Why facelifts (and all other facial surgeries) fail…

Failed facelifts and other surgeries like rhinoplasty fail much more often than you think.  We frequently see patients for consultation for revision surgery due to a failed outside procedure.  Rarely, these are due to poor expectations or surgical misadventures, and even more rarely simple bad luck.  Instead, the vast majority are due to errors in thinking and strategy due to gaping deficits in medical/surgical education.

The foundation for achieving any form of success in surgery relates to repositioning or resizing tissue.  In the case of rhytidectomy or facelifts, the tissue being resized and repositioned is the jowl and neck soft tissue, that must be brought into better balance with the facial skeleton of the lower jaw and cheek.  The tissued must be re-engineered via re-sizing and re-positioning to permanently reach this new goal.  Thus, the engineering principles that I call the four R’s must be successfully undertaken:  Release (separating of the tissue from its attachments), Resizing (shortening the overly long length of the tissue), Repositioning (moving the tissue or jowl to its new, higher position), and Reinforcement (simply the sutures and bandages that hold the tissue in the new position until the body undergoes the full healing process).

Most surgeons do not think of surgery this way.  They were trained to follow a series of steps, sometimes illogical, but very rigidly. (cut here, suture here, etc.).  This prevents thinking along the four Rs, (release, resizing, repositioning and reinforcement) which literally are all that matters.  Instead, we have our doctors competing to draw in your attention by using complicated, scientific sounding terms like SMAS lift or SMASectomy, deep plane, thread lift, mini-lift.  These terms are partially to confuse and partially to impress you.  Rhinoplasty terminology is full of the same lack of logic, with modern doctors only concerned about how many grafts they are using, or how “meticulous” their “attention to detail” is when applying “delicate sutures”.  Attention to detail and meticulousness are lovely, but only matter when the job is getting done, not as distractions or marketing phrases.  So, when the doctor your are looking at attempts to distract your attention from the four Rs that matter with a lavish office or OR, attractive staff, white coat or confusing terminology, you may wish to become a little more skeptical about what they offer!

So, why do the facelifts fail?  A failure to Release the tissue = eventual relapse…A failure to Resize the tissue = odd-looking bulges and eventual relapse.  A failure to Reposition Released tissue = Relapse!  Most doctors do NOT fail to reinforce, and this is why MOST fail.  They focus upon the sutures, threads, incisions and dressings, all simply part of approach or reinforcement!  Again:  Suturing technique is nearly IRRELEVANT!  If this is what your provider focuses on…Run!

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