WHAT IS A FACE LIFT?
A face lift, or rhytidectomy, is a surgical procedure designed to improve the visible signs of facial aging. There are many types of face lift techniques. However, the skill of the surgeon is the single most important factor to achieving impeccable results.
WHY MIGHT I BENEFIT FROM A FACE LIFT?
Everyone’s outlook on aging differs. Aging itself is not the problem as with age comes wisdom, experience and worldliness. However, we all want to be in control of how we present ourselves to the world. Particularly in Washington, Dr. Rad finds one of the most common reasons patients choose face lift surgery is to restore an appearance that reflects the bright and vibrant person they feel inside. Some patients whose work requires vigor and a youthful energy choose face lift to be perceived as still "relevant" in work, social circles and relationships. Wrinkles, drooping tissues and hollowed features often create dissonance with the vital inner self that has remained, if not strengthened, over time. Patients may feel disconcerted, with the onset of loosening neck tissues or under-eye bags, by their resemblance to an aged mother or father. Other patients leading a healthy lifestyle often find their aging, deflated faces to be out of sync with their fit and toned bodies. In Dr. Rad's experience, the common thread running through each person's decision is the desire to restore a vibrant outer appearance that reflects his/her vibrant inner self. While each patient's reasons to have a face lift are varied and deeply personal, they are all valid. And when one feels self-confident in his or her personal appearance at any age, inevitably it has a positive effect on all aspects of life.
WHAT ARE THE GOALS OF FACE LIFT SURGERY?
As facial tissues lose elasticity with age, sagging tissues can alter facial features and display unintended emotions. For example, patients often complain that they look fatigued, sad or angry when, quite the contrary, they feel positive emotions. Confidence and self-esteem can be deeply affected by these changes in appearance. While skin laxity and hollowing are generally the result of aging, these changes are accelerated by smoking, sun damage, dramatic weight loss, and illness.
Excerpt from The Washington Post, July 13, 2014:
“Patients come to us and say, ‘People are saying I look tired or upset, when actually I’m not feeling those emotions at all,’ ” explains plastic surgeon Ariel Rad. The problem? All those non-verbal cues that come from aging faces: drooping eyebrows that look sad, weak jaw lines, corners of the mouth that turn downward. “People want some control over it, because those cues are important in their ability to communicate.”
The goal of face lift surgery is not to smooth every crease, fold or wrinkle, but rather to restore a rested and refreshed appearance through subtle, targeted improvements that add up to a beautiful result. While a face lift does not stop aging, when done skillfully it can "rewind the clock” in one's appearance.
In Washington, patients seek subtle, refined and nuanced results to present themselves to best advantage without looking "done." Dr. Rad’s patient’s seek to be the best versions of themselves, and not to be extremely altered. A perfect surgical result sparks in observers' minds a sub-conscious reaction that “this person looks much better but I’m not sure why.”
The best face lift work strikes a delicate balance: it reveals the best version of one’s appearance, yet it goes unnoticed by the casual observer and does not induce speculation. Dr. Rad’s goal for each patient is to achieve this balance.
WHAT ARE THE SIGNS OF AGING?
The typical signs of aging include:
- Sagging, wrinkled, thin and sun-damaged facial skin
- Dark circles and bags under the eyes
- Deflated and hollowed apples of the cheeks
- Deep facial creases such as the nasolabial folds (nose to mouth), nasojugal folds (across the cheek), and marionette lines (puppet lines from corners of the mouth)
- Downturned corners of the mouth
- Squaring of the lower face due to loose skin over the jawline (“jowls”)
- Loose neck skin and prominent neck muscle (platysma) bands
- Thin and wrinkled lips
- A double chin
Dr. Rad utilizes sophisticated techniques to target each of these anatomical changes to restore volume, restore contour and smooth harsh transitions throughout the face. Dr. Rad carefully assesses which techniques best address the anatomic areas of greatest concern and customizes a unique approach for each patient.
HOW DO I CHOOSE THE BEST PLASTIC SURGEON IN WASHINGTON DC?
