Patients with aging countenance face this common dilemma: What works better, Botox or facelift?
One should realize that facial aging is a multifaceted process. The skin sags and thus creates jowling, the cheek fat pads deflate leading to a gaunt look, the face experiences soft tissue atrophy or shrinkage that results in the appearance skeletonized eye socket and concave temple, and the wrinkles become more prominent, says renowned Los Angeles plastic surgeon Dr. Tarick Smiley.
Dr. Smiley says that Botox and facelift work differently in erasing or at least minimizing the signs of facial aging. Botox paralyzes the muscles responsible for the appearance of dynamic wrinkles, while facelift surgery elevates the skin, fat, and soft tissue all as a single unit.
Occasionally, Botox is used to paralyze the muscle that is pulling down the brow, allowing the one responsible for elevating it to work more efficiently.
Botox, whose effects typically last 3-4 months, appeals to male patients who generally dislike going under the knife and the ensuing recovery. This approach also suits people who cannot afford the prolonged downtime of surgery.
However, Botox cannot improve a markedly sagging skin, which entails facelift. Also, this non-surgical treatment cannot reposition the drooping cheek fat pad nor improve the soft tissue deflation that comes with aging.
Facelift is generally the ideal choice for patients with more advanced signs of facial aging. Nonetheless, Dr. Smiley says that individuals as young as 45 can be a good candidate, particularly if they are seeking for subtle improvements and want their surgery to be “discreet.”
Postponing facelift until one has full-blown facing aging can lead to discernable and drastic changes that refuting surgery would be impossible. Hence, some “younger patients” resort to mini facelift and then undergo minor touch-ups down the road to maintain their youthful appearance in a more discreet manner.
Today’s facelift is commonly performed with fat grafting or injection, a critical component in holistic facial plastic surgery. This complementary procedure prevents surgical stigmata such as gaunt cheeks, abrupt lower lid-cheek transition, and overall pulled appearance.
Hence, facelift with fat injection is dubbed as 3D facelift surgery because it not just corrects soft tissue descent (i.e., skin sagging) but also loss of facial volume.
Brow lift uses incisions behind the scalp or in front of the hairline to lift the sagging brow, soften the forehead creases, and eliminate the “11” lines between the brows. Occasionally, it is combined with other procedures such as eyelid lift and dermal filler or fat graft injection for additional rejuvenating effects.
Experts at the California Surgical Institute provide a list of brow lift FAQ to help patients decide if the surgery is right for them.
Brow Lift FAQ:
- Question: Am I a good candidate for the surgery?
Answer: The ideal patients should be healthy, non-smoker, and have realistic goals and expectations. Hence, the surgery entails a strict patient selection process to avoid risks and to deliver satisfying results.
- Q: What are the preparations involved?
A: A good rule of thumb is to avoid blood-thinners (aspirin and some herbal supplements and vitamins) and tobacco products; and to achieve one’s optimal health through lifestyle changes and/or medications.
- Q: Does it result in visible scar?
A: While brow lift comes in several variations, all efforts are made to ensure that the resulting scars are behind the scalp or exactly along the hairline for their optimal concealment. Simply put, a properly executed procedure should not result in visible reminders of plastic surgery.
- Q: Is it possible to perform brow lift at the same time as other facial rejuvenation surgeries?
A: Yes. In fact, brow lift is routinely combined with eyelid lift, fat graft, or some type of facelift. Nevertheless, it remains in the patient’s best interest to keep the operation under six hours to minimize bleeding and surgical trauma.
- Q: What are the risks involved?
A: Poor healing, less than optimal scar appearance, residual sagging, surprised or unnatural look, infection, and bleeding are some of the risks. However, a board-certified plastic surgeon who performs the surgery on a regular basis can avoid or at least control these risks through proper patient selection, surgical execution, and close monitoring during the initial healing stage.
Serious complications are extremely rare when the surgery is performed by a qualified plastic surgeon.
- Q: How long is the recovery period?
A: Recovery differs from patient to patient; however, “social recovery” or looking presentable in public typically happens after 10-14 days.
- Q: Can Botox serve as a feasible alternative?
A: Yes, provided the patient only has mild brow descent and accepts that she will need 3-4 “touch-ups” every year. But for individuals who want longer lasting effects and/or have significant soft tissue laxity, brow lift remains a better method than any type of non-surgical procedure.
Natural looking brow lift can be achieved with proper patient selection and surgical planning. Instead of just lifting the sagging brow, good surgeons know that reshaping it based on the underlying anatomies and gender is also critical to produce great results.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that botched or overdone brow lifts typically result from lifting the medial brow excessively, or elevating it despite that its original position is already acceptable.
According to several studies, the ideal medial brow position is at the level or slightly below the bony orbital rim especially in men who need to preserve their “heavy” and masculine brow appearance.
For most brow lift patients, only the lateral part of the brow or “tail end” is slightly elevated, leaving most of its parts to their original position, Dr. Smiley further explains.
Another parameter to produce natural looking brow lift results, he adds, is to consider the beauty ideals of men and women. For instance, feminine brows are generally accepted to appear more arched and higher at the tail end, while male brows are more horizontally oriented and have a shorter distance between the upper eye crease and the bottom part of the brow.
Should the patients need the “inside” of their brow to be elevated, it must be done in a very conservative manner to avoid the perennially startled appearance or the quizzical expression, says Dr. Smiley.
A good number of brow lift patients can benefit from minimally invasive procedures, which may involve 3-5 small incisions behind the hairline to reshape and elevate the drooping brow. Another viable option is to place two concealed scars in the temple area, a technique that only lifts the outer 1/3 of the brow.
