First Facelift

The term “first facelift” is showing up more and more frequently on Google searches these days. Although what the term means is intuitive, it is not a medical term that plastic surgeons frequently use. Medically speaking, the proper term is primary facelift but you can’t argue with a Google search.

Not particularly in tune with the “mind” of the internet, my assumption is that a first facelift is considered intrinsically different than secondary (second) or tertiary (third) facelifts. While there is some truth to the fact that first facelifts are performed differently than the others, there is no truth to the thought that a plastic surgeon can be an expert at firsts and not seconds or thirds. Although I am unaware of any statistics to the effect that at least half of the patients who have a first facelift before the age of 55, will also have at least a second as well as any number of touch-up procedures.

The importance of first facelifts is that any plastic surgical procedure including facelifts, eyelids, noses as well as cleft lip and palate achieve the best results the first time they are done;

Thus, the term first facelift. A good first facelift can lead to an even better second and even third. I truly was not aware that “first facelifts” were something people look for, or Google for, but I learn something about Google every day. With that said, I’m probably the best first face lifter around these parts.

Read more about top facelift surgeon Dr. Paul Howard in Birmingham, Alabama.

Facelift Swelling

The subject of facelift swelling is one that has driven a large part of my facelift procedures and practice over the last decade. It’s an easy subject to get your mind around because no one likes it, your reputation can depend on how much of it your patients have, once created it is hard to get rid of and regardless of how well patients are prepared for their surgery and the incumbent, yet evil swelling, they still feel like something is wrong when they have it.

For years all plastic surgeons thought that the swelling after a facelift under general anesthesia was a necessary evil and therefore spent little time trying to figure out what causes it and how to prevent it.

After years of failing to prevent swelling by doing small things that never worked like corticosteroids, drains, dressings, Vitamin K and dozens of other special medications and emollients. Being unwilling to accept failure, we started to question the basic tenets of doing a facelift. The most obvious and successful change was to stop doing general anesthesia for all facelifts. This was met with skepticism by many plastic surgeons that could not imagine operating on a patient for the hours necessary and have to deal with the anesthetic also. It was thought that the patients, usually a bit older than our average patient, wouldn’t or couldn’t tolerate the procedure “awake.” Concerns about the volume of anesthetic needed as it relates to toxicity and whether or not the entire face, neck and eyes could be rendered numb enough for surgery. All of these concerns quickly fell to the wayside; patients hated general anesthesia and the ability to anesthetize the face only required relearning all of the pharmacology of local anesthetics we learned in medical school. The only remaining question was whether or not the plastic surgeon (me) would exhibit patience in dealing with the conscious patient and subjugate the ease, comfort and lack of responsibility inherit in general anesthesia to the need and desire of the patient to have little or no swelling and a simpler, faster return to normal. The answer to the question for me was –absolutely.

From that point forward, we worked out the details of the sedation, the local anesthetic agents, monitoring and significantly changed the operation to accommodate the wishes of the patient which were primarily based on having minimal to no postoperative swelling. The accumulation of the techniques of anesthesia and its agents, sedation, operating room ambiance and the ability to perform a first-class and lasting facelift under these circumstances has led to what we call the Howard Lift procedures which include rejuvenating procedures for not only the face but the eyes, forehead, nose and neck. The Howard Lift is not necessarily a procedure but a new way to do facial procedures concentrating on minimal swelling leading to minimal downtime and a first-class, longstanding natural result.

Read more about facelift recovery.

Lifestyle Lift® FAQS & Fiction by Paul Howard, MD

Facelift Scar Comparison

Facelift Scar Comparison

How is the LSL better than other Facelifts?

The LSL is not a breakthrough procedure nor are any of the LSL techniques new in any way.  THE LSL is first and foremost a marketing company that hires physicians to do a version of the LSL.  In fact, their surgeons are not even required to do the LSL procedure.

How is the LSL different than other procedures?

The LSL is a version of the short-scar facelift procedure that was first described by others.  Included in the procedure is a so called SMAS plication which has been around for 20+ years and is one of many ways to tighten the deeper layers of the face.  The only possible advance the LSL offers is that it is performed under local anesthesia which has been available since the 1920’s.