A plastic surgeon's years of experience, number of face lift surgeries performed, aesthetic nuance, and certification by the American Board of Plastic Surgery are essential. Princeton and Duke educated, and Johns Hopkins trained, Dr. Rad has performed many hundreds of facial cosmetic surgeries. As Assistant Professor at Johns Hopkins Hospital, Dr. Rad directed the Aesthetic Surgery division wherein he taught residents (surgeons in training) advanced surgical face lifting. Known for his exceptional ability and artistic vision, Dr. Rad's face lift results are unparalleled and he often sees patients for corrective work after prior inexpertly performed lifts.
Your safety is Dr. Rad's highest priority. Complications arise when patients undergo anesthesia and surgery with untrained or inexperienced anesthetists, surgeons and staff. Dr. Rad operates in operating facilities at the top hospitals in DC and northern Virginia. Furthermore, he works solely with Board certified anesthesiologists and experienced surgical staff for the safest delivery of care. Achieving impeccable results requires careful planning, and Dr. Rad spends time with his patients and he customizes each patient's surgery and plan of aftercare.
WHAT SHOULD I EXPECT IN MY CONSULTATION?
Dr. Rad spends time with his patients, and you can expect to receive his undivided attention for an hour or longer. Your consultation will be unhurried and your questions will be answered fully. To ensure the highest level of privacy of our patients, there is no waiting room, and your consultation will be held in a private, sound-proofed cabana (a discrete back entrance is available for those requiring the highest level of privacy.)
Dr. Rad’s primary concerns are for your safety and to achieve the best results possible. During your consultation Dr. Rad will endeavor to:
- understand your aesthetic goals to determine which procedures will best achieve them
- determine the optimal approach to minimize anesthesia and recovery time
- customize the surgical and non-surgical approaches to achieve impeccable results, and minimize invasiveness and scars
In preparation for your consultation, Dr. Rad recommends bringing old photographs, from 10, 15 or 20 years ago. These are helpful to illustrate age-related changes to your facial anatomy and will facilitate discussion of how to restore your normal facial architecture.
Patients require “medical clearance” from their primary care physicians (PCP) and possibly from specialists. Additional medical tests and blood work may be needed.
Dr. Rad sees his patients another time prior to surgery, and he makes himself available to answer your questions after surgery, 7 days per week.
WHAT FACE LIFT TECHNIQUES ARE BEST?
Many different face lift techniques have been described, such as the “S Lift,” “SMAS Flap,” “Deep Plane,” “Mid-face Lift,” etc. Surgeons often tout certain face lift techniques to be superior to all others. However, scientific research has proven that one technique is not better than another. In fact, only 2 factors determine the quality of the result:
- the skill of the surgeon performing the lift is the most important factor: you’ll know when you’re in the right hands if your surgeon has the pedigree of training and ABPS certification, and s/he demonstrates thoughtful discussion, careful planning and aesthetic artistry.
- The use of a proven muscle-tightening (not skin-tightening) procedure: tension should be placed on the muscle layer (called the superficial musculo-aponeurotic system, “SMAS”), and minimal tension placed on the skin. Dr. Rad employs a “SMAS imbrication / platysma suspension” technique (read below).
The bottom line is that Dr. Rad tailors his approach uniquely for each patient depending on many factors. This requires time with each patient to determine what combination of procedures will achieve a desired result while minimizing scars and down time.
HOW DOES DR. RAD PERFORM FACE LIFT SURGERY?
Gone are the days of face lifts that tighten only the skin. Lifting and tightening the muscle layer, avoiding tension on the skin, and an eye towards proportion and symmetry are key to a natural result. Dr. Rad employs a “SMAS imbrication / platysma suspension” face lift technique which restores natural contours without an unnatural “pulled” look.
Dr. Rad places scars in the most hidden locations along hairlines, inner aspects of the ear and tragus, and behind the ear. He gently elevates the skin to reveal the muscle layer which he tightens to sharpen the neck line, remove jowls, restore volume over the cheekbones, and define the jawline. Permanent sutures in the muscle layer are essential for a permanent result. Skin is gently re-draped over the tightened and lifted muscle layer, and the excess skin is trimmed. Incisions are expertly hidden in the natural hills and valleys around the ear and along the hair line. Small drains are placed for 24 hours to remove fluid that otherwise might collect under the skin. Dr. Rad then places a dressing around the face and neck for gentle support.
