Facial Aging Explained

Facial aging is related to four main factors:

1. The facial muscles drop and loosen which causes the fat compartments of the face to drop
2. Facial fat volume loss, particularly in the cheeks
3. Aging of the skin
4. Facial Skeleton Shrinkage

These changes cause wrinkles and folds in the face which in turn cause the face to look more tired, deflated, and bottom heavy. This leads to the formation of jowls and heaviness of the neck. As a result, the nasolabial folds or “smile lines” deepen, and the “marionette lines” become etched in. When performed by a highly specialized facial plastic surgeon, a deep plane facelift from Chevy Chase Face can be used to reverse this aging process by focusing on returning the soft tissues to where they used to be.

View Facelift Before and After Gallery

What is a mini facelift at Chevy Chase Face?

Our approach to facial rejuvenation surgery focuses on natural results and minimizing incisions. We customize our surgical lifts to the individual which allows us to successfully achieve amazing results across all ethnicities and age groups. A mini-lift can also be referred to as “short scar”, “weekend”, “MACS”, or “S-lift”. These can be excellent choices for people in their 40’s who have mild to moderate skin laxity. This involves tightening a sheet of connective tissue under the skin called the SMAS with sutures.

A vast majority of plastic surgeons rely on this technique alone and perform all of their facelifts and neck lifts in this manner. The deep plane technique, in which our surgeons specialize, is more complex than a typical SMAS lift. The deep plane technique is a more effective way to reverse significant facial and neck aging and can be used to lift the midface because it focuses on fully releasing the anchor points of the face. This technique has the added bonus of improving the appearance of the cheek without the need for fillers or other volumization.

A “mini” or “weekend” facelift addresses mild to moderate signs of facial aging including the jowls. This technique minimizes the incision and the recovery time. This procedure may not be appropriate for those with heaviness in the neck or more severe signs of facial aging. Your surgeon will inform you of the best course of action depending on your individual anatomy and goals.

What is the Deep Plane Technique performed at Chevy Chase Face?

The deep plane technique performed at Chevy Chase Face is the most effective way to tighten the jawline and lift the midface/cheek. With this technique, patients in their 50’s and above can restore balance to their faces and improve the look and appearance of the nasolabial folds. This technique involves fully releasing the SMAS, a connective tissue layer under the skin. Unlike face and neck lifts performed at other practices, by releasing the anchor points of this layer, our surgeons are able to achieve a much more powerful lift. Since there is no tension put on the skin during closure, the deep plane technique allows us to achieve consistently natural results.

In most cases, the surgeons at Chevy Chase Face will extend this deep plane technique into the neck to tighten the platysma muscle and achieve an elegant neckline. This is done at the same time as the deep plane facelift and is commonly referred to as a lower face and neck lift. By correcting both the lower two-thirds of the face and neck at the same time, we are able to achieve dramatic improvements for our patients’ profiles. The deep neck lift also allows our surgeons to contour a fatty layer in the neck that is not accessible with simple liposuction procedures.

Patients undergoing a deep plane face and neck lift can expect:

• Well-hidden incisions around the natural curves of the ear and into the posterior hairline (sometimes referred to as a “Ponytail Lift”).
• Substantial correction of facial and neck lines and wrinkles, including the nasolabial folds.
• Lifting of the corners of the mouth to improve the appearance of “marionette lines”
• Lifting of the cheeks and jowls.
• Significantly improved neck contour and appearance.
• Enhanced jawline definition.

Am I a candidate for Neck (Submental) Liposuction Alone?

Liposuction of the neck (submental liposuction) to correct a double chin can be done as a stand-alone procedure in patients under the age of 40 with good skin elasticity. This procedure removes fat from under the skin and helps contour the jawline. This is reserved for those under the age of 40 due to a lack of skin laxity in this population. After the age of 40, some form of skin tightening must be done to prevent a sagging appearance of the neck. This can be done via a neck lift where the muscle is tightened and excess skin is removed or via skin tightening devices such as FaceTite/Morpheus. Your surgeon at Chevy Chase Face will be able to assess your skin at your consultation and suggest the best possible approach to fit your goals.

If you are a candidate for neck liposuction as an independent procedure, this can easily be done in the office under local anesthesia. After you are completely numb, your surgeon will use 1-3 small sites to contour the fat in the neck and jawline. Downtime is very minimal and involves a few days of wearing a compressive garment to reduce swelling and bruising.

Your surgeon may suggest liposuction instead of Kybella for multiple reasons:

1. Kybella requires multiple treatment sessions (3-4 on average) whereas liposuction is done in one sitting.
2. The recovery is faster. This is difficult to believe since Kybella is an injectable, but the swelling, redness, and pain after Kybella injections is significantly worse than the typical recovery for liposuction.
3. Liposuction is more precise and powerful than Kybella.

