Facelift in Atlanta, GA

Technically, there is not a scarless facelift because when we make an incision, if you look under a microscope, there is a scar. But when people say, is there a scarless facelift, what they really mean is there one that you can't see any scars. And the answer is yes. I do a scarless facelift I call the InsideOut™ Facelift, where a lot of the work is done through the mouth, behind the lower eyelid, and then through sites that allow me to get to certain areas through the hair. And I close those areas with a stitch or two. So you technically have a scar, but you can't see the scar. So in terms of, is there a scarless appearing facelift, the answer is yes. But technically, there is a scar.

An endoscopic facelift is basically a facelift that's done with smaller incisions so you have access to larger tissue areas. You have an endoscope which is a lighted camera in one hand and in your other hand you have a surgical instrument. Endoscopes have been used for years in facial surgery. I started using them around 1990-1991. We first did brow surgery, then we did cheek and mid-face and now we have advanced to doing even lower facelift and neck lift surgery through incisions in the mouth and inside the eyelids, so you don't have an external scar. The endoscope has many advantages, especially in the beginning when you're learning all the detailed anatomy. Later to be able to do a facelift, without having scars, with someone that has a lot of experience with an endoscope is a huge advantage for people.

Technically, you cannot have a facelift without a scar. But what most people mean by that is a disfiguring scar or a noticeable incision. So the answer is you can get a scarless facelift, but you're going to have hidden areas that were accessed. So for instance, I might make an access in the hair or behind the eyelids and insert an endoscope through the mouth. When those incisions heal, they will technically have a scar. But if you can't see them and you can put your hair up and you can get out of a swimming pool and you can wear earrings and do other things, you don't worry about people seeing any scars. That's what people consider a scarless facelift.

The best way to prevent unsightly scars when you have a facelift is to look at a lot of before and afters of the surgeon you're considering and make sure that he/she has not only an advanced technique but also the surgical skills to produce good scars. The other way to look at it is to do a technique that has no visible scars and that is a combination of endoscopic and intraoral where you have lots of access areas to get to the facial tissues but there are no external unsightly scars. So your ear looks normal, behind your ear looks normal, you can put your hair up. So the best way to have a good scar so to speak is to prevent it in the first place.

A minimal incision facelift is a term that usually refers to an incision in front of the ear and temple hair and behind the ear but not into the posterior hairline. So it's a slightly shorter incision than the traditional incision. A lot of times when a person makes a small incision, unless they're using advanced techniques to be able to go deep plane and through the mouth and behind the eyelids, they're not having access to the important structures that have to be recontoured. So I like to say with a mini facelift, you get mini results.

Facelift scars are traditionally performed at the edge of the hairline, in front of the ear, behind the ear, and into the posterior hairline. So they're usually highly visible. If you put hidden access in the hair in different areas and you go through the mouth and you go behind the eyelids, those are all access points to do surgery on the face that is going to be truly scarless as far as appearance goes. Anytime you make an incision, there's technically a scar, but the real key is we don't want to see the scar. And if your surgeon uses a technique where you can see a scar, you want it to be the best scar it can be, and that depends on experience and lack of tightness and different treatment parameters that your surgeon can perform.

An endoscopic facelift lasts approximately 10 to 15 years for someone a little older, say 55 to 70, and it lasts 15 to 20 years if it's somebody on the younger end when they have it done, say 40 to 55. And the reason is the younger you have it done, the better it heals and the longer it lasts because your tissues are in better shape. And the endoscopic approach allows you to have larger areas to reset and anchor the tissues through a smaller incision that's hidden, as opposed to an open incision where you can't get to certain areas without there being a larger scar. So the tradeoff for most surgeons is they do a smaller incision to try to prevent scarring, but it affects how long that facelift will last. The InsideOut endoscopic facelift will actually last longer in experienced hands.

An endoscopic facelift is performed with a lighted telescope about the size of a large McDonald's straw and you have instruments in the other hand and that's called an endoscopic camera setup. It allows a surgeon to have smaller incisions with a larger view of the tissues. There is a steep learning curve because you have to learn the anatomy from the inside out so to speak because you're inside the tissues and you're not seeing the tissues from the outside. The endoscope allows a person that understands all that anatomy to do a lot of surgery that's very hidden so that's the advantage of the endoscopic approach. Unfortunately there's a learning curve and so it takes years to be very proficient and efficient at performing endoscopic surgery.

The facelift recovery is less time than a traditional facelift because you're not disrupting a large vascular area and you're keeping the tissues intact. So if you go through a small incision with an endoscope and you're working on that tissue, but the skin is not disrupted, that's where the supply of blood comes from, the skin and the fatty layer that does not get disrupted with an endoscopic approach. So I tell people that the minimum to get back full steam ahead is about two weeks and I prefer for people to take three weeks for endoscopic facelift recovery.

When you think about having a facelift, you want to have a facelift that has natural results. You want to have no or very little scarring. You want to have minimal downtime and long-lasting results. And in my opinion, to get that combination, if you do it from the inside-out approach, you're going to have essentially no scars that are visible. You're going to have a relatively quick recovery. You're going to have a long-lasting result because I free all the attachment areas and recontour before it's reset. I think the best result, the longest lasting, most natural, is an inside-out approach using an endoscope and using areas to access the face that are not visible after you recover from surgery.

When we talk about scars, what we mean is it's something visible or kind of distorted. Technically, when you have an incision, you always have a scar. But if a tissue has tension on it, it's going to give a noticeable scar. So you can see facelift scars if you know where to look for them. The area that's the most distorted is right in front of the ear. And a lot of people know that if you look in front of the ear or in back of the ear or even at the temple hairline or posterior neck hairline, you might see a facelift scar.

Facelift scars will improve over time, but the scar will always be present. It goes through some color changes. In the beginning, it's a little red because it has extra blood flow. And then it starts to fade out. And at the end, hopefully you'll have pigmentation that matches the other pigmentation. If there's a little faded area because of loss of pigmentation, it's going to be more noticeable. That's why if you can avoid a scar, it's always the best.

A traditional facelift involves an incision right by the sideburn area, in front of the ear, around the ear, and back in the hairline around the ear. I recently did a presentation where it's shown that that's about 70 centimeters. If you do a non-traditional facelift, what I call a no-scar technique, then you can hide incisions and it's only about 7 centimeters. So it highly depends on the type of facelift that you have as to where the scars are going to actually be.

After a facelift, the wound will go through predictable stages of wound healing. And whether you have a one inch incision or a 10 inch incision, you still go through the different stages of wound healing. The wound will be a little pink in the beginning, and then it will start to fade, and it will actually look its best at about a year. The reason that most doctors don't recommend any further enhancements or touch-ups or adjustments for at least six months is because of the scar maturation process. So everything does look better with time. If you have an unsightly scar, that's a different situation that could actually look worse over time. So the real key is a facelift that has either good scars or has hidden scars. Obviously, a hidden scar in the hairline or in the hair is always better than a visible scar.