The Laser Facelift: The Mixto Fractional CO2 Laser Facelift

The Laser Facelift can be very effective in patients with Fitzpatrick Skin Types I-III. The fractional CO2 laser can effectively tighten the skin around the upper and lower eyelids, the nasolabial folds, and the pre-jowl area. The CO2 laser is also very effective at reducing dyschromias or pigment irregularities on the face due to sun exposure.
The fractional CO2 Laser works by producing a controlled burn to the surface of the skin as well as stimulating collagen formation in the dermal layer of the skin. It is therefore quite common for the appearance of the face to improve up to one year or more after the procedure.
It is becoming more common for many women with Fitzpatrick Skin Types I-III to undergo fraction CO2 Laser skin resurfacing to improve the skin texture and then returning to undergo a formal facelift 2 to 3 years following the laser treatment.


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Facelift Surgery. Deep Plane Facelift & Fractional CO2 Laser

While the neck is often a significant area of concern for many patients who present for facial rejuvenation, I find that the deep plane facelift is very effective at restoring the position of the cheek.

In the youthful face, the cheek is positioned beneath the lower eyelid so that a smooth contour exists between the lower eyelid and the cheek. As we age, the cheek begins to descend, causing a gap to be created between the lower eyelid and the cheek.

When performing facelift surgery, the surgeon repositions the cheek back to beneath the lower eyelid to restore this contour. Often after patients have a facelift they remark about the improvement in the appearance of their eyes. This is because the volume of the cheek is now repositioned into the proper location.

The patient in the above photograph underwent deep plane facelift, and CO2 laser to her lower lids and peri-oral rhytids or “wrinkles”. In the before photograph she is 89 years old, in the after photograph she is 89 years and 10 months.

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Facelift. Male Necklift

Traditionally as male individuals age, the greatest signs of aging occur in the neck. Males often do not have deepening of the nasolabial fold as seen in females. Therefore, I often find the best way to rejuvenate the face in males is to address the neck.

This can be done with the same incision as seen in female patients to address the lower face and neck or it can, in some males, be performed with the z-plasty on the anterior aspect of the neck. The incision is limited to the area beneath the chin and above the thyroid cartilage.

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Facelift. Deep Plane Facelift.

I enjoy all of the different types of facelift techniques that I have learned.

My preferred facelift technique is the deep plane technique. Which technique I perform depends upon the presence of jowling, the heaviness of the neck, and the depth of the nasolabial fold. I find that a significant amount of youth can be restored to the face with effective treatment of the neck in facelift surgery.

Appropriately addressing the neck requires a small incision beneath the chin to adequately correct the presence of platysmal bands or deposits of fat beneath the chin.

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Necklift. Male Facial Rejuvenation.

More male patients are seeking consultation regarding facial rejuvenation. Male patients often present to the office wanting to improve the appearance of their face and neck.

Prior to performing any procedures, I first determine if the jowls or nasolabial folds need to be addressed to create a more youthfull appearance. If a male patient has significant jowling or a deep nasolabial fold then we can proceed with a lower face and neck lift.

If there is no jowling and a nasolabial fold which is not deep then we can proceed with a necklift. The necklift can be performed with an incision in the neck itself, with an incision beneath the chin, or with standard facelift incisions. Another very effective means to address the aging neck in the male is with a platysmalplasty and neck z-plasty.

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Facelift. Necklift. Neck Liposuction

Patients frequently come to consultation asking whether or not they need a facelift, necklift, lower facelift, full facelift, etc. It is important to individualize each facial rejuvenation operative plan depending on the desires of the patient as well as the surgeon identifying those objective indicators of aging that can be corrected with surgery or another non-surgical modality.

For example, the patient in the above photograph did not like the appearance of her neck. While even the untrained eye would notice the neck laxity, when one examines the before photograph closely the jowling which obscures the mandibular border is easily identified. Therefore it was important to address the jowling as well as the neck to optimize the aesthetic outcome.

It is quite common the aging female patient to address at least the lower aspect of the face when addressing the neck. Almost invariably, when there are signs of aging in the neck, there are also signs of aging in the face. Therefore women will also undergo a facelift or other maneuvers to address the jowls and nasolabial folds.

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Facelift Surgery. Deep Plane Facelift

The deep plane facelift is a technique that can be used in conjunction with an upper and lower blepharoplasty as well as a coronal brow lift.While the deep plane facelift affords excellent correction of the nasolabial folds, jowls, and neck, I have found that the aperture of the upper eyelids can yield a significant positive impact on the aesthetic result on the overall youthful appearance of the face.

It is very common for women as they age to have an accumulation of skin on their upper eyelids. This accumulation of skin has been given the medical term, dermatochalasis. Often this accumulation can be asymmetric-meaning greater on one side versus the other and can create differences in the aperture of the eye.

It is important when correcting this asymmetry to note the location of the tarsal fold or eyelid crease.As you can see in the above photograph the patient's right eye has significantly more skin pre-operatively than the left eye. Careful notation of these asymmetries is important so that post-operatively the eyes can have equal apertures and yield an optimal aesthetic result.

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