Is the Lifestyle Lift® Cheaper?

The cost of the LSL procedure is different depending on where in the country one lives.  The fact is that the actual cost of the LSL is roughly equivalent to what most Plastic Surgeons charge especially when you consider the “fine print” procedures that are required on almost all patients.

Is there a difference in recovery from the LSL?

The rapidity of recovery depends more on the individual surgeon than the exact procedure performed.  Patient selection is probably the most important adjunct in recovery time and LSL patient selection is initially done by “consultationists” without even a medical degree.

Will I Bruise More?

One of the ways a Plastic Surgeon can decrease bruising is due to the technique chosen and in many cases whether or not the surgeon uses drains expeditiously. Part of the LSL marketing scheme brags about not using drains as if not using drains when indicated is somehow better.

Are the LSL Scars Better?

The short facelift scar pattern is pretty much the same for everyone.  The execution of the scar varies from surgeon to surgeon, but the scars don’t seem to do as well nor are they properly positioned in many of the LSL procedures (my personal experience). It is also easier to obtain good scarring with frequent follow-up and in-depth patient instruction which is not typical in practices that are volume driven like the LSL.

What is the Most Important Decision when Choosing a Facelift?

Most people believe that the most important aspect of achieving good results in facelift surgery is the choice of SURGEON and not the procedure or any number of other considerations.  It is interesting that the one thing that the LSL marketing scheme minimizes is the surgeon; such that the surgeon is the last person one meets in the process.  The consultationists and the people who collect the money seem much more important and meet the prospective patient well before the surgeon is chosen for you.

Read more about top facelift surgeon Dr. Paul Howard Birmingham, Alabama.

Call today to schedule your Facelift Consultation with Dr. Paul Howard

205-877-PAUL

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Lifestyle Lift – The Small Print by Paul Howard, MD

It’s clear that the Liftstyle Lift ® (LSL) brand is a marketing juggernaut.  Cable, non-cable, internet, Debbie Boone is everywhere “lighting up my life.”  Their TV testimonials are uplifting by simply showing regular people with that blank stare pre-operatively and that smiling, happy visage after their LSL.  It is easy to see why there are so many lawsuits accusing this marketing company of being false and deceptive in their TV ads.  One of the oldest Plastic Surgery tricks to improve facial surgery results is to take the post-op photos of the patient smiling; smiling is the first and best natural rejuvenator lifting the sagging face without a single stitch.  Giving in to the “marketing police,” the LSL folks do add a few sentences in fine print at the bottom of the TV ad admitting that each patient had a litany of other procedures in addition to their LSL.  It is the other procedures in the small print that actually determine the quality of the result and are the subject of this article.

Over the time that I’ve been in practice, two things have actually vastly improved my facelifting results.  Recently, it has been the use of local anesthesia with sedation rather than general anesthesia.  The second improvement has been improvements in the neck contouring and the blending of the lower eyelid with the cheek as an adjunct to our version of the mid-face lift.  In the LSL marketing parlance these are called “neck firming” and “eyelid firming” procedures that really make a difference in the quality of the result, especially when the patient is not smiling.

Eyelid blending has always been a problem except in the extreme cases of facelifting procedures done at deeper levels that allow for more tension on the SMAS and facial muscles with their fascia.  These operations are not an option for many people who cannot take 3-6 weeks out of their busy schedules to be swollen.

One of the integral causes of the dark circles and lower lid “crescent,” in addition to the weakening of the tissues that are meant to contain the lower lid fat allowing the fat pockets to bulge outward, is the dropping of the thin lower eyelid skin down onto the cheek accentuating the junction between the thin lid skin and the thicker cheek skin.  Lifting the midface necessarily raises the lid-cheek junction upward creating excess lid skin.  This is addressed surgically by making a lower lid incision through the muscle so that the lid-cheek junction at the orbital bone can be addressed directly.  Blending of the lid and cheek is done at the same time that the bulging fat is partially removed or simply cauterized.  The remaining tissue (septum) is cauterized to thicken it so that it can then be bolstered by dissolvable sutures.  The extra lid skin created is conservatively excised and a temporary muscle tightening stitch is placed to keep the lower lid from pulling down during the early phase of wound healing.

