Technical Talk

The facelift of the future is available today. Known as the composite facelift, it has become the first procedure to adequately address the problem of loose skin or nasolabial folds (the folds running from the nose along the corners of the mouth).

The skin, fat, and muscle of the check are lifted and repositioned in one piece and not separated as is done with the standard facelift technique. This results in a smooth, “un-pulled” appearance which was not possible before.

First conceived in Sweden, the composite facelift was fully developed in 1986 by Sam Hamra, M.D., a plastic and reconstructive surgeon in Dallas. “It is difficult to evaluate a facelift,” said Dr. Hamra. “Any improvement is frequently regarded as a good or acceptable result.” However, three areas should be evaluated: 1) The contour of the jawline, 2) The contour of the neckline, and 3) The status of the nasolabial folds.

The composite facelift (named because it is composed of several parts) produces a result similar to what you see if you pull the skin of your cheeks upward with your hands. In the composite procedure, the total release of skin, muscle and fat together allows the flap of the face to be lifted back to its original position. The traditional facelift, as mentioned above, does little or nothing to smooth out the folds of the face and sometimes gives a mask- like appearance.

Developed in the 1920s, simple skin-lift surgery was the standard procedure utilized by plastic surgeons. Today, the majority of plastic surgeons perform another type of facelift which elevates the deep muscles of the face as a separate layer from the skin. The procedure using this layer, called SMAS (Superficial Musculo Aponeurotic System), was considered state-of-the-art until the introduction of Dr. Hamra’s composite facelift. The skin-only procedure is consid- ered a first-generation facelift. The SMAS lift is referred to as a second-generation tech- nique’. The composite facelift is the third generation, the most medically advanced procedure to date.

In surgery, the composite lift involves incisions running from above the ear and extending from inside the ear canal, to behind the ear and into the hairline of the neck. Another incision is placed underneath the chin. Through these incisions only the skin is lifted approximately one inch. At this point, the composite flap begins and the dissection goes deep beneath all layers of the face and extends to the mouth. The composite flap is then held in place in front of the ears with dissolvable sutures.

Beneath the chin, the neck muscles that have split apart with age are folded back together with sutures. This aspect of the procedure eliminates the “turkey-gobbler” look.

For the first time, a facelift is capable of correcting the jowls without the irregulari- ties associated with liposuction or carving. Every patient’s face has its own natural layer of fat, which is easily manipulated by the surgeon using the composite technique. In addition, the problems relating to the bags of the cheeks and nasolabial folds have finally been reconciled.

Another benefit of the composite tech- nique involves the even layer of the neck muscle which is completely covered by fat (similar to padding under carpet). Since the integrity of the attachment of the skin to the fat is not disrupted, the skin of the neck also becomes smooth without appearing “overpulled.”

There is minimal pain following a com- posite facelift. Many times, however, pa- tients experience numbness of the checks for four to six weeks. In addition, the face becomes more swollen after this procedure than with the standard facelift because the surgery is more involved and elevates deeper layers of the face.

The results speak for themselves. Patients actually look younger because the fat and jowls are lifted back to their original posi- tion. They appear very natural and youthful without the suggestion of surgery. Over the The following are answers to some common patient concerns. Dr. David Benvenuti addresses questions about having a facelift. years following surgery, this facelift ages gracefully since it is based on the natural repositioning of the patient’s anatomy.

Dr. Hamra has introduced the composite facelift to nearly half of the country’s 2,800 board certified plastic and reconstructive surgeons. He estimates, however, that only 100 have mastered the technique. As David Benvenuti, M.D., is one of the first surgeons to learn, implement and successfully practice the procedure, Dr. Hamra refers to him as one of the composite facelift’s pioneers.

Questions and Answers About Face Lifts

  1. Is it safe to have facelift surgery in the office?
    Yes. It is safe to have almost any type of plastic surgery in my office. I have one of only seven Orange County plastic surgery facilities that is fully licensed and accredited at the highest level by the American Associa- tion for Accreditation of Ambulatory Plastic Surgery Facilities (AAAAPSF). I use only sophisticated and state-of-the-art surgical equipment and monitors. Also, each member of my surgical team is a Registered Nurse (not a technician) and is ACLS certified (Advanced Cardiac Life Support), Overall, aside from the normal risks one takes in having elective surgery, procedures in my office arc completely safe.
  2. How do I know when I am ready for a facelift?
    It is difficult to establish strict guide- lines because everyone is different. There are both emotional and physical aspects of determining when you are “ready” to have a facelift. The age at which people decide to have facelifts varies considerably. As a general rule, coming in for a consultation is a sign that you are very close to being emo- tionally prepared for the procedure. During the consulting process, some patients need more explanation and reassurance than others. My staff and I understand the importance of responding to the individual needs and apprehension levels of patients. If you are ready to have a facelift you may feel as though you appear tired and “dragged down.” Or you may have over- Heard a loved one or friend commenting on how “worn out, wrinkly or old” you look which confirms your concerns. Lastly, you may find yourself looking in the mirror, pulling your skin back and imagining how you would look if your face was smooth and firm again. These are all good physical and emotional indicators that you are ready to have facelift surgery.
  3. ill people know I’ve had a facelift?
    This depends both on the level of change to your face and the level of obser- vance by others. Initially many patients arc secretive, but when they see the results they want to talk about it. Yet there arc still those who never admit to having a facelift. When you combine procedures (a facelift with an eye, nose or dermabrasion procedure) it is usually more noticeable. A facelift on its own, however, simply gives you a fresh, new look. It is a softer and rested look, similar to what photographers do when they “touch up” portraits.
  4. How long do the results of a facelift last?
    This differs in each case. The facelift which I most commonly perform -the
    composite facelift created by Dr. Sam Hamra of Dallas – is proven to last longer than the traditional facelift. Facelifts usually last between five and 15 years, depending greatly on the age and skin type of the patient. The aging process still continues after a facelift, but, contrary many beliefs, the face does not fall. Many factors figure into how long a facelift lasts. These include a patient’s general health, stress level and heredity. The results may not last as long, for instance, if a patient undergoes a longstanding personal tragedy or trauma this type of stress wears away at the fresh, soft look of a facelift.
  5. Can I combine a facelift with other plastic surgery procedures?
    Yes. The most common and recom- mended procedures to combine with facelifts involve the eyes, nose, cheeks and brow. Some women, however, choose to have a breast augmentation and/or lift at the time of a facelift – thus taking care of their face and body all at once. People either choose to combine procedures for the convenience of not having to undergo additional surgery, or to complement the facelift by improving a particular area of their face.