By: Asher Carey, MD, FACS

As we age, the effects of gravity, sun exposure, stress and other factors of life can easily be seen on our faces. No matter how hard we try, over time we all develop looseness of the skin, wrinkles, creases around the mouth, fullness of the jowl area and, around the neck, loose skin and banding of the skin and muscles.

When they look in a mirror, most of our patients who are considering a facelift and forehead lift see a totally different person compared to how they feel. They generally are in very good health, active and taking good care of themselves. The difference between how they feel and how they look brings them to my office. Most of my patients want to look better and also younger while still keeping the unique characteristics of their face and avoiding the dreaded “operative look”.

My approach is to first have an in-depth consultation with a patient to determine if surgery or non-surgical methods are best to achieve his or her goals. This includes a review of the patient’s medications, allergies and medical conditions, as well as their activities, lifestyle and time available for improvement Most importantly, I spend significant time with each of my patients to carefully define the exact problems – as they see it – and then discuss the results they can expect from cosmetic surgery. I have found it reassuring that most patients do not want an “extreme makeover”, nor do they want to look like someone else.

A modern facelift no longer results in excessively tight skin or a widening of the mouth. The incisions and subsequent scars are shorter and less noticeable than ever before, and the operation is safe and short. The result: a faster recovery with minimal bruising and discomfort. As a result, our patients resume normal activities sooner, returning to work within a week or 10 days.

The Basic Procedures

Facelift: Through a small incision, deep tissue and fat is elevated higher in the face, reducing the fullness along the jaw line and increasing the fullness high in the face to create a more youthful appearance. Our patients immediately notice that the square contour of their face before surgery is replaced with a pleasing oval shape that reemphasizes their cheek bones. The skin is tighter and smoother, with a major improvement in the cheeks and folds around the mouth. The jowls, of course, are smoother. The neck shows improvement as well, with smoothing of the vertical bands and removal of excess skin and fat. Improving both of these areas reemphasizes a more youthful and undulating contour, sharper jaw line and natural hollows and muscular structures of the neck. Forehead lift: a facelift is frequently combined with a brow lift to improve forehead wrinkles and drooping eyebrows. To soften the wrinkles and elevate the outer portions of the eyebrow, I usually make a separate small incision in the hairline. This results in a more pleasing shape and smoother forehead area. The eyes immediately looked less tired or heavy, more open and brighter. The eyebrows have a pleasing arch without being too dramatic or high on the forehead. And those wrinkles between the eyes? Gone. The surgical scars are well hidden in the hair and routinely unnoticeable.

The operations are conducted as outpatient procedures under either sedation or a general anesthetic. Each takes one to three hours to complete. Recovery is rapid, with minimal discomfort, and our patients are up and about the next day. I recommend that my patients take it easy the first week after surgery and avoid strenuous activities for three to four weeks.

Done either separately or at the same time, the rejuvenation provided by a facelift or forehead lift results in natural looking, pleasing improvements that both please and surprise our patients. They look younger and fresher, and the improvement in self confidence is evident. This is the result of both the sophisticated techniques that we use and, even more importantly, the time we spend with the patients to elicit their desires and goals.

A facelift or forehead lift will not rejuvenate everything. Further improvement can be made by enhancing skin texture. Our skin care specialist offers state-of-the-art options, including light chemical peels. Laser peels or resurfacing can be used to complete the rejuvenating result. Fat can be injected at the time of surgery or later to help replace areas where fat has been lost and patients require more contour. I’ll discuss this fascinating subject in a future article.

Dr. Asher B. Carey received his undergraduate degree from Duke University and his medical degree from Jefferson University in Philadelphia. He completed a residency in general surgery at Tulane University, a plastic surgery residency at Vanderbilt University, and special training abroad with international leaders in cranial and facial surgery. In his spare time, Dr. Carey is a sculptor. He brings his fine eye for graceful shaping to both his profession and his hobby. Dr. Carey is a native of southern Delaware and has been serving the cosmetic and plastic surgery needs of patients in Dover and Lewes and surrounding communities for more than 20 years. Double Boarded in both General Surgery and Plastic and Reconstructive Surgery, Dr. Carey works with you to achieve a natural and healthy look. He is an advocate of minimum scar surgery for most procedures, including forehead and face lifts, tummy tucks, and breast enlargement and reduction. For more information or to schedule a consultation, contact the Carey Cosmetic Surgery Center at 302-678-3443 or visit www.ashercareymd.com.