Sometimes when you’ve tried everything else, it’s time to take the leap. And when the issue is wrinkles, that final leap may be into the operating room. Surgical procedures to correct facial lines and wrinkles are no longer restricted to a complete facelift, with options based on individual needs and circumstances. In some cases, surgery is accompanied by less-invasive procedures that provide a final touch to create the optimal result.
In fact, some surgeons are moving away from surgery to address wrinkling. “Some deep wrinkling of the sides of the face—cheeks and the area outside the smile lines—can be slightly improved with facelifting, even though lasers or peels are still better,” says Dr. Mike Nayak, a facial plastic and reconstructive surgeon with Nayak Plastic Surgery and Skin Enhancement Center. “Wrinkles in the central oval of the face, lower eyelids and around the mouth are best treated with injectable fillers, relaxers such as Botox, and lasers or peels.”
Nayak reserves surgery for removal of excess or sagging skin. “Think of it as tailoring a dress that fits poorly,” he says. “Surgery just moves wrinkled skin to a new location. When a dress is wrinkled, you wouldn’t take it in a couple sizes and wear it tight like a sausage skin; instead, you’d treat the fabric itself by steaming or ironing it. With skin, that would be chemical peels or lasers.”
However, if surgery is the agreed upon solution, surgeons are likely to use newer techniques that differ greatly from the old-fashioned facelifts that created a windswept appearance. “The best, most natural look is achieved by repositioning deeper tissues and bringing the skin along with it, instead of the other way around,” explains Dr. Timothy Jones, a plastic surgeon and director of Genesis Cosmetic Surgery Center and Medical Spa. This procedure is known as a ‘deep-plane facelift’ or ‘high SMAS facelift.’
Jones often pairs a surgical lift with fat transfer, in which fat is removed from another area—usually abdomen or thigh—and purified and injected into the face in order to fill out deep lines.
Dr. Samer Cabbabe, a plastic surgeon with St. Louis Plastic Surgery Consultants, performs endoscopic techniques using instruments inserted through very small incisions. Using this approach to lift the brow, for instance, “the muscles that act to depress the brow are weakened, and the brow is freed up and elevated and secured in place,” he explains. This prevents the patient from looking surprised, an effect sometimes created with traditional brow lifts.
A very popular surgical procedure for middle-aged women is the cheek lift, Cabbabe adds. This procedure addresses the cheeks and corners of the mouth while also improving the jowls and lower eyelid. “This is a good option for women with early jowls but who don’t yet have a lot of excess skin,” he says.
All the experts recommend seeking out a boardcertified plastic surgeon. And “beware of gimmicks,” Cabbabe warns. “If a procedure’s being promoted that sounds too good to be true, it probably is. You want your face in the hands of someone with experience and specific plastic surgery training. Don’t settle for less.”