Are There Other Procedures Involved With a Facelift?

Dr. Porter and Dr. Sitapara commonly combine a facelift with other surgeries to restore your facial features more comprehensively. These include:

• Blepharoplasty (eyelid lift). Rejuvenating the eyelids can give you a more youthful, rested, and alert appearance. This is sometimes combined with a brow lift as well. Undereye bags or loose skin can be addressed with a lower blepharoplasty and is commonly done in conjunction with facelift surgery.
• Rhinoplasty (nose surgery). This can change the shape, size, slope, and nostrils of the nose to complement surgical changes in the lower face. When done concurrently with a lower face and neck lift, our surgeons are able to achieve tremendous changes to a patient’s profile.
• The “LIFT AND LUMINATE” Program. The Lift and Luminate Program is an individualized program designed by the surgeons at Chevy Chase Facial Plastic Surgery to improve all aspects of facial aging. As we age, the soft tissue of the face and neck drops, we lose significant volume in the cheeks and temples, and our skin begins to deteriorate. Our specially curated program, combines the deep plane facelift procedure with fat grafting to restore diminished volume and a deep chemical peel to build collagen and improve the appearance of the skin. This is the most comprehensive way to address all signs of facial aging with the advantage of only one recovery process.
• Buccal Fat Reduction. See below.

Buccal Fat Pad Removal

This 24 year old male underwent buccal fat removal in the office. His result is shown 3 months after the procedure. He is thrilled with the volume reduction he has already seen in his cheeks and the more mature appearance we were able to achieve.

Am I a Candidate for Buccal Fat Pad Removal/Reduction?

This procedure is ideal for people who have always been told they have a “baby face”, despite their age or how much weight they lose. The buccal fat pad is just one of many fat pads in the face and is one that contributes to having round and full cheeks. Dr. Sitapara can safely reduce the size of this fat pad in the office or operating room (depending on patient preference) to improve the contour of the face in a natural fashion. The downtime for buccal fat pad removal/reduction is minimal, so this is a perfect procedure for the right candidate. During your consultation, Dr. Sitapara will examine your facial soft tissue structure as well as your asymmetries to determine if you would benefit from buccal fat pad removal/reduction. He prides himself on reserving this procedure for those that would truly benefit from it and has performed buccal fat pad removal/reduction in people between the ages of 21 and 65.

This 24 year old male underwent buccal fat removal in the office. His result is shown 3 months after the procedure. He is thrilled with the volume reduction he has already seen in his cheeks and the more mature appearance we were able to achieve.

How Do You Perform Buccal Fat Pad Removal?

Buccal fat pad removal can easily be done in the office or operating room with or without light sedation, through two small incisions in the mouth. The minimally invasive incisions are closed with absorbable stitches, so you do not have to have any sutures removed after the procedure. After the procedure, patients do not need to wear any sort of head wrap or dressing and can resume normal everyday activities the next day. For patients already undergoing a deep plane face lift, the buccal fat pad can be removed through the facelift incisions.

How long do the Results of Buccal Fat Pad Removal/Reduction Last?

Since the buccal fat pad is physically reduced during the procedure, the results of buccal fat pad removal are permanent. Weight gain after the procedure can add volume to the rest of the fat pads in the face, but the portion of the buccal fat pad that is removed will never regrow. Initially, there is mild swelling where the buccal fat pad was removed, but patients will see a gradual improvement in their cheek contour as that fluid is resorbed. Most patients will start seeing results of their buccal fat pad removal after 1 month and will continue to see improvements over the following 6-12 months.

Benefits of Receiving a Facelift from Chevy Chase Facial Plastic Surgery

Chevy Chase Facial Plastic Surgery (CCFPS) is a specialty practice, meaning that the majority of our procedures are dedicated to facial rejuvenation. Patients choose CCFPS for expert care and a supportive experience. Our surgeons, Dr. Jennifer Parker Porter and Dr. Jigar Sitapara, prioritize the safety, comfort, and natural appearance of those in their care. With facelift surgery, they use techniques that minimize scarring, with the goal of achieving results that look like the patient’s younger self.

Dr. Sitapara is board certified in Otolaryngology – Head and Neck Surgery, is a faculty member at George Washington School of Medicine, and completed fellowship training in New York to master the nuances of the deep plane technique. He is a current member of the American Academy of Facial Plastic and Reconstructive Surgery and has numerous publications in the field. Dr. Porter has been in practice for over 23 years and holds dual certification with the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology Head and Neck Surgery. She is a clinical associate professor at Georgetown University Medical Center.

With the deep plane technique, Chevy Chase Facial Plastic Surgery emphasizes natural-looking outcomes with minimal scarring. They focus on rejuvenation rather than alteration. Our practice is one of less than a few percent of practices that use the deep plane approach, which is the best way to address aging in the lower face and neck.

