The vertical facelift -volume restoration procedure: a new concept in facial rejuvenation.

A new trend is taking the plastic surgery world by storm and it is based on new concepts of how to interpret beauty and facial rejuvenation. I called the "deflation theory". In the face, the aging process causes atrophy of the skin and underlying layers while the effect of gravity cause the facial tissues to droop in a vertical direction creating redundant skin and "jowls". The end result is an absolute loss of volume of the face (the deflation effect) and a relative shift of volume from certain areas of the face to other, less desirable areas such as the nasolabial fold, the jaw line, the areas below the eyes and the neck. Traditional facelift surgery attempts to correct the problem by pulling in an unnatural, lateral direction, producing the so-called "wind swept look". Also conventional facelifts cause a flattening effect on the face by pulling the skin tight. Therefore facial rejuvenation has been plagued for decades by two major mistakes:wrong direction of the pull vector,(lateral vs vertical) and bidimensional, skin-only, (flattening) approach.

If you look at how Botticelli painted Simonetta Vespucci in his Primavera's, you can appreciate the"volume theory"of a youthful, beautiful face: basically, aging causes volume loss and the ultimate goal of facial rejuvenation should be to restore the lost volume. The vertical facelift was conceptualized in the same way Botticelli created his paintings: thinking in a tri-dimensional fashion by restoring volume and, therefore, youthful shape and beauty. The planning is an important part of the procedure: a careful analysis of computerized images of the patient pre-operativly are invariable combined with old pictures of the patient in their twenties and thirties. This analysis results in a road map that we follow in our rejuvenation process.

An important role in achieving this goal is played by the advent of new, state of the art endoscopic technology which allowed us to minimizes scars by minimally invasive procedures. Cameras attached to scopes which are introduced through tiny incisions project amplified images to our operative room monitors, therefore allowing us to access critical areas of the face with specially designed instruments and modify and shape underlying tissues according to our aesthetic needs. Using similar technology, the vertical facelift is performed. Two tiny, inconspicuous incisions in the hairlines and inside the month are made and then a careful space is created where sutures are then carefully placed to suspend, reposition and secure the facial tissues in a vertical, more youthful position. The technique by itself causes less swelling and bruising and virtually eliminates any visible scars. With reduced post-operative recovery to less then a week, this technique also suits the patient with a previous facelift who has unnatural, pulled back look. It is also popular in a younger patient because the less invasive nature of the technique and the absence of any visible scars.

In the older patient, the vertical facelift is also combined with an endoscopic neck lift to reduce redundant skin in the neck area. The volume restoration is often completed with the placement of micrografting of fat in crucial areas such as the cheeks and nasolabial fold and often combined with endoscopic browlift. The final result is a restoration of the face in a volumetric fashion giving a soft, natural, youthful shape and form.

A technique is not a pure invention of a single mind but an evolution and/or a
combination of other techniques. I like to knowledge the other minds whose
thinking has stimulated me the most: Bill Little,M.D., Steve Hoefflin,M.D.,
Oscar Ramirez M.D., Sam Hamra,M.D., Sherrell Aston,M.D.