As a facial plastic surgeon, Dr. Cilento has had the opportunity to train with pioneers in facial rejuvenation and facelift techniques.
He is an experienced facelift surgeon who has an intimate knowledge of facial anatomy and the most current and advanced facelifting techniques. During your consultation, Dr. Cilento will evaluate your unique attributes, aging pattern and specific desires in order to select the treatment that is right for you.
Facial Rejuvenation & Aging
To understand facial rejuvenation, you first have to understand facial aging. Our understanding of the aging process is advancing every year, and in fact there is an entire body of knowledge developing in the field of anti aging medicine. We now know that changes on a cellular level, senescence, give rise to all the changes we have come to associate with aging in our appearance.
Loss of volume and structural support in the tissues of our face give rise to drooping and sagging as weaker tissues lose their battle against gravity. It is also the loss of certain cells and cell products over time that give rise to the skin changes such as fine and coarse wrinkles, hyper and hypo pigmentation that are associated with aging.
The soft tissues of the face are not the only areas to experience this degeneration, our bones are also losing volume and changing over time with effects seen in cheeks and chin accordingly. To manage the changes that occur with aging, there should be a comprehensive approach that addresses all of these issues.
Underlying health and fitness, skin rejuvenation procedures, facial contour deficiencies and skin drooping and sagging should all be addressed according to the age of the individual seeking to improve their natural appearance.
Younger individuals (20′s and 30′s) may be looking to maintain their appearance or prevent aging changes with topical products, injectables or appearance enhancement. People in their 40′s, 50′s and 60′s may benefit from a combination of preventive and reversing procedures and products to help their appearance match how young they feel inside. Patients in their 70′s and beyond need more individualized care that takes into consideration their underlying health and overall goals for rejuvenation.
In general, a facelift or rhytidectomy is an operation designed to reverse the signs of aging in the jowls, cheeks and neck region by repositioning loose and sagging tissues. However, it is important to remember that the term “facelift” does not describe just one procedure. Over the years the procedure has evolved and currently there are several procedures that carry the title “facelift” each with its own merits and limitations.
In the beginning, facelifts were performed by simply pulling the skin tighter. This gave good results but in some people the appearance was unnatural and in all cases the results lasted only a few months due to lack of support. In the 70′s, surgeons began recruiting deeper, sturdier tissues to help support the redraped skin and this has given rise to the more modern forms of facelifting today.
Dr. Cilento performs the standard facelift or SMAS lift, and also the more sophisticated procedure known as the “Deep-Plane” facelift. Both procedures give a more youthful appearance in the neck and jowl region that is both natural appearing and long lasting. Deciding which procedure is right for you depends on multiple factors.
Standard SMAS Lift
The SMAS lift or “standard facelift” is sometimes called the muscle pulling lift because it recruits the underlying sturdier tissues of the face to help support the skin as it is redraped. The SMAS (Sub Musculoaponeurotic System) layer of the face separates the deeper facial structures that are not as affected by aging from the superficial structures such as the skin.
Once the skin is lifted, the SMAS is tightened by a series of carefully placed sutures that are designed to take tension off of the skin when it is redraped. When it was introduced it was seen as a vast improvement over skin-only methods and it is still used today on younger patients who need a small amount of improvement in the neck and jowls. It is the underlying procedure in all of the popular “quick lifting” techniques packaged under many names.
This procedure is the most effective in restoring the midface and nasolabial folds (creases from our nose to our mouth) because the fat pads in the cheeks are lifted and repositioned removing facial hollows and restoring the youthful shape to the cheekbones. In addition, since the SMAS layer is connected to the loose muscles of the neck, a deep-plane facelift is also the most effective in recreating a smooth neckline.
Unlike the standard facelift where the skin is separated from the deeper tissues, the deep-plane technique repositions the tissues of the face as a single unit causing less tissue trauma and faster healing. Also, since the deep-plane technique is accomplished in a plane that naturally exists in our face (instead of an unnatural plane that is used in other facelifts), there is less bruising and minimal pain after this procedure.
Regardless of the technique used, it is important to understand the goals of a facelift. Irrespective of age, a facelift should restore a youthful appearance with a natural result. Patients uniformly report feeling younger and looking refreshed without changing who they are. Younger patients can expect the results to last a bit longer, but older patients often experience more dramatic improvement. Facelift incisions are hidden behind the ears and in natural skin creases. This ensures excellent camouflage, as the incisions typically heal as fine thread-like lines.
A facelift usually takes several hours to complete, and occurs either in a hospital or outpatient facility. General anesthesia or a combination of local anesthesia and deep sedation is most often used during facelift surgery. Following surgery, some patients may spend a night in the hospital.
Typically there is minimal pain associated with a facelift. However, we will prescribe medication for you to ensure that you are comfortable throughout your post-operative healing period. It usually takes 10-14 days for patients to return to normal social activities, and incisions will continue to heal and refine for slightly longer.