View Facelift Before and After Gallery

What to Expect for Your Facelift Consultation

As part of your initial consultation at our office:

• You and your surgeon will spend extensive time discussing the facial features that you would like to improve.
• You will have a physical examination and review your medical history to ensure that you are a good candidate for facelift surgery.
• The doctors will use facial morphing technology as a communication tool so you fully understand what type of results you can expect.

Once you receive medical clearance from your primary care physician, you will return to CCFPS for a preoperative visit. We will provide you with a kit that has items to make your recovery safer and more comfortable as well as postoperative instructions and answers to any questions you may have.

Dr. Porter and Dr. Sitapara perform all surgeries at the SurgCenter of Silver Spring, Bethesda Surgery Center (Johns Hopkins), or at Georgetown University Hospital in Washington, DC. On the day of your procedure:

• Your doctor will prepare you for surgery and the nurses will escort you to the operating room.
• You will receive either sedation or general anesthesia; you and your surgeon will discuss this anesthetic protocol as part of your consultation.
• A head wrap will be placed to speed the healing process. This will be removed by our team on the following day.

After you wake up from surgery, you will spend about an hour in the recovery room and then be taken home or hotel by a loved one.

The Recovery Process

Expect to stay out of the public eye for 7-10 days following a mini-lift and 14 days following a deep plane face/neck lift. Most people can easily work from home after a few days and take only Tylenol for pain control. Rigorous exercise is not advised for the first two to three weeks, but light activity is encouraged once your sutures are removed. Your surgeon will advise you about homecare, which will include sleeping with your head elevated. You will be able to eat a normal diet and be on your feet after surgery. Tiny drains are placed on a case-by-case basis in order to speed up your recovery, and will always be removed the day after surgery.

We will ask you to return to CCFPS at different points during your recovery:

• One day after surgery, we will remove your dressing, slip out the small drains if they were placed, and place a new lightweight wrap. This light wrap can be removed at home the following day, so you can wash your hair/shower approximately 48 hours after your surgery.
• After 7-10 days, we will take out the sutures. You may have some light bruising and swelling that will continue to improve on a daily basis.
• We will see you back at CCFPS one month post-op to ensure you are healing as expected and see you regularly after that.
• After you have fully recovered, you should see the complete benefits of your facelift: more youthful features and a firmer, more well-defined appearance in your lower face and neck.

Facelift Frequently Asked Questions

How Much Younger Will I Look After a Facelift?

When getting a facelift, there is no set guideline for how young a patient will look after the procedure. Results can vary drastically depending on the extent of age-related wrinkles and laxity of the skin, the overall health of the patient, and the patient’s age, as younger patients tend to heal faster and better. Additionally, following the facelift aftercare regimen is essential, as otherwise, the healing process may be inhibited, reducing final results.

However, numerous studies have tackled this subject and found that the average patient looks seven to twelve years younger after a facelift procedure. This is not a hard limit; it’s entirely possible for to look even younger under the experienced hands of our surgeons, especially if they avoid sunlight, stop smoking, and drink lots of water while they are healing. Results can be even more impressive with our Lift and Luminate Program or if a facelift is paired with other treatments in the face and neck area for a completely revitalized appearance.

To know for sure what kind of results they might be able to expect, patients should schedule a consultation with Chevy Chase Facial Plastic Surgery. We can take a look at their medical history and perform a full examination to get a better idea of the condition of the patient’s skin. Together, we collaborate with our patients to discover their expectations and find a treatment plan that can help them achieve the results they crave. Using this information, we can provide a more accurate estimate for final results.

What Is the Ideal Age to Get a Facelift?

Getting a facelift is an extremely personal decision that must be made by each patient on an individual basis. Everyone ages differently, and some people might be much younger than average when they start to see fine lines and wrinkles ravage their once smooth and taut skin. For most people, this process begins in the mid-20s to late 30s and progresses over time. What might start out as a small crease during a smile can turn into always-present lines that make a person appear older than their age.

The right time to have a facelift is highly variable. It depends on the person and their anatomy. Some people age much quicker than others due to genetics and lifestyle choices. Once the onset of jowls and neck laxity become more noticeable, often patients begin to consider the option of a mini facelift or full facelift. Our surgeons most commonly perform these surgeries in patients between the ages of 40-70.

Book Your Consultation

Through a skillful and detail-focused facelift procedure, Drs. Porter and Sitapara can restore a firm and youthful appearance to a patient’s lower face and neck. Comprehensive knowledge of facial anatomy and aesthetic ideals promote results that are attractive, in harmony with other features, and in line with each person’s goals.

Find out more about facelift surgery and other aesthetic procedures through our practice. Contact CCFPS online for a consultation or call our office at (301) 618-0733.