Dr. Gruenwald's Difference
Stress, sun exposure and genetics are all formidable forces pitted against us as we age causing varying degrees of change to our once youthful faces. Dr. Gruenwald can help smooth lines and wrinkles, correct loss of volume and diminish the effect of reduced skin elasticity. He uses the most modern facelift techniques resulting in a more natural look with inconspicuous scarring.
Much confusion surrounds the familiar word "facelift,”
A Short History of Facelift Surgery
The origins of facelift surgery go back to the early part of the 20th century, when surgeons started to "rejuvenate” facial appearance by simply removing loose and excessive facial skin. For many decades, skin of the cheeks, jowls and neck was drawn tight, using incisions in front of the ear and also within the hairlines, above as well as behind the ear. This did provide an immediate tightening of the loose face and neck skin, but it had two distinct drawbacks. First, it flattened natural and desirable facial contour, producing a somewhat distorted "surgical" appearance, which I'm sure you've seen before. Second, the skin (which is very elastic) would soon stretch out, returning to the degree of looseness that was believed to have been surgically corrected. In short, patients received a "not so natural" and "quite temporary" facelift result.
It gradually became apparent that there are several factors contributing to the appearance of facial aging and stretched, loose skin is only one of them. It's now realized that there also exists a loss of youthful facial fat volume and a sagging of "under the skin surface” tissues, including fat, muscle and connective tissue. Starting in the mid 1970's, facelift procedures were dramatically improved by relying upon the "under surface” SMAS layer (Superficial Muscular Aponeurotic System) to tighten the facial muscles and skin support structures, thus "lifting” the skin without stretching it. This became known as the "SMAS Facelift” and it significantly eliminated the two drawbacks of the "Skin-Only Facelift.” It preserved and restored natural and youthful appearing facial curves, and it also provided a means of support, not dependent upon skin stretching, which was capable of lasting for a long time.
My Preferred Technique
Over subsequent decades, various methods of "SMAS” lifting were introduced, creating a wide array of SMAS facelift techniques. Some were found to produce a strong and lasting SMAS tightening, while others failed to achieve that goal. From my personal experience and observations, I have become convinced that my finest and most reliable results are associated with a type of SMAS facelift, known as a "High SMAS Facelift."
This technique is performed, using skin incisions depicted on the diagram to the right. Through this incision, the next layer is the facial fatty layer (subcutaneous fat) followed by the SMAS layer. This SMAS layer can be freed, for a short distance (toward the nose) from the overlying skin and subcutaneous fat and freed for an even greater distance from its underlying attachments (to the parotid gland and connective tissue "anchors”), which would otherwise prevent SMAS tightening. This freeing of SMAS from overlying skin is also continued
Once the SMAS layer has been sufficiently freed, it can be easily moved in an upward direction and tightened. This SMAS maneuver immediately flattens and eliminates the jowels, diminishes the depth of the crease that runs from the nose to the angle of the mouth
In review, the ability to perform a reliable SMAS facelift is the gold standard in the industry and I prefer the high SMAS technique. When comparing physicians and procedures, this is something to consider since there are some doctors still performing
