Plastic, reconstructive and aesthetic surgery is a specialty dedicated to the treatment of morphological and aesthetic problems. Among the surgical specialties, it has the particularity of providing each patient with a unique technical solution, the most appropriate to the problem.
“Aesthetic concern must be an integral part in all our reconstructive surgical acts. In the same way, in aesthetic surgery, it is always necessary to keep a certain idea of reconstruction, reconstruction of the ideal aesthetic aspect lost or desired ideal. It is in this approach, both plastic and aesthetic, that lies the future of our specialty; and in order to give the best possible result for each patient” (Plastic and aesthetic surgery: one and indivisible. DELAY E. Réalités en chirurgie plastique 2016 ; 14 : 3-4).
It is here that all the talent and experience of the best plastic surgeons and the best aesthetic surgeons, can be used to give the best solution and the best possible result for each patient, while using small tricks, or technical improvements, adapted to each case.
The techniques used to correct the multitude of problems encountered by a plastic surgeon are constantly evolving, and it is important that the plastic surgeon is up to date of the most modern and effective techniques. Also, the involvement of the Plastic Surgeon in the medical scientific community, in Plastic Surgery, is fundamental for its maintenance at the best level of its discipline.
Between 20 and 30 years of age:
Before the age of 30, the surgery has rare indications. Sometimes we can perform lipostructure when the patient has a remarkable family history and specially if another surgical procedure is provided for something else.
Between 30 and 40 years of age:
Surgical indications between the age of 30 and 40 are equally rare, and they correspond to facial aging signs inherited on the family line. In this rare cases, the patients present genetic predisposition to aging of the orbital region. We are prone to perform a blepharoplasty of the upper eyelid to correct the excess of skin or a blepharoplasty of the lower eyelid in the appearance of palpebral pockets.
Between 40 and 60 years of age:
The signs of aging can appear and analyzing them precisely requires the patient in front of the mirror. It is generally around this age that facial rejuvenation surgery is performed. It has to be done with delicacy and subtlety to preserve the natural look of the face and not to alter the expressions. In this period of our life, the facial lift has to be adapted to the intensity of aging, without waiting to the point where a complete aging process took place. We will adapt the surgical gesture, based on the aging signs, addressing every area of the face with a simpler intervention instead of a “complex lift”, and individualized to every patient. The message to be passed on is that it’s rather worth to preserve the signs of youth instead of waiting for significant signs of aging, requiring heavier surgical procedure that are harder for the patient. This concept leads to a faster recovery, smaller scars, and a more natural result tag is in harmony with the natural evolution of the face.
After the age of 60:
For the patients that never had any facial rejuvenation surgery, a facelift will be proposed specially for the lower face, usually the patients’ main requirement in order to correct cheeks, jowls and neck area. It is good to know that it’s not ideal to wait too long before considering a face-lift; once the tissues are too loose, two liftings one year apart may be required in order to obtain the same result because the significant tissue excess can trigger a tissue loosening in the first year post-op. Even if most of the patients are focusing on the lower face, an examination of the entire face should be done, and a blepharoplasty should be suggested at the same time so that the whole face would be more harmonious. In fact, it is the homogeneity that gives the face its harmony and avoids the situations of a bad rendering or a « surgical-look ».
Who to trust for the completion of a facelift?
The cervico-facial lifting is decidedly one of the most emblematic of our profession as Plastic Surgeons. This procedure, and all the related complementary interventions (lipostructure, blepharoplasty, mid-face lift, temporal lift, eyebrow lift, upper lip lift) made incredible progresses in the last years in terms of quality, safety and natural look. That’s why we have dedicated the our presidency report of French Society of Plastic, Reconstructive and Aesthetic Surgery on this subject with the title The Renewal of cervico-facial face-lifts. The Plastic Surgeon, by his training and aesthetic approach, is the best suited to perform this surgery. An experienced Plastic Surgeon at a mature age is often the right choice as he has the experience required for this delicate intervention. It is also the age at which his reputation and experience give him access to the patients that can afford this expensive surgical procedure. At this age, the Plastic Surgeon has also the required empathy, as he sees on himself the signs of aging, and is interested in it a lot: he understands the person’s need, and can try to meet the expectations by explaining the possibilities and the limits, thanks to his experience. On the other hand, this procedures can be pretty stressing for the patients and dealing with this stress is necessary: experience and maturity help a lot in managing the postoperative period.
The cervico-facial face-lift is in fact a considerable “adventure" and the patients’ postoperative difficulties should not be underestimated. That’s why the patient’s strong motivation is essential, and the presence of a caring person from the patient’s entourage is desired postoperatively. However, this procedure is a major contribution to the look of the patient that had a correct indication, a strong motivation and received a flawless intervention from an experienced surgeon. The contribution of this intervention explains, in the majority of cases, the post-operative constraints. During this process the optimal support is mandatory. Not only technical or surgical but also humain with optimal support in terms of pre-, peri-, and post-operative care, with a great availability of the Surgeon if the patient is worried. Throughout quality of human relation before the intervention and quality of post-operative care, the Plastic Surgeon can bring the patient to satisfaction and obtain the best possible results while reducing the risk of further complications. The Aesthetic Medicine allows also to refine and complete the result, to correct eventual remaining imperfections, and this way to accompany patients towards satisfaction, offering the best possible result for each and everyone.
The Renewal of cervico-facial face-lifts directed by Delay E. Paris : Elsevier, 2017 :253.