Combined with fractionated laser, patients can expect a youthful appearance and healthier skin without a pulled look in a matter of 2-3 weeks. A skincare regimen, comprised of products from the world's elite skincare brands, is customized for your skin's unique needs and helps to maintain your results for many years.
SHOULD OTHER PROCEDURES BE CONSIDERED WITH FACE LIFT?
Since aging affects all areas of the face, Dr. Rad often performs eyelid lift, brow and forehead lift, and facial fat grafting at the same time as face lift surgery. Furthermore, emerging science Customized aesthetic dermatology care can delay the need for future surgical lifts, and can ‘protect your investment’ after surgery.
- injectable Dermal Fillers provide temporary facial volume and contouring and Botox smooths dynamic wrinkles
- collagen-stimulating treatments such as laser and chemical peels restore skin elasticity
- skin Care treatments maintain skin health and elasticity
WHAT COMPLICATIONS CAN HAPPEN AFTER A FACE LIFT AND HOW ARE THEY AVOIDED?
Surgery is very well tolerated and entails extremely low risk. Nonetheless, Dr. Rad takes every precaution to minimize risk. Rather than in a private office surgicenter which cannot handle potential, albeit rare, complications of anesthesia, Dr. Rad performs surgery at the best hospitals in DC and northern Virginia. Dr. Rad works only with Board certified anesthesiologists and experienced staff. This assures the lowest risk of complications. In Dr. Rad’s hands, the risk of injury from daily driving a car is much higher than the risks from surgery.
Procedure-specific complications that are possible, albeit very uncommon when under skilled surgeons' care, include hematoma (a blood collection under the skin), infection, nerve injury and delayed wound healing. However, these are not dangerous to patients' health, and are rare to occur. Dr. Rad's patients take comfort in a very low complication rate and, should a concern arise, that they will be guided every step of the way towards optimal healing and results.
The most common difficulties Dr. Rad sees arise after inexpert face lift work by other surgeons. Patients whose skin is severely sun damaged and show extensive surface wrinkles are often erroneously treated by other surgeons with high-tension skin lifts in an effort to smooth wrinkles by pulling skin taut. This creates a ‘waxy,' unnatural appearance with windswept, stretched features and odd facial and mouth movements. Dr. Rad often corrects these deformities with muscle-tightening face lift, and patients benefit from laser treatment to improve the skin’s texture, elasticity and skin tone, which invariably improves wrinkling without an unnatural, pulled look. For best results, face lift surgery and fractionated non-ablative laser (Clear+Brilliant laser) synergize. Dr. Rad often collaborates with his wife and Board certified dermatologist, Dr. Noëlle Sherber, to deliver such synergistic surgical and laser treatments thereby optimizing results.
HOW LONG CAN I EXPECT MY FACE LIFT TO LAST?
When the right technique is employed, you can expect a face lift to last 10-15 years before another face lift is needed due to ongoing environmental and aging effects. The longevity of your result depends on the following factors:
- genetics of aging (how one is 'programmed' to age - uncontrollable)
- facial architecture and anatomy (determined by genetics - uncontrollable)
- stress/sleep (in Western society - controllable)
- diet (a balance of fruits, vegetables and protein is best - controllable)
- sun exposure (the single most important preventive measure to collage damage - controllable)
- smoking (this is very damaging to collagen and accelerates aging - controllable)
- skincare and dermatologic maintenance regimen (aside from sun protection, this is the most important controllable factor to slow the appearance of age-related changes)
Dr. Rad's patients benefit from the expertise of his wife, Dr. Sherber, a Board certified dermatologist and world expert in collagen biology. Dr. Sherber routinely advises and treats Dr. Rad's face lift patients in order best to maintain their results for many years.
WHAT ARE THE TELLTALE SIGNS OF A BAD OR OBVIOUS FACE LIFT?