This description of surgical lid-cheek blending may seem highly technical to some.  For those less interested in details, the net result of the operation is depicted in the photos (note that the patient is not smiling, although she wishes she could!)

Eyelid Surgery Before & After by Dr. Paul S. Howard

Eyelid Surgery Before & After by Dr. Paul S. Howard

The basis of a good result in the lower eyelids as well as the neck is the performance of a proper mid-face lift with an aggressive approach to the jawline and jowls.  The LSL, when done well, can provide this platform to address the neck, lower eyelids as well as the cheek as a unit.  It is very rare to see a patient who has never had surgery that requires only a mid-face lift making these so called “firming” procedures an integral part of facial rejuvenation yet they only get a small print footnote in the marketing juggernaut that is the Lifestyle Lift®.

Dr. Paul S. Howard

Top Facelift Surgeon Birmingham Alabama

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Advances in Facial Rejuvenation – How They Occur by Paul S. Howard, MD, FACS

Facelift Alabama

Plastic Surgeon Birmingham Alabama

“Doc, how can you make me look better, fresher, and maybe even a little younger looking?”

The answer to this question depends on many variables, but actually is easy for each individual surgeon to answer.  In fact, all surgical advances begin with a patient asking a doctor his opinion on a problem that is bothersome to the patient.  In the early 1900’s, the question may have been, “Doc, can you get rid of this unsightly hump on my nose?”  Maybe it was a teenager who wondered if her protruding “Dumbo ears” could be set back.  In the 60’s it might have been, “Doc, what can you do for these fat deposits on my thighs?”  Each of these questions was first met with skepticism by the surgeon followed by a moment of reflection and ending with the promise to get back to the patient after having a chance to think about it.  These accumulated “moments of reflection” are the substance of hundreds of manuscripts and then textbooks describing all of the innovations that have become the essence of Plastic Surgery as we know it today.

Recently, the question that continues to arise refers to looking more youthful, but is tainted by the attempt of many surgeons and non-surgeons to answer this question with a multitude of poorly conceived procedures, potions, lotions, and quick fixes that frequently fail to provide the answer to the question.  Photos that are presented fail to show youthfulness and frequently are not honest and believable.

The part of this anti-aging scenario that surgeons have come closer to accomplishing is the anti-gravity part where the desire for a procedure that lifts drooping facial tissue, especially the cheeks, forehead and neck, is accomplished with minimal incisions, safe anesthetic techniques and a rapid recovery time to the resumption of normal activities.  These accomplishments in facelifting are actually recent because advancements only happen when our patients ask for them.  There came a time when massive swelling and bruising, general anesthetic and a month recovery was not good enough and patients asked for more (or less).  It became clear that simply tightening skin to elevate facial fat and remove wrinkles was a simplistic approach to facial rejuvenation.  Although lifting and tightening worked to a certain degree, it did little or nothing to address that facial deflation by the loss of fat is an integral component of the aging process.  The use of fat transplantation, as is has now been perfected, has provided a therapeutic answer to deflation while fulfilling basic Plastic Surgical principles as described by Ralph Millard, MD.  In a nutshell, fat transfer is the result of identifying a problem, replacing what is lost with tissue in-kind, all the while improving the donor site via liposuction – Dr. Millard would love it!

This is the magical point in the scenario where luck comes into play as it applies to the “law of unintended consequences.”  The smartest of our brethren saw it almost immediately, but the rest of us took a while to see that which was right in front of us.  Our fat grafts carried with them a myriad of growth factors, cytokines, and unknown chemicals that helped the grafts “take,” but also exerted their influence on the overlying skin; the last aspect of the aging face addressed surgically.  By the simplest of methods – observation – it was noticed that the skin was visibly improved by the fat grafts; it had more collagen, more elasticity, improved texture, and an improvement in the fine lines and wrinkles.  As our knowledge evolved it became clear that these secondary consequences were the result of the stem cells that we now know to exist within the fat grafts.  The next small step was to isolate the adipose-derived stem cells from the fat and reintroduce the stem cells to improve the “take” of the fat and add improvement to the skin.  The addition of other known growth factors found in platelets as a PRP boosted the rejuvenation ability of fat grafts even more.  I think it has also become quite clear that depositing these rejuvenating aspects with an appropriate scaffold (fat) beneath the skin improves the results drastically from the awkward attempts to simply rub these against on the skin’s surface.  It follows that the best we can do from the surface is to accelerate the turnover of the skin cells and remove as many of the dead cells as possible; hoping to unveil the dermal and sub-dermal improvements obtained from our stem cell assisted lipo-transfer protocol.

