Sydney plastic surgeon Dr Leith Barnouti discusses the modern approach to lifting, rejuvenating and recontouring the ageing face.
geing of the face affects each person individually and therefore consideration of any facial rejuvenation or recontouring procedure is a very personal decision and must be customised to each individual patient.
However, some of the common aspects of the ageing face include loss of youthful volume in the mid-face region, loss of definition to the jaw line, the formation of jowls, excess tissue or ‘fullness’ and banding of the neck, as well as a blunting of the chin/neck angle. The appearance of lines near the eyelids or around the mouth, or a lowering of the position of the brow may also become evident.
The 21st century approach to facial rejuvenation and lifting involves more than tightening of the skin and deep tissue. It is a comprehensive strategy to achieve a younger looking appearance and may include skin resurfacing using laser or chemical peels, liposuction, as well as volumetric restoration and lifting of deep tissue and skin – all performed in a synergistic fashion. To achieve an individualised and natural-looking facial rejuvenation, the surgeon must have a complex understanding of facial anatomy, and an in-depth knowledge of surgical techniques and the latest technologies.
The modern approach to facial beauty emphasises the importance of shifting facial volumes rather than applying traction on the skin. I believe the restoration of facial volumes is more important than the amount of skin resected, and the tension on the skin and superficial musculoaponeurotic system (SMAS).
Assessment and planning
A technically demanding area, facial surgery requires careful attention and clear planning. I advise my patients to bring pictures of themselves, preferably not smiling, when they were younger (20 to 30 years of age). These photographs can help determine the volume and shapes needed to restore the more desirable facial structure of youth.
When considering a facelift procedure, careful assessment of the whole face is required: skin quality, appearance and position of facial lines, and the bony facial structure. I believe the meticulous analysis of the patient’s facial form is one of the most interesting and complex aspects of plastic surgery.
All facial signs of ageing are addressed individually and the treatment of that targeted area is explained to the patient during consultation. One of the most important issues in facial surgery is to establish the patient’s expectations and goals.
Rejuvenation vs recontouring
Facial rejuvenation can generally be described as ‘refreshing’ a person’s appearance; when the patient wants to look the same but younger and more youthful and refreshed.
Facial recontouring is when the patient wants to look the best they have ever looked by reshaping particular facial features or structures. In simple terms, rejuvenation is improving existing beauty while recontouring is creating beauty.
Generally, I find Australian and European patients opt for facial rejuvenation procedures as opposed to American patients who commonly opt for facial recontouring procedures. It is important to ascertain whether the patient is seeking rejuvenation or recontouring so the appropriate surgery can be carefully planned.
The options for facial rejuvenation and recontouring procedures range from mini facelifts, laser resurfacing, chemical peels, dermabrasion, liposuction, lipofilling, non>surgical wrinkle and volumising treatments, or a combined synergistic approach.
The decision to undergo a facial cosmetic treatment – whether surgical or non-surgical
is a highly personal one that not everyone will understand. What is important is how the individual patient feels about it. If they have realistic expectations of what surgery can achieve for them, optimal results physically and psychologically can be achieved.
