Rejuvenation Surgery / Face Lift

Rejuvenation Surgery/ Face lift

Just as recent as fifteen years ago, the menu available in the facial rejuvenation arena was limited, and the “face-lift” or “combined forehead and face-lift” surgery through a wide open incision technique was often the best or the only option. However in this era of definitely proven “targeted” surgical methods as well as “non-surgical” methods for facial rejuvenation, some of which have even received the golden seal of “FDA” approval , the patients have so much choices in terms of how much improvement is desired over which specific area, over how long of a recovery period, over what budget. But what is clearly important is that the patients no longer wish to transform their face into someone they never were from their cosmetic rejuvenation procedure; they simply wish to look their best and more youthful and well-rested, while maintaining their self-image. No matter how extensive the rejuvenation process, Dr. Kang will always attempt to achieve this “natural look” simply because this has always been his philosophy of performing cosmetic rejuvenation procedures.

When a patient comes in for a consultation for rejuvenation procedure, many still feel that a face-lift surgery is the “panacea” procedure to making everyone looking ten years younger. In many instances, this may not be the case. The traditional face and neck lift surgery has been mainly designed to improve the jowling along the jaw-line and improve the aging appearance of the neck. It is ideal for a patient who has classic oval facial shape where the lower face bony features are not too wide and who still retain adequate soft tissue volume of the cheeks. For patients who experience early deflation of the cheeks due to volume loss, lipo-transfer or dermal filler needs to be considered at the time of face lift surgery. Quite often, patients can look great with just lipo-transfer or dermal filler procedure alone if their jaw-line and neck is still youthful in appearance. In those patients who experience mid-facial sagging, mid-face lift alone or mid-face lift along with face-lift may be a better option. Finally, for many patients who have relatively wide lower facial bony features and thicker skin, as many patients of Asian descent do, it has been Dr. Kang’s observation that while the neck lift is beneficial, the face lift provides minimal aesthetic gain other than going through the motion of surgery. Even worse, sometimes the posterior sweep behind the ear, as part of multi-directional pull during facelift, can render them appearing awkward due to gaining a “wind-swept” look.

In order to evaluate how and what rejuvenation surgery can be beneficial for the patient, first a comprehensive consultation should be done to see which and to what degrees, the three main problems of aging process have set in. These are the:

• sagging of forehead (upper 1/3), mid-face (middle 1/3), and jaw-line and neck (lower 1/3)
• deflation of the facial volume from loss of collagen and fat; and, finally
• aging and sun-exposure changes of skin.The degree of aging changes in these three respective areas can truly vary from individual to individual; and, depends on multiple reasons, some of which include your genetical pre-disposition to facial aging pattern, your ethnic make-up, your bony foundation and thickness of skin, and finally based on how well you have taken care of yourself in terms of avoiding excessive sun exposure, vices and stresses in life, as well as nutritionally.

For patients who are looking for long-term surgical improvements, the appropriate surgical option(s), usually using minimal invasive techniques, are recommended, sometimes, combined with non-surgical procedures, to provide the most natural “non-surgerized” look with recovery time usually no more than a week to ten days, no matter how extensive the surgery proposed. Quite often, especially for patients who have only a weekend to recover or for patients visiting from out of state, “Weekend Makeover” is offered which addresses all three areas of sagging, volume loss, and wrinkling all on the same day, in matter of hours. (Please refer to the Non-Surgical Procedure section for more information). Very often, these patients can go out to dinner on the same night without any hesitations whatsoever, and perhaps even receive a complement or two on their improved appearance.

At the time of consultation, Dr. Kang will carefully evaluate your facial aging pattern, and depending on what your goals are, advise you the most appropriate and best combination of procedures tailored to your needs.

Face/Neck lift


Forehead Lift

If the peri-orbital complex is the first area to show signs of aging changes, then the forehead is the next area to show greatest amount of aging changes. Two very distinctive changes take place. First, due to years of facial expression through forehead “worry” lines and glabellar” frown” lines, these “dynamic” lines begin to get more intense until they “statically” remain in place, even when you are not expressing any anger, tension, or sadness; thereby sometimes imparting these expressions, even when you don’t want to. Second, because majority of the muscle groups of the forehead pushes the skin inferiorly; along with the natural effects of the gravity, your forehead along with the brows will ultimately sag down inferiorly.

At early stages, Botox alone works wonderfully to minimize these expression lines when your muscles are in action, and will help to minimize the lines, wrinkles and furrows from getting etched into your skin. As the lines and wrinkles become deeper, dermal fillers combined with Botox work wonderfully to soften or erase the lines and the wrinkles. However, when you notice actual sagging of the forehead and brows, thereby worsening the aging process of the eyelids, then you will benefit with a forehead lifting surgical procedure.


