Facelift Series #5: Facelift Friends

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your co-host, Summer Hardy,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The title of this episode is Facelift
Friends. Illuminate this title for me,

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Dr. Bass. What are we talking about today?

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We're talking about treatments and
procedures that are often done in

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conjunction with the facelift.

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Our main focus is procedures
that are done at the same time,

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but there are also treatments that
may be taking place in a series before

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or after the facelift.

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All of these associated procedures
or friends are intended to

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address other features that the
facelift doesn't address or to

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amplify the degree of correction
that the facelift can produce.

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Some of these features the facelift
doesn't address are in the zone of the

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tissues the facelift works on,

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other features are aging changes in
parts of the face that the facelift does

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not modify,

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but are subject to aging changes
along with the rest of the face.

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Okay, let's get right into it.

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What are some examples of procedures
that address areas of the face that

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facelift doesn't?

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Some examples include
blepharoplasty, brow lift, lip lift,

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and earlobe reduction,

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which are the more common procedures
that are done in concert with a facelift.

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A blepharoplasty is a surgery to remove
excess skin and fat of the upper and

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lower eyelids.

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This is a very nice surgery with nearly
imperceptible scarring that removes

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redundant overhanging skin of the
upper eyelids and eye bags of the lower

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lids, leaving patients looking
more refreshed and well rested.

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A brow lift surgery is a surgery
that is exactly what it says.

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It lifts the brows.

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The lift can be customized to create
the brow shape the patient desires,

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and there are many different
types of brow lift surgery.

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There are coronal brow lifts, minimally
invasive endoscopic brow lifts,

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gliding brow lifts, temporal
brow lifts, direct brow lifts,

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and many other variations
to these techniques that
each use their own incision

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placement and fixation techniques to
create a lifted, youthful brow shape,

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which brow lift is best for you will be
a discussion to have with your plastic

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surgeon. A lip lift is a surgery that
places a scar that's hidden within the

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contours at the base of your nose,

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and it's used to shorten the
length of the upper lip. As we age,

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the distance between the nasal
tip and the upper lip increases,

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and our columella lengthens.

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This surgery shortens this distance
to create a more youthful upper lip.

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Earlobe reductions help to restore a
younger looking earlobe that is not as

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stretched and elongated.

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Patients often overlook how impactful
an earlobe reduction can be to giving an

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overall refreshed and
younger look to the face.

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All of these surgeries are great adjuncts
to add on during a facelift surgery so

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that all areas of the face are addressed
to maintain a natural balance after

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surgery. We have mentioned this a
few times already in this series,

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but a facelift is a surgery that primarily
focuses on the midface and the lower

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face. It corrects chowing,

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repositions cheek fat
softens nasolabial folds,

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and helps correct loose skin and
platysmal banding of the neck.

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When you address the lower and the
midface alone with a facelift and fail to

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address aging of the eyes,

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brows and other areas mentioned
that are a telltale sign of aging,

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you can be left with an unnatural
appearance as the harmony of the face is

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disrupted.

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And these areas that are not
treated by the facelift, again,

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are centered in the perioral area,

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the area around the mouth,

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the periorbital area or periocular area,

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the area around the eyes
and the upper face or

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forehead area. So they're not
action areas for the facelift.

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But when you think about it,
when people interact with you,

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they spend most of their time
looking at your eye area.

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About 70% of the time studies show.

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So working on periorbital changes

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along with face changes as well
as some of these other areas like

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lip contour, earlobes,

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but particularly that area around
the eyes is really important to

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project the kind of image
you're trying to project,

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that useful restored image and nod
your aging looking a little bit

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worn out kind of image.

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Okay, so we discussed
examples of procedures that
address areas of the face the

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facelift doesn't,

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are there any procedures done in the
area of the facelift to amplify the

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correction?

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There are indeed, and this has
become a really big thing. In fact,

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a central thing in facelifting in 2025 and

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beyond. Fat grafting to
add volume back to the

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face to enhance the restoration
of a youthful facial

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shape has become really central to

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facelift surgery because we lose not only

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a loosening of the skin as we age,

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but we lose volume in the
face and repositioning the

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reduced volume moves us
back towards a youthful

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shape.

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But adding back some of the
lost volume using fat grafting

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moves us a lot closer back
to that youthful shape.