What I have described is the way Plastic Surgical advances happen.  Doctors and patients have been dancing this question and answer Waltz for over a hundred years so it should be of no surprise that many of the questions were asked a hundred years ago, but the answers have only recently shown themselves to those who continue to look for them.

Call today for your consultation! 205-877-PAUL

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The Lifestyle Lift™ vs. The Howard Lift by Paul S. Howard, MD

Facelift Alabama

Plastic Surgeon Birmingham Alabama

The Lifestyle Lift™ (or LSL) continues to generate publicity, both good and bad, in the beauty business universe.  Ongoing lawsuits in the State of Florida brought by attorney general Pam Bondi as well as dueling articles in Plastic Surgery practice magazines explaining and dismissing the litigious nature of the LSL Company keep the spotlight on this controversial marketing company.  It is not known, the malpractice history of the LSL doctors, yet their history of suing and being sued regarding their trademarked name and aggressive marketing practices is well documented in public forums.  Let me be absolutely clear, LSL is not a facelift nor any kind or combination of surgical procedures.  Once again, the LSL is not a facelift.  The precise nature of the company is a little vague but we do know that it is a marketing juggernaut flooding the TV waves, radio and more recently the internet with a multi-million ($15 million or so) dollar ad campaign featuring the once popular Debbie Boone, daughter of teen idol Pat Boone of white-buckskin-shoe fame.

When one analyzes this expansive company it is easy to understand why there is a cottage industry of cases (patients) searching for Plastic Surgeons to re-do or correct the surgeries done under the auspices of this marketing company.  The LSL brand is metastasizing to every possible market as researched through their massive call bank in Troy, Michigan.  The major problem they are experiencing is the fact that they have grown rapidly, have roughly 90 doctors on the payroll nationwide, and it appears they are having one helluva time controlling the quality of their product.  Roughly 20% of their surgeons are actually Board Certified Plastic Surgeons.  As with any statistical analysis, there is a bell curve describing the quality of their surgeons.  It’s just the numbers are so large that the one’s with poor results number in the thousands every year.

The LSL marketing machine touts 3-4 facelifts a day (per doctor) and a procedure that only takes an hour to do.  When you consider that many of their surgeons are youthful, an hour facelift is improbable.  It seems that time is made-up by handling the incisions with haste.

Dr. Paul S. Howard

Regardless, Forrest Gump said it best, “Life’s like a box of chocolates, you never know what you’re gonna’ get.”  You can say same about the LSL.

In our efforts to separate what we do from LSL, we make a point of offering only one facelift per day performed entirely by a myself, a Real Board Certified Plastic Surgeon with no consultationists, no fellows or residents involved with the personalized patient care.

As far as the facelift procedure itself, our Howard Lift has many commonalities with the LSL except it was developed from patient requests and follow-up over many years and not to satisfy a preconceived marketing plan.  Also, the Howard Lift is only the base procedure taking care of the cheeks and jawline.  Each patient receives a complete evaluation including the neck, eyelids, brow, and nose as needed.  A complete skin care evaluation with appropriate skin care including chemical peels and CO₂ laser resurfacing as indicated.  All of this is included at a cost comparable to the LSL except you know your Board Certified Plastic Surgeon and his entire staff prior to the day of surgery.  Follow-up is provided exclusively by myself and my staff so there are no covering physicians or strangers involved in your surgical care or follow-up.

For an in-depth explanation of our philosophy of practice and opinions on the surgical issues of the day, log-on to our web site www.thehowardlift.com and access our photo galleries and informative Faceliftology™ Blog.  The number one reason for unhappiness with a Plastic Surgical result is a lack of information and not being fully informed about your surgeon and his

Dr. Paul S. Howard is Board Certified by the American Board of Plastic Surgery.  To schedule a consultation with Dr. Howard to discuss your cosmetic surgery goals, please call 205-871-3361

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*Faceliftology is a registered trademark, registered by Dr. Paul S. Howard, Plastic Surgeon Birmingham, Alabama.

