The aim of surgery, even when performed in the best conditions, is not to stop the tissue aging process.
Dr Olivier Claude
After a first face lift, patients will inevitably see the sagging that led them to undergo the procedure gradually start to come back. However, today there are tools that allow us to make the results last longer and improve those achieved by the operation.
It is important to regularly monitor patients in the years following their face lift. It is no longer about waiting until the sagging is sufficiently severe (often after about 10 years) and another operation is needed. The slow yet unavoidable appearance of sagging can present earlier if the patient has an anatomical predisposition and an unhealthy lifestyle.
A cervicofacial lift is still an extremely satisfying procedure for our patients, but it primarily treats the consequences of aging. It is therefore fundamental to treat the causes after having carried out a full analysis, which will be personalised to every patient. This enables us to suggest the best therapeutic strategy for every case. Since aging is multifactorial, we need to know how to treat its different components in order to ensure the results look natural and last a long time. This synergy of treatments allows us to only use small doses of each product, thus avoiding any side effects, which are most often caused by the excessive use of any one therapy.
All of the facial tissues suffer from involution and are all responsible for how the face ages. Ideally, they should all be treated in order to ensure the results are balanced.
With age, the facial skeleton suffers from a loss of bone. This is well known to dentists, who often have to perform bone grafts for dental implants. This goes hand in hand with the resorption of the deep fat, which makes the face look more skeleton-like. These two phenomena create a loss of facial support, like a house whose load-bearing walls have lost their supportive function. Deep injections of cohesive hyaluronic acid into very precise points can restabilise the face while avoiding a bloating effect. The muscle and skin tissues are then repositioned. The quantity of hyaluronic acid placed superficially is kept to a minimum, as its aim is primarily to restore the skin’s hydration and support. This is done using very fluid, cross-linked hyaluronic acids, often combined with a small amount of collagen inducer to help make the skin “glow”.
We also need to stimulate the fibroblasts, which is where our collagen and elastin fibres are produced. This allows us to restore the skin’s firmness and suppleness by using fractional radiofrequency or focused ultrasounds. What is more, these highly efficient technologies reduce skin sagging and excess localised fat. The tools’ settings are particularly important and require medical experience in order to optimise the results without altering the tissues. Fractional ablative lasers and new-generation pulsed light therapies stimulate the fibroblasts while also improving the appearance of the skin by reducing marks, redness and fine lines.
For patients with more severely marked skin who are prepared to undergo a “minimally-invasive” procedure under local anaesthetic, internal radiofrequency such as Facetite® or Renuvion® allows us to tighten up the tissues in the lower face with more intense energies.
Tensor threads can reposition the skin tissues after they have been restored by the techniques described above. They can be resorbable or permanent, depending on the indication and the doctor’s discretion. The results are even better if they are used alongside other tools that target the causes of aging.
The role of the muscles is also decisive in facial aging. The muscles waste away and begin to contract in an anarchic and excessive way over time. Injectable muscle modulators, known under the name “Botox”, play a fundamental role because, in addition to treating wrinkles, they also reset the muscle balance in order to favour the elevator muscles. The depressor muscles become dominant as we age, which leads our face to express less positive emotions. Reducing their dominance in a precise way can lift the skin tissues and restore the positive energy to our face. It is vital to treat both the lower and upper face at the same time in order to obtain optimal and coherent results.
Nowadays, we can also stimulate the elevator muscles directly using High-Intensity Focused Electrical Stimulation, HIFES (EMFACE® technology). The session targets the zygomatic muscles but also the risorius in order to correct any expression lines and the onset of jowls, and even the digastric muscle which supports the floor of the mouth and whose integrity prevents a double chin from forming. High-Intensity Focused Electrical Stimulations will help tighten the muscles, which is needed to give the face its harmonious contours and support. Furthermore, the dynamism of the facial muscles will be restored, which improves the functional aspect of the face.
In order to allow our patients to age as well as possible, it is important that we combine surgery with aesthetic medicine as part of a global approach that covers the whole face. The recent technological evolutions have provided us with valuable tools that allow us to treat the different causes of aging. Any treatment plan should always be personalised and drawn up following a precise medical and aesthetic analysis.
Dr Olivier Claude
Plastic, reconstructive and aesthetic surgeon. Member of the International Society for Aesthetic Plastic Surgery – ISAPS. Member of the French societies for plastic and aesthetic surgery – SOFCPRE / SOFCEP. Former member of Pr. Lantieri’s face transplant team. Former assistant to Pr. Yaremchuk – Plastic Surgery, Harvard-Boston
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