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And there are other advantages besides.

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Sometimes instead of using fat grafting,

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this is done with chin and cheek implants,

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which have a more
predictable volume and shape.

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And overall fat grafting will enhance skin

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re-draping and overall
harmony of facial shape

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because the more projecting
the underlying scaffolding,

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the better, more completely
the skin will re-drape.

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Okay, so finally,

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we're ready to talk about procedures
that do other things besides what the

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facelift does.

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These are things the facelift doesn't
do at all or maybe only does minimally.

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So for example,

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wrinkles and other
features of skin quality.

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Dr. Edinger, what are
the main approaches here?

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Some of the main ones are laser
resurfacing, chemical peels, dermabrasion,

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and other energy treatments of the skin,

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like radiofrequency microneedling are
basically some examples of the modalities

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that we use to enhance skin
quality by improving its texture,

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coloring and wrinkling.

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These modalities can be tailored and
how aggressive they are depending on the

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patient need and their
tolerability of downtime.

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They all come with similar risks including
hyperpigmentation or darkening of the

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skin, hypopigmentation or lightening
of the skin, and scarring.

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Which modality is best for each patient
really depends on several factors,

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including their degree of wrinkling,
their texture, their patient's skin color,

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and ethnicity.

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There are other modalities you'll
possibly have heard about including skin

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rejuvenating treatments like
platelet-rich plasma or PRP and exosomes.

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Platelet rich plasma is a concentration
of platelets and growth factors that are

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actually derived in the patient's own
blood. Exosomes, on the other hand,

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are a bottled version of platelet derived
growth factors and signaling molecules

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with proteins that are harvested from
stem cells and manufactured into a topical

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product. The platelets,

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growth factors and signaling proteins
from PRP and exosomes are often used in

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combination with microneedling or
injections to deliver their regenerative

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molecules to the target
tissue more directly.

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They're used to reduce inflammation,
stimulate collagen production,

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and enhance skin tone quality and texture.

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And I alluded to this before,

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but fat grafting itself for
certain forms of fat grafting

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like nanofat, in addition
to adding back volume,

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also signal a lot of the biological

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youthful skin responses
that things like PRP and

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exosomes can signal.

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So part of the interest in fat
grafting is restoring that facial

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volume,

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but part of it is also
about trying to modulate the

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biology of the skin in a favorable
way to get new blood supply,

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new collagen, better
healing and a more vibrant,

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youthful looking skin.

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It sounds like there's a
lot of different options.

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How do you decide when
other procedures are needed?

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Deciding which procedures to apply really
depends on what the specific patient

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needs. We do not want to treat
one isolated part of the face,

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leaving the face unbalanced
and unnatural after surgery.

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So we approach each patient holistically
and come up with a treatment plan to

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meet their unique goals and their needs.

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Not every patient is going to need a
blepharoplasty or a brow lift in concert

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with a facelift to maintain
that facial harmony.

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Some patients will need more aggressive
skin rejuvenation efforts to improve

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their texture and wrinkling,

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while other patients may need more
of a focus on volume restoration.

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Each treatment is thoughtfully considered
and applied to each patient based on

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what they need and what they're
hoping to get out of the surgery,

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all while ensuring that at the end of
the day they're left with a natural,

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youthful, balance result.

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I think that's so important.
You said that beautifully.

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It's extremely common. In other words,

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not every facelift, but most of them,

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almost all of them that some other
procedures included at the same

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time and often multiple additional

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procedures.

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But this is always based on
careful physical exam by the

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plastic surgeon to identify features
that need to be addressed and

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that mated with the
individual patient's aesthetic

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concerns.

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So it's that customization that
Dr. Edinger was talking about

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that creates an individual
plan for that patient.

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Are there downsides to adding
procedures? How does it impact recovery?

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The main downside to adding more
procedures is increased cost in anesthesia

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time.

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The adjunct procedures we have discussed
will have minimal impact on recovery

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time,

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but they may increase the overall amount
of bruising and swelling after surgery.

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Some procedures can be
done exactly as you usually

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would as a standalone,

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and other procedures are modified
a little bit if they're done in

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conjunction with a facelift.

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So things like laser
resurfacing in particular

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is a good example of that,

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especially if it's full field
and not fractional resurfacing.

