they all come with a series of pros and cons, which will be discussed in detail during your consultation.
Dr. Moelleken offers his patients lip augmentation through LiveFill®, or fascial-fat grafts from their own bodies (autologous nontraumatized fascial fat grafts). This method has proven very reliable at achieving soft, full results and he finds it to be much more reliable than fat injections. This is because the grafts do not need to be aspirated and injected the way fat injections do and the grafts cannot be rejected because they come from your own tissues. Dr. Moelleken cautions against the use of silicone in any form for the lips, or any semi-permanent filler for that matter. Silicone, Artecoll, and ArteFill can cause a chronic swelling reaction over the years that can become disfiguring and often uncorrectable in some patients. Even patients injected with microdroplets of silicone can develop a blunting of the vermillion border and white roll of the lip that looks as though swollen lips had been sanded down. Silicone can run downhill and cause a very characteristic “trout lip” deformity over the years and several celebrities who have had this happen to them are very public about their dissatisfaction with silicone. Dr. Moelleken says it is important to remember that anything but your own tissue has no defense against the colonization of bacteria setting up shop in or on top of the filler.
360 Facelift® Recovery and Risks
The 360 Facelift® is usually performed as an outpatient procedure under a light general anesthetic, which means you will be asleep. In some cases, a “twilight” anesthesia may be used but these techniques will be discussed during your consultation. A board certified anesthesiologist, who will remain in attendance throughout your operation to monitor your progress, will administer the anesthetic. You must be in good health to have a 360 Facelift® and if you smoke, it is imperative that stop all nicotine products four weeks prior and four weeks after your surgery. You must also take aspirin or aspirin-containing products for two weeks prior and two weeks after you surgery as this may cause bleeding. The length of your surgery varies depending on how much work you have done. There should be a minimal amount of pain associated with this surgery but medication is available to control any discomfort. The scars left by this procedure are unpredictable and although they eventually fade, they are permanent. Swelling is mostly resolved in two to three weeks and bruising is usually localized to the area immediately beneath your eyes and the area on either side of your neck. This usually subsides within one week and it is important to remember that it will be impossible to judge the final results of your surgery until all of the swelling has subsided and the operative area has smoothed out. Recovery is the same as for a traditional face and neck lift procedure so you should be able to return to your regular routine approximately two to three weeks after your surgery