Four-Dimensional Facelift, V.I.P. Face Lift & Neck Lift

Dr. Sawisch performs rhytidectomies, or facelifts, to enhance your appearance and correct these conditions. Like all facial cosmetic procedures the facelift has undergone an evolution of technique and results, especially with the advent of new technology like the laser, endoscope, tissue healing adjuncts such as platelet rich plasma and biocompatible facial implants. The greatest contribution (awarded by the American Academy of Cosmetic Surgery in the year 2001) in the last few years is that of the development of the Four Dimensional Facelift, as pioneered by Dr. Stephen Watson of Dallas, Texas. Dr. Sawisch spent an entire year working under the direction of Dr. Watson perfecting this technique.

A traditional “facelift” was a purely skin-stretching procedure whereby patients often complained of the “tight, operated” or “wind-tunnel” look that lacked longevity of results. Later, surgeons learned to reposition the muscle deep to the skin as well. In the hands of many cosmetic surgeons, this led to longer-lasting results and a somewhat more natural appearance.

The Four Dimensional Facelift utilizes sophisticated, high-tech instrumentation to reposition every layer, starting with the periosteum, then the muscle, followed by the skin. The traditional facelift has evolved to a completely new and revolutionary level. Several principles are utilized.

Good form follows good function. Problems with the old techniques of facelifts revolved around improper positioning of the skin and muscle which over time descended due to gravity and laxity of the collagen matrix, or the scaffolding complex of the skin. Patients developed the “unnatural, operated” look because the vector of the pull of the tissues was straight back, as though human beings walked on all fours. When patients would speak, smile or exhibit other facial expressions, this improper surgical positioning of the muscles of facial expression would exacerbate the resultant deformity. So essentially, in order to accomplish good “form” or appearance, an intimate knowledge of good “function” of the muscles needed to be applied to the repositioning of the drooping muscles affected by gravity. This should be the foundation of all modern cosmetic surgery.

Reposition and add to before you take away. The traditional techniques always applied a stretch to the tissues and then involved a removal of “excess.” This is a false pretense. We do not typically grow “excess” skin as we age (unless accompanied by large weight gain) in the facial tissues. Rather a laxity of the collagen matrix occurs and the underlying skeletal structure resorbs, or melts away with time, much like elderly family members seem to get shorter every year. Therefore it is logical to address the aging effects of skin laxity with the skin-tightening effects of the laser and augmentation of the resorbing skeletal features with biocompatible implants or grafting techniques. These are minor parts of the procedure that yield tremendous rejuvenating effects!

Consider the face as a whole and don’t divide it into anatomic parts. As analytical surgeons and as artists, we learn to study the symmetry of the face in parts: the forehead, the eyes, the cheeks, the nose, the lips, the mouth, the chin and the neck. We have been trained in multiple techniques in order to address these “parts” of the face that patients want addressed. The problem is that the over thirty muscles of facial expression don’t adhere to this division of anatomy. That is to say that the bone, skin and muscles are all connected and if we effect change on one part, it may adversely effect change or prevent change as desired. A facelift without a component of neck lifting will not correct the common complaint of jowling, or irregularity of the jaw line. The same muscle, the platysma, crosses this anatomical division of parts and will prevent change without repositioning the entire muscle. As such a facelift alone will not affect the crows feet around the eyes unless the drooping muscles of the lateral forehead are repositioned.

Multiple small procedures are better than one large one. Together multiple small, minimally invasive procedures addressing the face and neck as a whole can yield a more natural result with a shorter healing period.

The components of the complete Four Dimensional Facelift include an endoscopic brow/midface lift, a multivector/mulitlayer face and neck lift and facial laser resurfacing. This procedure is performed under I.V. sedation anesthesia on an outpatient basis in our surgical suite. For patients who have limited skin laxity, a “V.I.P.”, vectors in planes facelift may be performed which does not utilize the component of laser resurfacing. The finesse of this procedure involves a tailoring of the technique to each individual in order to achieve long-lasting, natural-appearing rejuvenated results.

Surgery

A Rhytidectomy can be performed under I.V. Sedation or general anesthesia in our surgical suite. These options will be discussed in detail with you. Pre-medication is administered for relaxation. Incisions are made inside the hairline at the temple, running in front of the ear then around the earlobe and behind the ear, ending in the hair of the scalp. The loose skin is separated from underlying tissue and is pulled up and back. Excess skin is removed. Sagging muscles and connective tissues are tightened. In some cases, fatty deposits are removed from beneath the chin and neck. Small sutures are used to close the incisions. The procedure may take up to five hours depending on whether any other procedures are performed at the same time.

Postoperative Care

It is recommended that you stay one night in the recovery care center to receive specialized care from the nursing staff. Bandages are applied to the area of surgery and are removed within a few days. Pain is moderate and controlled with oral medications. Your sutures are removed within the first 5 to 10 days. In order to minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision.

It is recommended that you avoid the sun for several weeks after surgery. Healing is gradual so you will not notice final results for up to 6 months. Improvement varies, depending on the your initial condition. In most cases, a single procedure achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.