*The LifeStyle Lift is a registered trademark, registered by Lifestyle Lift Holding, Inc. Michigan.

Count Dracula and the “Vampire Facelift™”

Vampire Stem Cell Face Lift

Count Vlad’s Castle in Romania. Dr. Paul S. Howard visited Romania several years ago to operate on orphaned children born with facial deformities.

Author Anne Rice benefited from the allure of the Vampire in pop culture where there has always been a certain interest in all things Romania.  From Count Vlad “the Impaler,” to the gypsy culture and even gymnast Nadia Comaneci have all fueled interest in the darkest of the former Eastern Bloc Soviet satellite countries.  Our fascination with Romanian people may stem from their unique Eastern European history.  The Romanian is proud of his Dacian ancestry making their culture and language more like that in Rome than their geographic neighbors which are Slavic countries such as Hungary, Serbia, Moldavia, and Bulgaria.

The myth that is Dracula has a basis in fact steeped in the history of Romania and the Dark Ages of Europe.  Vlad III, Prince of Wallachia, member of the House of Draculesti, known by the patronymic name Dracula was born in Transylvania in 1431.  The translation of the name Dracula comes from his father Vlad Dracula, meaning “dragon” or “devil.”  Vlad III was known in his adult life as the son of the devil.  It was only after his death in 1476 that he became known as tepes or “the spike,” alluding to his famous battles with the Islamic Turks and his father’s battles with the Boyer Family for the thrown of Wallachia.  Both the Boyers and the Turks were “spiked” or impaled as punishment and as a deterrent.  Thus, Vlad “The Impaler” was born.  It was left to the Irish author, Bram Stoker, to rekindle the Dracula legend as well as embellish it to include the Vampire myth in his 1899 gothic horror novel, Dracula.

The recent fascination with the Vampire myth was stoked by any number of books including those by Ann Rice and the TV series Vampire Chronicles.  It comes as no surprise that medical marketing would jump into the Vampire craze even though the institution of Vampire tales is beginning to wear thin even in pop culture.  We now have a non-surgeon entering the pop-culture marketplace with the so called “Vampire Facelift.”  The connection with vampires is interesting in that vampires are a Gothic myth with no factual basis much like the vampire Facelift™ is more of a New Age myth with no basis in fact.  The connection to Vampire culture is through the use of Platelet Rich Plasma (PRP) as an adjunct to the use of temporary foreign fillers (Juvederm™, Restylane™) to effect some sort of facial rejuvenation akin to the well-worn “Liquid Lift™.  Fillers plus PRP equals the Vampire Facelift™.

Platelet Rich Plasma is obtained by drawing blood from the patient’s arm (not the neck as in vampire-lore), and by processing the blood one obtains platelet poor plasma (PPP) and platelet rich plasma.  The most well-known use of PPP is “fibrin glue,” a soft tissue sealant used in many kinds of surgery.  PRP has a bewildering array of uses, but all of the known benefits come from the activation and stimulation of growth factors and cytokines.  These are necessary for cellular activity which benefits blood supply, healing and specifically the “take” of fat grafts mediated through the activation of stem cells.

Recently it has come to light that activated stem cells and PRP have a beneficial effect on aging skin causing increased collagen synthesis, may be helpful to increase elasticity and is believed to improve skin texture as well.

Platelet Rich Plasma, coming from blood, has many important functions, but none of these functions create volume nor “lift” tissues in any way.  Additionally, PRP is very easy to obtain from blood.  The actual skill involved is drawing the blood which is easily processed to PRP, is easy to activate with calcium and thrombin, and actually is a source of protein when swallowed (vampire’s diet).

Utilization of PRP is a useful adjunct for facial rejuvenation, but in and of itself has not shown to have much of a rejuvenating effect.  The addition of temporary fillers does not improve what is already known about the temporary volumizing effect of hyaluronic acid based fillers.  The two together serve to prove the uselessness of trademark laws as applied to medical science.

Dr. Paul Howard is Board Certified by the American Board of Plastic Surgery.