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I have actually written a
couple of discussions on
this in medical journals and

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book chapters where we
modify how we do the laser

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resurfacing because we're attacking
the skin from the surface as well

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as from underneath with
the facelift surgery.

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In order to do that safely,

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we need to change things up a little
bit and use a different set of

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laser parameters,

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but these things can be done
reliably and safely at the

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same time.

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Okay. And what are the most common
facelift friends in your hands?

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I most commonly perform blepharoplasty
and fat transfer during the time of

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facelift surgery.

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I find that most patients need
that in addition to the facelift,

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and I usually add in a skin resurfacing
modality to improve their texture and

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wrinkling to the treatment plan,

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whether this be at the time of surgery
or at some point before or after the

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surgery.

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And I'm going to sound a little bit
like a broken record because I have

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more or less the same answer.

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Blepharoplasty is extremely
common at the same time

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as a facelift surgery unless
the patient has done it

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previously.

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And fat grafting is associated
with facelift surgery in many,

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many cases unless there's
a particularly heavy face

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and not just for the faces
that are strikingly hollow,

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but there are more subtle aging
changes that are volume mediated

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in most faces that can
benefit from fat grafting

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along with those biological
benefits. In addition,

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I'm a big laser resurfacer.

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I think lifting a face and
leaving a bunch of wrinkles is

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half a job or glass half full,

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and I'd rather have the
glass all the way full.

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So I do this frequently with the facelift,

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but sometimes it's better to do it as
a standalone to get a more complete

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treatment.

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But localized areas like the perioral
area with those lipstick bleed lines

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are really, really common at
the same time as a facelift,.

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As an alternative,

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you can do it as a
fractionated treatment in a

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series starting at the facelift,

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but then with more treatments
later on after recovery.

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That makes a lot of sense. So Dr. Edinger,

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do you have some takeaways
for us on this topic?

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For me, treating all aging faces with a
facelift alone is a lot like repairing a

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weathered home's foundation without
replacing the roof or updating the windows

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or repainting the house itself.

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So while the aging face may very well
require a facelift to improve and reverse

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the signs of aging,

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it is not the only modality we have
at our disposal to restore youth.

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We have to approach the
face not in isolated units,

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but as a comprehensive
entity. When we restore youth,

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it has to be balanced and tailored
to give them that natural result.

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So that's really important.

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Dr. Edinger really laid it
out nicely that there are

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circumstances where someone has done other
things and all they need at this time

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is a facelift or a secondary lift,

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but usually a few other
features are really ready for

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treatment at the same time.

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And you'll notice the next worst thing
if you take the worst thing away,

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things that are very minor, you can leave.

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But things that are really ready
to be done are commonly performed

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along with the facelift.
More often than not.

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Skin quality in particular
needs other treatments.

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This is often done as a series
or sometimes at another time.

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And the other aging features, again,

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the areas that facelift
doesn't treat or that facelift

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doesn't fully address need
additional concomitant treatments.

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So as I said, when you
take away the worst thing,

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you inevitably see the next worst thing,

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and you don't want to turn around in
three months and be back for another

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procedure. That's about planning.
Have a detailed discussion with your

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plastic surgeon, see what they suggest,

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and look at yourself in
the mirror and in pictures.

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I usually show patients a photograph
of themselves during a consultation,

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and if the features the surgeon
points out are meaningful to

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you, take this chance at the same
time as the facelift to chase them.

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If you're really convinced
they don't matter to you,

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it's okay to leave them off.
But overall facelift friends,

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these associated procedures are an
essential part of putting together the

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most complete rejuvenation
possible, a harmonious,

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beautiful face.

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Take advantage of them during the
facelift and use them to best advantage.

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All of these add-ons make deciding what
to do when having a facelift a lot more

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confusing, but they also promise
a lot of additional rejuvenation.

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Thank you Dr. Bass,

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Dr. Edinger for schooling us on these
additional options and all they can do for

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us. They truly are facelift
and patient friends.

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Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

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Follow us on Apple Podcasts,

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00:16:11,630 --> 00:16:13,880
write a review and share
the show with your friends.

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00:16:14,030 --> 00:16:17,540
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missing all the great content that is

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00:16:17,540 --> 00:16:21,110
coming your way. If you want to
contact us with comments or questions,

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we'd love to hear from you.

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Send us an email at
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