High skin tension, poorly placed scars, and overfilled features are the hallmarks of an unnatural appearance. Specifically these include:
- a windswept face - too much tension on facial skin flattens features
- a “balloon” face - too much fat or filler overfilling the face, lips and cheeks
- a “Joker” mouth deformity - the corners of the mouth are stretched like the Joker’s mouth
- visibility into the ear canal (called "ear canal show") - too much skin tension pulls forward the tragus ear cartilage (the small triangular cartilage covering the ear canal) and the dark hole of the ear canal becomes visible
- "pixie ear" deformity - too much skin tension pulls the earlobe downward, elongating it.
- a wide nose - too much skin tension on the base of the nose causes it to widen
- hairline “stair step” deformity - this is caused by poor incision placement: when the hair is pulled back, the hairline behind the ear shows a “zig zag” pattern because the incision was placed in the scalp rather than along the hairline
- widened scars - too much skin tension widens scars, making them more visible
- absent sideburns - particularly in men, but also in women, the sideburn can be pulled back when the incision is placed in the hair-bearing scalp and the sideburn is moved from its normal anatomical position
HOW DO I AVOID THESE PROBLEMS?
Meticulous attention to detail and exquisite training, skill and artistry are the keys to impeccable results. Vet the surgeon based on education, training, ABPS certification and aesthetic results. Then, in consultation, ask the surgeon how s/he avoids these complications. The answers should be thorough and thoughtful with attention towards your particular care.
Dr. Rad sees many patients for corrective work. These patients commonly say “my result looked good for a few months and then it all disappeared.” If you’ve had prior surgery and seek revision work, it may not be too late to correct. If you're concerned with your results and seek improvements, bring the following to your consultation:
- prior operative or procedure notes (you have a right to full access of your records, and a written request should be submitted to your prior caregiver's office)
- photos prior to your procedure: lateral, oblique (diagonal) and frontal views are important to assess your appearance prior to surgery (these may be part of your medical record and should be requested)
Note: all medical records from outside offices should be requested by you.
CAN I COMBINE OTHER SURGERIES AT THE SAME TIME AS A FACE LIFT?
Because a face lift addresses the neck and lower ⅔ of the face, Dr. Rad often performs other procedures at the same time as face lift such as facial fat grafting (to add volume to deflated and hollowed areas), eyelid lift surgery (for excess skin and under eye bags), brow and forehead lift, rhinoplasty, neck lift, and other minor procedures such as corrugator muscle weakening (“number 11 lines”), etc. A multi-procedure surgery is generally safe, it involves a single recovery period, and it is also more cost-effectiveness because the incremental cost of anesthesia, OR and surgery time decreases after the first hour. However, in-depth consultation with Dr. Rad is essential.
WHAT SHOULD I EXPECT FOR RECOVERY?
Dr. Rad’s face lift patients routinely recover without significant pain. Mild to moderate discomfort is temporary and manifests as a feeling of tightness through the face and neck. However, this is expected, normal and temporary, as previously sagging tissues are lifted and tightened post-surgery. While the sensation of tightness subsides fully after a few weeks, your face lift result remain. If muscle is not tightened, as in a “skin only” face lift, then the lifted feeling and the result disappear quickly. Dr. Rad sees many patients for corrective work after skin-only face lifts performed by other surgeons. Therefore, a transient feeling of facial and neck tightness is a normal aspect of recovery and should not be feared.
Recovery is as an outpatient. Social down time (the length of time you should plan off from work or social activities) lasts 2 to 3 weeks (depending on the approach and your unique healing process) after which most swelling has resolved and you can return to activities progressively. All prescriptions and pre-op instructions are provided in advance of surgery and your aftercare is carefully planned to ensure smooth recovery.
HOW DO I CHOOSE A SURGEON?
Surgery can’t be reversed and it is challenging (but not impossible) to correct inexpert work. Patients should choose wisely. When choosing a plastic surgeon, ensure that s/he is certified by the American Board of Plastic Surgery. Education, training and credentials are essential: Princeton and Duke educated and Johns Hopkins trained, Dr. Ariel Rad is Assistant Professor and former Director of Aesthetic Surgery at Johns Hopkins where he instructed surgeons-in-training the nuanced and sophisticated techniques of face lifting.
HOW DO I SCHEDULE A CONSULTATION WITH DR. RAD?
Contact us at firstname.lastname@example.org or 202.517.7299. We look forward to providing your care.