Dr. Lowenstein often fields questions about avoiding an over-done look in facial surgery.  He feels it important that patients understand that the over-pulled, over-tightened facial plastic surgery so often seen in Los Angeles and Hollywood is NOT the type of results that our Santa Barbara patients should expect.  “I frequently get asked about how wealthy celebrities with unlimited resources end up with such bad face lifts.  Honestly, I just don’t know,” says Dr. Lowenstein.  At his Montecito Plastic Surgery center in Santa Barbara, Dr. Lowenstein’s area of concentration is a natural appearance following facial plastic surgery. 

The Santa Barbara Face Lift reflects a restorative rejuvenation without an over done, operated look.  Nuance procedures such as the Santa Barbara Cheek Lift can be combined with the Face Lift in Santa Barbara to provide a comprehensive approach to facial rejuvenation, or either procedure can be performed alone to improve the lower face, the neck, the mid-face, the cheek, and/or the nasolabial area.

What is a Santa Barbara Face Lift?

The Santa Barbara Face Lift reflects a modern three dimensional understanding of detailed facial anatomy.  Repositioning and sculpting of fallen facial tissue recreates the facial contour of youth and provides an individualized rejuvenating procedure.  The Santa Barbara Face Lift is designed to make patients appear as more youthful, rested versions of themselves. 

Contemporary studies of detailed facial anatomy have mapped out specific regions of youthful volume that give the face its younger appearance.  Specialized layers of connective tissue envelop these areas, and maintain their position in our early years.  The principal enveloping layer is called the SMAS, and is in continuity with the broad, flat muscle of the neck called the platysma.  As we age, these studies have shown that we actually lose volume in our face, while the connective tissue of both the skin and the SMAS become less supple and elastic.  In fact, it is partially the loss of a protein called elastin that is responsible for the wrinkly appearance of older skin. 

With the deterioration of these elastic properties, the facial tissues tend to droop over the jawline, producing unwanted wrinkles and jowls as the face no longer has the underlying volume to support it.  Similarly, these mechanisms cause excess skin and banding in the neck as the underlying platysma muscle is unable to retain it’s youthful contour.

In a Face Lift to restore the facial appearance to it’s youthful version, attention must be paid not only to the overlying skin, but particularly to the volume below it.  It is a sculpting of the tissue underneath the skin, made up of the SMAS and the platysma, that provides the appearance of an optimal face lift.  The Santa Barbara Face Lift addresses the SMAS and facial volume by repositioning them to their youthful state.  The operation is tailored to the individual patient, allowing specific sculpting techniques of suspension, folding, and contouring in order to restore a youthful structure. 

The Santa Barbara Face Lift includes a lifting of the neck tissue, improving the angle between the jawline and the neck This is called the cervico-mental angle.  Excess tissue in this area is apparent when stretched skin and platysma muscle, deprived of youthful elastin as we age, sags and looses its form.  The platysma, as it ages, forms bands in the neck that are commonly seen in nearly all aging necks that have not undergone a neck lift procedure.  As part of the Santa Barbara Face Lift, the platysma muscle is tightened under the jaw and laterally in the neck, effectively supplying a corset or sling to reshape the cervico-mental angle.  In some patients, resection or sculpting of fat either with liposuction or with direct fat removal is performed to further contour this area.  Again, the Santa Barbara Face Lift is tailored to the needs and requests of each patient to provide the appropriate rejuvenation.
         
The third key to Dr. Lowenstein’s technique is a re-draping, rather than a pulling of the skin.  If the skin is pulled tightly over an un-supported and un-sculpted framework, lines tend to form in transition zones of the lower face just above and below the jawline.  These telltale signs of facial plastic surgery are avoided with the Face Lift in Santa Barbara.  Additionally, it is the underlying sculpture that promotes the longevity of the Santa Barbara Face Lift.  The skin is not meant to support the underlying volume.  It is the supportive volume and re-positioned platysma muscle of the neck that allows the skin to drape without wrinkle producing tension.  This is the way the face was built- it is the structure that we see in the young person, and the structure that we see in the face of Dr. Lowenstein’s patients following the Santa Barbara Face Lift.         

