It is important to understand for patients to understand their facial aging process. There are several factors which contribute to facial aging including changes to the skin (fine lines, wrinkles, brown spots), loss of facial volume, and descent of facial tissue (sagging tissues).
Many surgeons attempt to combat the signs of aging by pulling the skin back as tight as possible. This is a flawed concept for several reasons. First of all, if you look at a young face of someone in their late teens or early twenties, the face appears plump, round and relaxed but definitely not tight. Pulling the skin back tight also assumes that it will lift the deeper tissues with it. Unfortunately, unnatural contours and depressions can occur with this type of lift.
A more pragmatic approach to facelifting is to directly address the tissues which have descended. Dr. Shah and Rosenberg have described a lift entitled CPMS (Complete Platysma Muscular Suspension). This lift is based off the anatomic findings that the platysma muscle has a significant facial contribution. By sliding this muscle posteriorly, several findings are evident. First of all, recovery rates are sooner because of less bleeding in this avascular plane. In addition, a natural appearance can be seen with the face because the root cause of aging, the descended deeper tissue, is repositioned, eliminating the need to place tension on the skin.
A facelift is not the only answer to facial aging but represents one critical component to rejuvenation of the aging face. The general understanding of the aging phenomenon has improved within the last several years but is still not entirely clear. There are clear changes which happen in the skin. Skin aging can be from the natural process of aging itself or from the sun. In natural aging, the skin becomes less thinner in certain layers, more fragile, and dryer as we age. Part of the problem with skin as we age is that the cells which make sebum, or oil, for the skin become less active. With sun aging, the skin becomes thicker and has frequent discolorations on the exterior often giving it a leathery appearance.
Volume replacement represent another critical aspect of rejuvenation of the aging face. Dr. Shah advocates the use of substances with an excellent track record of safety and minimal complications.