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Face lifting  just the facts

Sydney plastic and cosmetic surgeon Dr Darryl Hodgkinson explains face lifting procedures to help turn back the clock.

BEFORE & AFTER pan facial rejuvenation by Dr Hodgkinson: facelift, neck lift and upper and lower eyelid surgery
BEFORE & AFTER pan facial rejuvenation by Dr Hodgkinson: facelift, neck lift, endoscopic brow lift and upper eyelid surgery
BEFORE & AFTER facelift and neck lift by Dr Hodgkinson
BEFORE & AFTER facelift and chin implant by Dr Hodgkinson
BEFORE & AFTER facelift and upper eyelid surgery by Dr Hodgkinson
  • The ageing face is characterised by a square jaw line, while a youthful face is oval in shape.
  • The most common age to have a facelift is between 45 and 60 for women and 50 to 60 for men.
  • Face lifting elevates sagging skin, muscle and fat. Lax facial tissues including the neck, skin and jowls are key contributors to the signs of an ageing face.
  • Face lifting re-suspends sagging tissues and readjusts contours of the face, depleted due to fat accumulation or degeneration.
  • All scars for face lifting are hidden within the hairline as much as possible or placed in the crease in front of and behind the ear, and under the chin.
  • Loss of the definition of the jaw and neck by the sagging tissues is corrected by re-suspension of the platysma muscle and the SMAS layer.
BEFORE & AFTER pan facial rejuvenation by Dr Hodgkinson: Fogli facelfit, upper and lower eyelid surgery and laserbrasion

Pan facial rejuvenation

Pan facial rejuvenation refers to surgery that addresses all the aesthetic areas of the face required to give an overall fresher appearance. The combination of procedures can include a facelift, brow lift, neck lift, eyelid surgery, skin resurfacing and sometimes cheek or chin implants.

In the hands of an expert, the patient will have a younger appearance that does not look overdone or operated on – especially as all aspects of the face have been addressed equally. This avoids the problem of the telltale signs of ‘having something fixed’ , such as having youthful-looking, defined eyelids but a droopy neck.

The cornerstone of all pan facial rejuvenation is the facelift. The facelift, however, is a very misunderstood procedure and the name itself has been used for creams, treatments and lesser surgical procedures – none of which deliver the results of a well-performed true facelift.

Many patients who come to the clinic seem afraid of the word facelift. However, I believe a well-performed contemporary facelift is the only procedure which will in one step correct sagging jowls, neck wrinkling, chin laxity and improve loss of facial fullness and return the tone of youth to the face. There is no need to be scared of the facelift word.

BEFORE & AFTER facelift and lower eyelid surgery by Dr Hodgkinson

Acronyms exist to lessen the blow of the facelift word, including the MACS lift, the S lift, the Mini lift, the thread lift and the Z lift, but in my opinion these can confuse and also tempt a patient to choose a lesser procedure which leads to the likelihood of disappointment because of a lesser result.

Thirty percent of patients coming to me have had a disappointing experience with lesser lifts that have only partially improved the whole face and this inadequate correction may detract from the overall facial aesthetic. My technique has evolved over 30 years, having been trained by leading plastic surgeons in the United States in the late 1970’s and progressing over the years so I have a complex understanding of the contribution of skin laxity as well as fat accumulation, fat degeneration and sagging of the muscularity of the face, which all contribute to facial ageing.

Understanding the SMAS platysma muscle complex, which is responsible for the coordination of human expression, and how this complex structure can be manipulated to redefine the neck, jowls and cheeks, is imperative for the modern facelift. This understanding can only be learned over years of surgical experience and critical evaluation of
one’s results. I ask my patients to bring photographs of themselves from when they were 30 to 40 so I can assess how they have aged and the extent of surgical correction needed to give them a natural-looking appearance.

Having performed thousands of lifts, I can answer patients honestly when they ask me the following question: Will there be change? Yes. My advice to prospective patients is not to waste their money or time on a procedure that leaves a temporary or inadequate result.

To ensure a harmonious facelift procedure, eyelids and brow surgery are often combined in what we now call pan facial rejuvenation. These procedures are carried out as an outpatient at our fully licensed day surgery facility and we suggest our plastic surgical nurses stay with a patient for 24 to 48 hours to ensure minimal early post-operative problems, particularly in reducing swelling.

I rarely perform these procedures in local hospitals due to the lack of personal control I have over hospital nursing staff who understandably are often too busy with other patients of more ‘significant’ surgical procedures to be able to impart the critical care necessary for facelift patients in the first 24 hours.

BEFORE & AFTER pan facial rejuvenation by Dr Hodgkinson: facelift, endoscopic brow lift, upper and lower eyelid surgery

Preserving expression

The purpose of a facelift is not to tighten the face but to recreate the youthful contours of the jaw line, neck and cheekbones. While the goal of a facelift is to make the face more youthful, natural lines of expression, such as ‘smile lines’ must be maintained so that the face is natural both in repose and when animated such as while speaking or laughing.

Around 80 percent of expressivity of the face is in the brow and the eyelids. For the past 15 years facial surgery techniques have evolved to create more natural-looking results and retain individual expression.
These techniques include the endoscopic brow lift, which can produce a more natural-looking result compared with the traditional open brow lift.

The endoscopic technique can achieve a nice gentle elevation of the brows without the startled appearance the older procedure typically produced. The endoscopic method also allows for small incisions to be made rather than one long incision, thereby minimising any resulting scars.

In addition, modern eyelid surgery focuses on reducing, rather than completely eliminating, wrinkles and excess fat around the eyes. The reason for this focus on preserving the patient’s individual expression is that surgeons recognised they were leaving their patients with a blank expression. I believe keeping a few lines actually enhances the result of facial rejuvenation surgery – the patient maintains their individual personality and appears to be happy, whereas a patient who has no lines around the eyes can appear blank and expressionless.

Eyelid and brow surgery are often combined together or as part of pan facial rejuvenation to achieve a naturallooking youthful enhancement, taking away scowling and tired-looking eyes while maintaining the individuality of the patient.

Expertise is everything

Dr Hodgkinson has more than 30 years’ experience in facial cosmetic plastic surgery. He was a preceptor in Newport Beach, California, in the late 1970s after studying plastic surgery at the prestigious Mayo Clinic. Dr Hodgkinson has continued to travel the world attending conferences, lecturing and visiting other leading surgeons to ensure that his results are the best they can be. Dr Hodgkinson credits Dr Alain Fogli of France with the latest advances in face lifting techniques which have led to his current achievement in pan facial rejuvenation. During his life of practising in the US and Australia, Dr Hodgkinson has performed thousands of facial cosmetic surgery procedures.

Patients come to Dr Hodgkinson for pan facial rejuvenation and facial cosmetic plastic surgery not only because of his expertise, experience and communication skills but also because of his ability to artistically assess all the aesthetic areas of the ageing face and choose as well as perform the appropriate procedures to achieve a harmonious, expressive, youthful and natural appearance to the face.

Dr Hodgkinson with the staff of the Cosmetic & Restorative Surgery Clinic and Double Bay Day Surgery in Sydney