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.

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