Have you ever noticed that entertainment personalities often seem to have had some of the worst plastic surgery? Not to mention names, but you would think that folks with that much money and who have access to the best in plastic surgeons should not have such garish outcomes when it comes to facelifts! Let me give you my thoughts as to why this occurs:
1. The patient tells the doctor what to do and he/she does it in spite of his/her better judgment. Some plastic surgeons are under the misimpression that this is the best way to make themselves popular with patients – to do exactly what they say, even if it is a bad idea. The result? Disaster!!
2. Too tight of a pull – If a facelift is pulled too tightly, the earlobes will be pulled out of position so that the earlobe is angled forward instead of the correct backward angulation. There may also be widening of the scars around the ears because of the excess tension. In addition, there is normally a natural depression in front of the ear. This is lost when there is too much tightness. There may even be flaring of the nostrils and widening of the lips.
3. The wrong direction of pull – What happens if you stand in front of a mirror and pull your cheeks directly backwards? You look as though you’re in a wind tunnel! On the other hand, try lifting your cheeks upward. Much more pleasing, huh? That is the correct direction of lifting. Not all plastic surgeons are aware of this.
4. Incorrect scar location – In a facelift there must be a scar in the temple area to take out the excess cheek skin. If the scar is placed within the temple hair, about 2 inches behind the hairline, the hairline will move up and back as the excess skin is lifted. Although the scar is hidden in the hair, the hairline displacement may be unsightly, giving one a receding hairline and even loss of the sideburn. In most cases it is preferable to place the scar at the temple hairline. Although this may be slightly more visible than the scar inside the hair, hair usually grows through it and there is no change in the position of the hairline. Most of the time this is a better choice than the scar back in the hair, although some patients refuse to accept this without advice from their plastic surgeon. Some doctors would rather tell the patient what they want to hear, not what they need to hear!
5. Too much of a good thing – Nothing ruins a good facelift like overdoing it with fillers, be they fat or out of the bottle. Seriously, some of these folks look as though they have been taken to the gas station and inflated to 50 psi! My goal in a facelift is to restore the face to where it once was, not to a place where it never was. Many of my patients will gain a bit of weight over the years following a facelift and if fat injection was overdone, they are really in a bad place since the fat cells grow in size as will the face! Facial injections can be very helpful, but good judgment is essential!
George Sanders, M.D.