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Facial Rejuvenation Case Study

This patient is a great teaching case to educate potential facelift patients on some of the thought that goes into evaluation and treatment of female patients considering cosmetic facial rejuvenation.

This particular female from San Diego, CA presented to our clinic requesting possible surgery to help her appear more rested and youthful. She was like many 50-60 year old females in San Diego who desire to look their best at that particular age. She showed signs of aging that were consistent with many candidates considering facial rejuvenation surgery at her age. These included excess upper eyelid skin, crepe lower eyelid skin changes, lower face jowling, poor jaw line definition and a heavy neck. This is visually highlighted in the following photos.

As you can see, her upper eyelids demonstrate moderately excessive skin that bunches up to the point it hangs over the eyelashes. This results in a prematurely tired, aged look. Although not readily seen in these photos, her lower eyelids have a more crepe appearance due to loss of skin elasticity in this region related to the aging process. Her lower face shows fairly typical jowling along the jawline, which contributes to the appearance the lower one-third of the face is falling. In this particular case example, there is also noted atrophy (shrinkage) of the jawbone in combination with a congenitally smaller chin. This results in the lower face looking even less defined in the setting of the aging process. Furthermore, her upper neck is heavy due to skin sagging in this area along with excess, unwanted fat and poor tone of the underlying muscle (called the platysma muscle).

Plan for Facial Rejuvenation

Having reviewed these issues with the patient, it was recommended that she undergo a variety of procedures to help rejuvenate her facial appearance. As with many patients seeking this type of cosmetic face surgery in San Diego, she was quite realistic in terms of what she wanted to achieve. She simply wanted to look more youthful and rested following surgery – without appearing surgically altered or ‘done’ as many people say. This is actually a very important prerequisite for having cosmetic facial surgery. Patients need to be realistic in terms of their expectations of what this type of intervention will provide them. For instance, as in this case, a 50-60 year old female should realistically anticipate that she would appear more rested and rejuvenated as a result of surgery. She should not expect to look like a 40 year old once again. We call this ‘age appropriate’ in the field of facial plastic surgery. In addition, it is unrealistic to expect that all of her wrinkles and creases would be gone following surgery. She is still going to have some residual lines and shadows around the face that simply cannot be erased by undergoing plastic surgery. The realistic goal of this type of facial plastic surgery procedure is improvement and enhancement.

In this particular patient, we recommended she undergo a combination of procedures to provide the desired outcome. This included an upper eyelid lift (called an upper blepharoplasty), a lower eyelid tuck (a lower blepharoplasty), augmentation of the chin with an implant, and a lower face/upper neck lift (referred to as a rhytidectomy). These proposed changes are visually indicated below in the diagrammed photo series.

As you can see, the excess upper eyelid skin was to be removed. This was planned so that the incision would be placed into her natural upper eyelid skin crease so that postoperative scarring would be minimized. In addition, the lower eyelid skin needed tightening, which was going to be done through an incision hidden underneath her lower eyelid lash line (called a subciliary incision). Her lower face was to be lifted back and up at the same time a chin implant was used to bring her jawline forward. This was going to involve making incisions around her ear to do the facelift portion and a short incision under the chin for placement of the implant. The neck lift was to be done in conjunction with the lower facelift using the same incisions around the ear extended into the hairline. These procedures were to work in harmony to create an overall more rested, rejuvenated facial appearance.

San Diego Facial Rejuvenation Results

As you can see in the following before and after photos, she clearly has a cosmetic improvement in her face and neck. More specifically, her upper eyelids are no longer as heavy and tired looking. Coincident with this is the fact her eyes now look more open. Her lower eyelids are also smoother in contour with less crepe skin change now noted. When looking at her lower face and upper neck you can now see an improved jawline with less obvious jowling. Looking from the oblique and side views, you can also get a good appreciation for what the chin implant did to further improve her jawline by bringing it forward. On side view, you can see that she now has a more angulated and defined neck. If you try and look more closely at her side view, you will notice that her incision lines around the ear are barely visible. Moreover, her ears are in essentially the same position they were prior to surgery without obvious signs of distortion.

Does she have some residual wrinkles and creases? Yes, she does. But, as pointed out above, this is to be expected in surgery of this nature in this particular age group. More importantly she does not look surgically ‘done’ – a concern that is much more of a priority. Overall, this patient has what would be considered a great surgical result from combined facelift, neck lift, eyelid lift and chin augmentation with an implant.

Facelift Consultation in San Diego

If you are interested in having a facelift procedure to enhance your facial appearance, feel free to contact our San Diego facial plastic surgery office today to schedule a complimentary consultation with one of the best facial cosmetic surgery specialists in the region – Dr. John Hilinski.

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