The Procedure: Mid Facelift and Traditional Facelift

Surgeons use the term “facelift” to describe any procedure on the face that results in a tighter, more youthful appearance. I will discuss the two most recognized approaches: the midfacelift and the “traditional” facelift. The midfacelift is a powerful new way to rejuvenate a person’s appearance who is just starting to show signs of aging. Unlike a traditional facelift, which pulls the entire cheek skin and neck skin in an upward and backward fashion to improve sagging jawlines and necks, the midfacelift pulls the area between the lower eyelid and upper lip in a more vertical direction. This serves to soften the fold between the nostril and the corner of the mouth (naso-labial fold) as well as add more fullness to the cheekbone and shorten the aged, elongated lower eyelid. Because the incision is inconspicuously located within the lower eyelid or within the temple, there is no obvious scar.

The traditional facelift, on the other hand, is a powerful procedure for improving the jawline and neck. With some of the more extensive modifications, naso-labial folds and sagging cheek fat can also be repositioned to produce a more youthful contour. The incisions are hidden in the hairline and around the ear and may or may not include a smaller incision under the chin. This latter incision is useful in approaching the anterior neckbands that may need to be modified through cutting, removal or suture tightening.

Browlift in the MtF TS patient

The female eyebrow is arched compared to the flat eyebrow in the male. The ends of the eyebrow (the club and the tail) are at the same level, and the highpoint of the arch is between the outside of the iris and the corner of the eye. Since many MtF TS patients have their supra-orbital ridges reduced, the eyebrows can be elevated at the same time by pulling the forehead skin upward in this open approach. On the other hand, if brow bossing is not an issue, endoscopic (closed) browlifting or even brow elevation through an upper eyelid incision can be performed. This latter technique would be a good approach if upper eyelid surgery were also being performed and most of the elevation that was needed was on the outside or lateral aspect of the eyebrow without significant drooping of the inside or medial aspect of the eyebrow.

Browlift (before & after)

Evaluating a Facelift Result

Though many facelifts are performed in Beverly Hills, the percentage of those that would be considered “excellent” or even “good” is not as high as one would expect. But rather than going into why this is the case, I would like to discuss what constitutes an excellent result. It goes without saying that there should be no serious complications, such as permanent sensory or motor nerve injury or loss of skin with resultant scarring. The result should make you look younger and refreshed. In many instances, colleagues at work will comment that you “look good” or “well rested” and that maybe you should take more “vacations”, like the one they think you just returned from. It should not look like you recently had surgery! The incisions should be imperceptible or well hidden. There should be no distortion of your features, like the corners of the mouth or eyes or the ears. There should be no significant asymmetries between the two sides of the face,  and improvement in the face should be matched by a similar improvement in the neck.

Finally, there should be no “lumps” or “depressions” following the surgery, nor should there be localized discolorations or edema, suggestive of damage to the vascular or lymphatic networks under the skin.