Endoscopic Forehead lift

Due to advances in minimally invasive surgical techniques, Endoscopic Forehead Surgery using minimal incision technique offers a truly natural appearing rejuvenated forehead with many decades of etched-in worry and frown lines significantly softened. The often obvious incisional scar, loss of hair, prolonged periods of numbness, and recession of hairline associated with traditional open forehead lift surgery is no longer encountered. In fact, the minimal incisions will be hard to find in a month or two. Whereas the Botox can only be modulated to elevate the lateral brows, surgery can accurately modulate elevation of the inner, central, or outer (later) brow areas. It is very important that the brows are elevated only to the position your old picture shows, otherwise you will acquire a startled-look rather than well rested and natural look. The key to the surgery is not to “over-do” the surgery. The recovery time is usually a week at best. In the case that you have a significant recession of your hairline, a tricophytic incision approach is taken where the bare skin in front of the hairline is carefully trimmed and meticulously closed so the scar can only be found upon scrutinizing the hairline. These patients are the happiest because not only is the forehead smoother, frown lines softened, and brow in a more youthful position, but the “receding” hairline is often in better position as well. At the time of consultation, Dr. Kang will advise the best combination of minimal incision, modified open, and tricophytic incision techniques which will yield the most natural and lasting result for the individual patient.

Mid face lift

Mid-Face lift surgery is recommended to restore the inferiorly sagging mid-face tissues to a more youthful appearing superior position, restoring the separation of the eyelid skin from the cheeks and improving the deflation of the cheek volume due to downward migration of the soft tissue. Once again, this is done through a combination of limited incision/endoscopic technique, well hidden in your temporal hair bearing scalp. The degree of the lift when performing the mid-face lift, is truly individual based, and the goal is to provide a more youthful appearing mid-face without creating a widened appearance of the cheek bone area or “porcelain doll” look, which is often the case using the “cookie-cutter” mid-face lift technique. For patients whose wide bony features of the lower face render them appearing awkward from the “posterior sweeping” behind the ear as part of traditional face lift, the mid-face approach, often combined with limited incision anterior ear face lift approach, which affords mainly a “superior vector” lift, can provide the best single directional pull to obtaining the most natural look.

Extended Temporal lift

Extended Temporal lift surgery allows improved re-positioning of the severe sagging of lateral brows and lateral peri-orbital tissues through a limited incision/endoscopic approach, well hidden in the temporal hair bearing scalp, and is often combined with the forehead lift surgery and/or Mid-Facek lift surgery.

Fat Transfer / Stem Cell Face Lift

Lipo transfer or fat grafting surgery is a great option for replacing loss of volume and hollowing that occurs in the face, particularly in the cheeks and around the eyes. The best candidates for lipo-transfer are patients who experience deflation of their facial volume more quickly than any other aging process. Based on your genetical make up (just look at the aging changes of your parents), your exercise tendencies, sudden weight loss, early dental extractions, you may experience early “deflation” of the youthful volume of your facial shape. Younger patients in 30’s or 40’s, may only need to volume enhance the deflated zones in the face, whereas older patients may require both volume enhancement and a lifting procedure. The surgery is two-fold: first, fat is harvested from the area where you have the most resilient fat in your body, usually the belly and the thighs for women and belly and love handle area for men. The fat is then gently harvested using a handheld syringe rather than liposuction machine to minimize traumatizing the fat during the harvesting process. The harvested fat is separated from impurities using a centrifuge and transferred into small syringes. Second, Dr. Kang uses a “micro-droplet” technique using many little gentle passes to transfer the fat droplets into the needed areas for the smoothest results and the longest effect possible. At the time of consultation, Dr. Kang will advise you as to the best zones of your face (high/mid/low check area, corner of mouth, jowl and jaw area, tear trough area, upper eyelid area) for the fat transfer to look as youthful and natural as possible. It is important to realize that fat transfer is mainly for volume restoration and not to erase all the fine lines, and wrinkles on your face, for which, Dr. Kang will recommend combined therapy with more “viscoid-elastic” injectables, such as Juverderm or Restylene. On the other hand, a unique unexpected gain in some patient is a long-term improvement in the overall tone, texture, and even fine wrinkles of the face which appears to last even after the fat volume enhancement depletes with time.

What to Expect

Final important point of lipo-transfer is that the down-time associated with fat transfer can match any surgical procedures and needs to be considered in matter of weeks and not matter of days. Because of the prolonged recovery period, lipo-transfer is ideal while another surgical procedure is being performed at the same time. Patients wishing no down-time whatsoever are given a choice of other injectable fillers, such as Restylane, Radiesse, or Juverderm, which can achieve similar volume enhancement, although with less lasting effect.