What is a Santa Barbara Cheek Lift?
         
As a minimal incision surgery, the Santa Barbara Cheek Lift produces more facial rejuvenation per millimeter of incision than any other operation that Dr. Lowenstein performs.
 
The Santa Barbara Cheek Lift is performed through a lower eyelid incision, and most often incorporates lower eyelid rejuvenation, or “blepharoplasty”, at the same plastic surgery session.  The natural fat of the cheek is accessed in the deep plane through this small incision, and is lifted in the natural direction of its youth- toward the temple.  Elevation of the soft tissue of the cheek, called the malar fat, produces two excellent results:  rejuvenation of the soft tissue of the cheek, and improvement of the shadows of the nasolabial folds.

As we age, the youthful fatty tissue that lies over the cheekbone area falls.  This tissue is called the malar fat.  The bright, youthful appearance of our cheeks lessens as there is less volume over the apex of the cheek bones.  At the same time, there is actually loss of some of the fat in the lower part of the mid-face, called the buccal region.  This produces a more hollow appearance, which is also a sign of aging.  The aging malar fat falls into the upper portion of the buccal region below it, which can emphasize the loss of volume there.  In severe cases, a shadow may be evident just below the cheek when this occurs.  As the volume loss in the mid-face progresses, the overlying skin, which used to drape smoothly over the youthful face, sags without the underlying volume to support it.  The result  is the worsening of the nasolabial fold below the buccal region as the excess skin falls over this natural crease to emphasize the worsening shadow.

The nasolabial fold, sometimes called the nasolabial crease, is a highly misunderstood region of the face that gets a lot of attention.  Since the increased popularity of soft tissue fillers exploded with the aesthetic enhancement of the lips, many practitioners have taken to injecting the areas of the nasolabial folds in an attempt to make them disappear.

While injection of soft tissue filler into the nasolabial folds can help soften their depth, it demonstrates a misunderstanding of how the fold develops and what its causes are.  When we “fill” an area with an injectable such as Juviderm or Restylane, we usually do so in an attempt to add volume to an area that is deficient or has shrunk.  In the nasolabial crease itself, however, there is no loss of volume.  In fact, you can see that even babies and children have nasolabial folds.  The worsening of the shadow of this crease occurs because of loss of volume above, in the buccal region, in addition to the sagging and falling of the malar fat.

The nasolabial crease itself is not a sign of aging.  For the same reason, a puffed out, over-filled nasolabial fold that has been treated with excessive injectable does not produce a youthful, or even natural appearance.  Why is this?

As we’ve seen, the nasolabial folds appear worse as we age because the cheek above and lateral to the fold falls downward as we get older.  Like the skin and tissue in the area of the jowl and neck sags progressively over time, the cheek tissue falls over the nasolabial region, causing a worsening shadow in the crease.  The fix for this problem is not to fill the area below the fallen tissue, but instead to lift the cheek back to its youthful position.  Just as a Face Lift repositions the facial tissue to eliminate excess in the jowl and neck, the Cheek Lift recreates the natural youthful appearance by returning the cheek tissue to its rightful place. 

Your Cheek Lift in Santa Barbara reverses signs of aging by re-suspending each specialized area of volume to its proper position.  The malar fat is replaced over the cheek to provide the beautiful contour that we see in every magazine cover-girl.  The buccal tissue is additionally lifted, reducing the skin excess and laxity over the nasolabial region and thereby reducing the shadow of the nasolabial fold.  The result of your Santa Barbara Cheek Lift is a youthful looking mid-face produced through a small, well hidden incision that restores a natural, non-pulled, and rejuvenated appearance. 

The Santa Barbara Face Lift and the Santa Barbara Cheek lift are specialties of Dr. Lowenstein at his Montecito Plastic Surgery Center.  Either procedure can be performed alone, or in combination to provide a composite rejuvenation to the aging face.  For more information about an individualized approach to rejuvenating your appearance, call us to schedule an informative appointment with Dr. Lowenstein at Montecito Plastic Surgery in Santa Barbara.

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