About the Howard Lift Facelift
by Dr. Paul Howard
The last ten years has seen dramatic improvements in our ability to provide rejuvenation of the aging face. As we questioned our facelift patients over the years, there were certain topics that came up again and again. Nobody preferred general anesthesia and all wanted to decrease the downtime to get back to their everyday activities. As it turned out, these requests are intimately connected.
General anesthesia is the culprit when determining how long your downtime might be. When compared to the advanced local anesthesia techniques we have developed and have used exclusively over the last decade, downtime has been reduced to a week or so rather than a month and costs have been drastically reduced.
The Howard Lift, as I currently describe it, is done in the office under oral sedation and our advanced local anesthetic techniques which sting very little and provide a solid anesthesia for hours. Some patients sleep, some chat and the adventurous few want to know exactly what I’m doing as well as seem to like the feeling of tightness, without pain, as the neck and jawline SMAS are plicated.
A general road map to the Howard Lift includes the judicious use of epinephrine in the three different local anesthetics we use to keep bleeding to a minimum. The incisions are kept as short as possible reminiscent of what are called mini-facelift incisions. The incisions are carefully hidden in and around the ear with special attention given to the tragus (the cartilage on the front part of the ear) and the earlobe. The earlobe frequently requires reshaping and re-piercing after reconstruction of its natural shape. The skin is undermined approximately 3-4 cm to gain access to the SMAS which is the basic structure that we use to apply tension (tightening) for the cheek, jawline and neck. The direction of pull on the SMAS, or vector, is different for each part of the face. When the SMAS is plicated, it makes the undermined area of skin much smaller (1-2cm). The skin is then undermined again and a second layer of permanent plication sutures are placed. The undermined area of skin, called dead space, is reduced just to the point where the extra skin is excised leaving only 2 cm of dead space where most facial bruising emanates. Most typical facelifts leave at least 4 cm of dead space and generally have more bruising and hematomas.
I have developed micro-drains to place in our attenuated dead space that are made of 21-gauge butterfly needles and their attached small tubing. We use a 7 cc hemovac tube used to draw blood as our suction device and reservoir for the minimal blood drained overnight. Because of our micro-drains, we rarely have any bruising in the face.
If one thinks about it, when you tighten facial skin, even just a moderate amount, you efface the contours of the face making them flatter. Adding volume to a facial rejuvenation procedure has been standard for years. We use autologous fat grafting on almost all our facelift procedures to re-contour the cheeks, fill the tear trough area and rejuvenate the areas inside the nasolabial folds concentrating on the lips and perioral area. Fat grafting, when done correctly, has proven to be the answer to volume and contour issues in facial rejuvenation procedures.
On many of our patients, even if they have had a previous lower blepharoplasty, we recommend our lower blepharoplasty which concentrates of redistribution of the fat and blending the lower lid skin with the cheek skin which already has been elevated and contoured with fat. This lower eyelid-cheek blending is ideal for resolving dark circles at the lower eyelid-cheek junction.
Our facelift patients are treated with individual care, being our only surgical patient for the day. We have the patient arrive in the morning and can expect to be here most of the day as we comfortably navigate the procedure allowing for complete patient comfort including breaks.
Facelift patients are able to go home following surgery but are requested to return to our office the following day so we can remove our micro-drains and clean the sutures. Facelift patients can shower after this office visit using the baby shampoo we provide in our signature post-surgical care kits. Sutures are usually removed after 7-9 days, but patients should still expect to take care of the surgical site.
To learn more about facelift recovery, please visit our FACELIFT RECOVERY page.