Dr. McKee talks about what makes a more youthful appearance, avoiding an “overdone” face, and whether TV commercial promises can live up to the hype.
What specific problems do facelifts address?
Its power is the neck and the jaw; you get some of the wrinkling out of the cheeks and pull a little of the nasal-labial fold up, but mainly its strength is the neck and the jawline. And it can rejuvenate that back to a– well, in some patients, to a look they’ve never had. There are a lot of patients that have had an area of fat under their chin that has always been there at every age, and they’ve never had a very nice flat platform. So what we do is we remove that fat and then we tighten the skin, so a lot of people end up having a neckline that they never had when they were 20. It makes a flat platform under the chin, back to a sharp drop.
We’re trying to achieve a refreshed, and certainly a younger look, but we’re not after an age-specific look. We’re not saying we’re going to take 30 years off of you, specifically, but a refreshed, rejuvenated, but still natural look. You will still look like you and not unnatural.
The “Over-done” look
I don’t think there’s any other cosmetic operations that we do that are so culturally determined as to what people think is a good result.
What that means is, patients that I see in my office complain about the celebrities they see on TV: they look over-operated on; they do not look natural. At the same time, those people you see on TV that I and my patients would call over-operated, would be disappointed if they didn’t get that dramatic operation.
So what is off-putting for many people in our section of the country about facial rejuvenation, is they think that everybody who gets a face lift, brow lift, eyelids, are going to end up with something that is very unnatural and off-putting. That’s not the case. I don’t do the same operation that the FL and NY and CA plastic surgeons do when I do facelift and facial rejuvenation surgery. I am after a very natural result.
Now what does that mean in very specific terms? That means that I make a tight, tight neck and jawline. My opinion is that you can’t tighten the neck or the jawline too tight. It is a nice look, at every age. And if you’re 75 and have a very tight, flat platform under your chin that goes to a sharp drop, nobody complains about that, it is a very nice look at every age.
On the right: “a flat platform back to a sharp drop”
It is the cheeks that are the problem, and the eyes and the brow that are the problem when they’re over-operated. If you try to use the facelift to rejuvenate the mouth, you will get a very unnatural, wind-swept look. That’s what the celebrities have that people do not like. Their mid-face is way too tight. They try to do things, in my opinion, with the facelift that you cannot do, which is rejuvenate the nasal-labial creases a lot (those grooves just above the mouth and the upper lip), and the area around the lips. You cannot really rejuvenate those with a facelift. And when you try to do that, it’s not a nice look, as far as I’m concerned. It’s an over-operated, unnatural look. So we don’t do that operation. We do a face lift, which is really a neck- and jawline lift, and some cheeks, and we tighten the neck and jawline up tight, but don’t tighten the cheeks up very tight.
Healing from a facelift
A facelift is about a 3-hour operation, it’s done in the Operating Room of the hospital, you can do it under local anesthesia with sedation, or you can do it under general anesthesia, probably as safely. The patients go home the same day, or if they live out of Nashville, we have them stay in town in a hotel overnight, they return to the office the next day, get the dressing out that was put on in the operating room, and any drains that might have been used, those are removed the morning after surgery.
The patients are allowed to go home, they are allowed to shower the day after surgery, shampoo their hair, then they return to the office 5-6 days after surgery for suture removal and, the day following suture removal, they are allowed to use make up.
In terms of the amount of bruising and swelling people get, is very variable. Some people get very little, some people get a lot, pretty unpredictable. Almost everybody gets some, particularly in the neck and low neck and it settles by gravity over time.
What I tell my patients is that in 3 weeks, they are going to look good. They may look good before then, but if they have a major social engagement, like a wedding or something like that, they really need to allow three weeks.
There is very little pain associated with a facelift. If you have a lot of pain, you need to call your doctor. It is uncomfortable and your neck is certainly tight, and you may have a sore throat (it may hurt to swallow from both the tightness and if you had a general anesthetic, from the tube that was in your throat during the surgery), but other than that, very little pain.
The only scars I’ve ever had to revise are occasionally the scars in back of the ears, where you move into the hairline in back, I’ve had to revise a couple of those. Otherwise, the scars are almost imperceptible, even those that lie in front of the ears- they make thin, white lines, very hard to see.
Franchised “Thread-Lift” Procedures
We’re talking about those advertised, franchised procedures you see on TV: most of the patients who go there will end up getting a facelift, of varying qualities, but they will get a facelift. And if you look at the captions underneath the pictures they show on TV, it will always say the patient had additional neck-tightening procedure. The procedure they are advertising is some kind of thread lifting, it’s supposed to be quick and easy, with long-lasting results. That is not true. It has a high complication rate. But most of the pictures they show, whether they had threads or not, they basically had a face-lift. Now they may have had it by a surgeon who had a 2-week training course instead of being a board-certified plastic surgeon trained in face lifts, but they had a face lift of varying qualities.
Almost every plastic surgeon in the Nashville area has a patient who has come to them because they’re unhappy with the results they had at one of these franchised sites. There are no shortcuts. There is no exercise you can do to remove fat or skin. You can do all the neck and facial exercises you want, you can tighten the muscles, but it does not increase the tightness of the skin, nor does it remove fat from that site. If you burn more calories than you eat, you’ll burn fat, but your body will decide where that fat comes from, so there are no shortcuts.
If you have a lot of hanging skin in your neck, the only good way to remove that skin is through surgical incision, and the only good place to remove it is in front of the ears, and that is a facelift.
David McKee, M.D. 