Expert Dallas Plastic Surgeon Explains Face and Eye-lid Lifts

We all want to look as young and fit as we can….and we want to look like that forever! 

Facelifts have been around for about 100 years. The original facelifts were a mere excision of the excess skin in front of the ear. This lessened the facial wrinkles somewhat and was the standard for the next 50 years. Because skin stretches when put under any tension whatsoever, the lifts didn’t last very long and the results left much to be desired. The SMAS facelift was introduced in the 1970’s and was a major step forward in facelift surgery. The SMAS lift is a tightening or lifting of the second layer of the skin which has much more strength and therefore gives longer lasting results. The tension is placed on the SMAS and not on the skin. The SMAS (Superficial MyoAponeurotic System) is the foundation of facelift surgery as we know it today. The SMAS starts on your collarbone and is a wide layer that is immediately under the skin of the face and neck. The lower portion of the SMAS contains the platysma muscle. Along the jawline, the platysma disappears but the SMAS layer continues in front of the ear and up into the temple as a wide layer of stronger fibrous tissue. Variations on how the SMAS is dealt with are numerous and have been termed many different names. All of these names are simply how the surgeon prefers to achieve his or her result.  Most early variations dealt with either tightening or overlapping the SMAS in front of the ear to pull it back and decrease the deep creases of the nasolabial folds as well as to improve the so-called jowls over the jaw line. As time went on, it was discovered that the SMAS could be lifted and actually repositioned for even better results. Variations of this are called “Deep Plane” face lifts. These can elevate the jowl up off of the jaw line and give longer lasting results, but have the risk of being much closer to the facial nerve branches that exit from under the parotid gland. The nerves are protected for the most part by the parotid gland because the nerves run deep to the parotid gland and the SMAS tightening lifts are above the parotid. When the SMAS is lifted off of the parotid gland, the nerves become much more superficial as the branches of the nerve exit out of the front of the gland. As more and more experience has been obtained, the risk of facial nerve injury has lessened and now is similar to the more superficial SMAS procedures.

Understanding the Eye Lid Lift Procedure

When upper eyelid correction is contemplated, it is wise to make sure that the brow is in good position. If the brow is in good position at rest, then removing the excess skin of the upper eyelid is recommended. If the brow is depressed, or not in good position, we recommend correction of the brow before removing the skin of the upper eyelid.  If the excess skin is removed and it is later decided that a brow lift is needed, the brow lift may not be possible without keeping the eyelids from closing properly. Dry eyes are difficult to treat.

Puffy lower eyelids make us look much older or more tired than we are. The bags in the lower eyelid are merely fat pads. We all have them. They are supposed to be there. They are supposed to be behind the orbital septum. The septum often gets weak and lets the fat pads pooch out into the eyelid. When it’s time, the fat pads are removed from where they are bulging out and are now repositioned under the “tear troughs” which gives a very natural youthful correction. The fat pads used to be discarded, but we now know that they are perfect fillers for the natural depression that we get as we lose the volume in our upper cheeks. The transferred fat still has its blood supply so it has a very high take rate. Fat transfer from the abdomen has to establish a blood supply before it can grow by absorbing the fatty acids from the diet. The take rate for fat transfers is not as high.  The fluid pockets on the cheeks are a different story. The “festoons” are not fat deposits, they are fluid collections. They are a result of the anatomy of the circulation or blood flow around the eye. The arteries bring the blood to the tissues where they flow through the capillaries and 99+ % of the blood flows back to the heart through the veins. The little that doesn’t return to the veins is called lymph. It has to return to the heart via lymph channels. The blood flow around the eyes does not drain down the cheek. The blood flow around the eyes flows through the nose and into the central veins in the brain and then back to the heart.  The cutoff between what drains down the cheek and what drains up hill into the nose, is usually along the bony rim of the lower eyelid. When you have a fluid pocket on the cheek, the cutoff is not at the level of the bony rim, but somewhat below that. The fluid has to drain up hill, so it never completely goes away.  It is worse when you have a stuffy nose for any reason such as from a cold or allergy attack. Since the nose has various amounts of congestion on any given day, the amount of puffiness under the eyes, varies as well. Keeping the nose open when you have any allergy or cold symptoms will help as well as reducing any excess salt intake. Salt makes you retain water, so that less fluid retention usually means less puffiness around the eyes.  Sleeping with your head slightly elevated on a thicker pillow or on your back. Never sleep on your stomach. Not only is it bad for your back, but when you sleep on your stomach, all of the fluid that collects in your legs and body during the day creates a virtual tidal wave into your eyelids when you lie down.

Having “a little work done” was and still is a very personal and private thing. We would all like to have that gift of ageless beauty and never suffer from the effects of aging. With the growth of the internet and social media and not to mention the Hollywood crowd exposure, the secretive nature is much less. In many circles, it is a status symbol.

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