Video Website powered by Einstein IndustriesMinas Constantinides, MD, FACS, PC

DR. MINAS CONSTANTINIDES: Face lifting is an operation that has really evolved over the last ten years. The old style facelift when it was first done really just a skin lift. And unfortunately, that caused a lot of stretch back over a short period of time.

And when it was repeated, it would give a really over tightened look. So the next phase in the history of face lifting came when the SMAS lift was developed. And that was mostly developed here in New York by a group of surgeons where, instead of the skin being pulled, the underlying support for the skin that ages and stretches over time, the SMAS, which stands for subcutaneous musculo-aponeurotic system.

It’s a muscle layer basically underneath the skin. And as it stretches, the skin stretches too and you get jowling and redundancy of the neck and that sort of thing. So SMAS lifting was fine except about three or four years or five years after the surgery, there would be these streaky lines that would develop in patients.

And so very, very classically, as one got older, they’d look a little bit better than they would have. But they kind of looked funny. There was something not quite right about it. Furthermore, SMAS lifting did very little to provide fullness in the face. And everything today is about volume, about trying to restore volume in the upper part of the face 'cause as we get older, we lose all that volume. Deep plane face lifting has come to fore over the last ten years or so.

And deep plane face lifting is a technique that I use almost exclusively in face lifting because it beats the other ways by a mile. Deep plane lifting is not only tucking up the SMAS, but in fact, raising the whole layer of SMAS.

So we're dissecting far forward into the face, all the way past the jowls into the lower lip area and to the upper lip area. And by lifting that whole sheet of tissue, which is SMAS and skin and fat and everything else, we were lifting and also filling at the same time with that fat that’s fallen forward.

And so that technique never gives an over-pulled look. It’s more technically difficult surgically, but the result is fantastic. It gives a really natural look. It naturally fills the face.

And, in my experience, it does not have to be repeated. I’d like to talk about neck lifting now for a few minutes. Neck lifting is something that most women and men see early on as a problem, early jowling alone the jaw/neck line, early sagging in the neck.

When it’s seen early on, sometimes just a liposuction to improve some sagging of the fat can be helpful. But liposuction never gives a tightening of anything. And so when any tightening is required, we do neck lifting.

Now neck lifting can be either aggressive or not. And very often we can do something called platysmaplasty, which is just tightening of the muscle of the neck that gets droopy over time through a small incision underneath the chin.

Now platysmaplasty can work really well in the younger neck with a little bit of laxity. But if there’s a lot of skin laxity or a lot of skin excess, that has to come out and we have to do a more formal neck lift.

And with that operation, we're doing a plastysmaplasty at the same time, which is that same step of tightening the platysma in the middle. But at the—now we're also going to pull from the back.

And that procedure can be done with a short incision around the ear lobe because it’s mostly designed for the neck and the jaw neckline.