4-D Facelift

Facelift surgery, or a rhytidectomy, like all facial cosmetic procedures has undergone an evolution of technique, 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. Dr. Vigliante trained closely with Dr. Watson, learning this technique with him. Both of them worked together to evolve this technique into other facelifting techniques, including the Precision Lift™. Dr. Vigliante offers a wide variety of facelift procedures, ranging from the least invasive, Contour Threads to the 4-Dimensional Facelift. Dr. Vigliante will tailor each treatment plan depending upon the patient’s needs and desires.

A traditional “facelift” was a purely skin-stretching procedure whereby patients often complained of the “tight, operated” 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 allow the skin and muscle facelift to evolve to a completely new and revolutionary level.

  • 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 skin and 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 pretence. 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 degenerates, 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 aging 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 do not 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 crow’s 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/multilayer face and neck lift and chemical or laser resurfacing. This is a very safe and predictable procedure and is often combined with rhinoplasty, cheek or chin augmentation and eyelid blepharoplasty when indicated. For patients who have limited skin laxity, a Three Dimensional 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.

Dr. Vigliante will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you.

Preoperative Care: Avoid drugs that contain aspirin several weeks prior to surgery to minimize excess bleeding. You may be required to take antibiotics to prevent infection. You may be instructed to shampoo your hair the night before surgery.

Post Operative Care: Our highly trained and experienced Patient Care Coordinator will be your personal “coach” in order to prepare before and after surgery. She, along with Dr. Vigliante, will review in great detail all that you need to know how to prepare for the recovery period. Elective surgical procedures such as these are “inconveniencing” rather than “incapacitating.” Compassion and handholding is what we do best and we want you to always feel that we are here to help you through the post-operative period.

It will be necessary to have someone drive you home and stay with you for the first 24 hours. Initially you will have a large dressing wrapped around your head. These will be removed in approximately 24 hours. The stitches will be loosened and removed in approximately 7 days.

To encourage healing, the doctor may remove the sutures in stages. 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.

We recommend that you avoid the sun for several weeks after surgery and always use protective sun block over the healing incisions for one year.

Complications following facelift are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and scarring. Infection is rare due to the large blood supply to the face. As mentioned, the risk of bleeding is greater if you take aspirin or blood thinners within 2 weeks of the surgery. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers.

By following pre- and post-operative instructions, you will minimize potential risks.

Recovery: What to Expect

In the weeks following surgery, the facial skin and area around the ear may be numb. There may also be some temporary discoloration as healing begins, which may take a few months to disappear. Occasionally, the facial nerve is bruised during surgery, resulting in temporary loss of function or sensation. However, actual permanent bruising of the facial nerve is rare.

One side of the face may heal at a different rate than the other side. This is the rule rather than the exception. We all are not perfectly symmetrical and one side of the face is never a perfect match for the other. The goal of cosmetic surgery is to equalize this natural asymmetry and may require “more surgery” on one side to achieve this result.

The healing process is gradual, so you will not notice final results for up to 6 months to 1 year. A single procedure often achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.