Instead of brow lift, Dr. Smiley suggests that sometimes an upper eyelid lift is a better option, particularly if the patients’ aesthetic goal is to open up the eyes. In this procedure, a fine scar is placed within the natural eye crease to tighten the loose skin and possibly remove some excess fat.
Dr. Smiley believes that a good number of botched brow lifts were patients who did not need them in the first place and should have received an upper eyelid lift instead.
While Botox may produce some of the brow lift’s results—i.e., this non-surgical procedure can also reshape and elevate the brow—it requires regular maintenance that adds up to the cost, he says.
Brow lift for young patients, i.e., aged between 20 and 35, is quite uncommon since the procedure is primarily designed to lift the sagging brow and correct the horizontal forehead creases and “11” lines between the brows, which are age-related problems.
However, some young people are born with lower eyebrow position that could make brow lift a possible option. Nonetheless, most plastic surgeons would recommend non-surgical or “temporary” solution to at least give them an idea of how much elevation that would suit them before resorting to a more permanent surgery.
Photo Credit: Ambro at FreeDigitalPhotos.net
Botox injection, which could be a good alternative to brow lift, is not just used to elevate the saggy brows; in the hands of a great injector it can also reshape the brow in a way that it “respects” the patient’s underlying anatomies and gender, according to California Surgical Institute website.
The effects of Botox can last four to six months, so the patient must accept that she requires regular maintenance to preserve her appearance.
Whether brow lift or Botox is used, the goal is to create gender-appropriate results. In general, female brow appears higher than the bony rim of the eye socket and is more arched compared to male brow.
Male brow, meanwhile, typically lies at the same level or even slightly lower than the bony rim of the eye socket.
Just like Botox, brow lift not only elevates the saggy brow, but also reshapes them in a way that the results look natural and proportionate to the rest of the facial features. However, a good number of patients only require the lateral part of their brow, or “tail end,” to be lifted.
Only a small number of patients experience significant medial/inner brow descent, as suggested by some Los Angeles plastic surgeons who advocate the use of temporal brow lift in which a small incision behind the hairline is used to lift the tail end of the brow.
Proponents of this minimally invasive technique suggest that it is an ideal brow lift for young patients who generally require a conservative elevation of their brow’s tail end, which in turn could also minimize the fullness in their upper eyelid thus leading to a more rejuvenated appearance.
To determine the most viable option, any form of facial rejuvenation procedure entails proper patient selection, honest discussion between the surgeons and patients, and comprehensive physical exam.
There are several neck lift options due to varying anatomies and underlying cause/s of the problem. For instance, some patients are concerned about the appearance of neck bands in which excess fat may be culprit, while others have “turkey wattle” that is typically caused by weak or splayed platysma muscle.
A comprehensive physical is always necessary to determine the best course of action. And during consultation, the patient must also share her motives and cosmetic problems, allowing the surgeon to explain and offer methods that can improve her appearance.
Before-and-After Photos of a Patient Who Have Had Neck Lift Surgery
Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, explains the three most popular neck lift options, which are occasionally performed simultaneously to achieve the best result possible:
1. Double chin and neck band appearance. If these are caused by excess fat beneath the skin, minimal liposuction can create a smoother, more rejuvenated neck contour.
A small round incision, about 1 cm in diameter, is positioned beneath the chin where a microcannula or hollowed tube is used to suction out the fat. However, it is crucial to preserve some fatty cells to maintain the natural contours of the lower face and anticipate soft tissue shrinkage that tends to progress with advancing age.
Over-aggressive liposuction must be avoided at all cost because the platysma muscle in the neck will become prominently visible beneath the skin—immediately after surgery or years afterwards—further contributing to the aged appearance.
2. Loose skin in the neck and jowling. A direct skin excision is needed to contour the lower portion of the face; this is generally accomplished by placing incisions around the ear’s contour that may sometimes reach the nape to achieve more rejuvenating effects.
Oftentimes, this excision-based neck lift is combined with standard facelift in which the incision starts from the temple behind the hairline that curves down and behind the ear, or even the nape if the neck requires contouring as well.
Proper wound closure is imperative to prevent scar migration and poor healing.
3. Weak platysma muscle. Sometimes, the vertical muscle in the neck that has become splayed causes the sagging appearance. To address this problem, a small incision beneath the chin is used to reshape or sometimes even remove a tiny portion of the muscle.
Patients with thin skin and very little fat may choose a non-surgical alternative in the form of Botox, which can be done in 15 minutes.
Brow lift for uneven brow. Is it a good option?
First and foremost, brow lift surgery is primarily designed to rejuvenate the upper third of the face by smoothing out the horizontal creases across the forehead, and the vertical lines between the brows. If needed, it can also reposition the sagging eyebrow or even “reshape” them.
Almost all people have some brow asymmetry, although it is often in mild form. But in extreme cases of lopsidedness, they may seek treatments to achieve a more balanced appearance.
Before and after photos of a patient who had brow lift surgery.
Significant or obvious brow asymmetry is caused by several factors such as bone irregularity, facial muscles acting or moving differently, unilateral eyelid ptosis or droop, and nerve damage due to trauma, Bell’s palsy, or other similar conditions.
If the underlying problem is caused by facial muscles [of expressions], Botox injection might be a better option than brow lift. While it is an inexpensive non-surgical alternative, its effects can only last 4-6 months, so it requires regular touch-ups to maintain its results.
With Botox injection as a non-surgical brow lift for uneven brow, the goal is to paralyze the offending muscle that is pulling down the lower brow. This is achieved by injecting this drug into the lateral crow’s feet region and the area near the inner brow, while leaving the other brow untouched.
The idea is to release the lower brow and let it somewhat “float” that it appears close to symmetry with the other one.
However, some patients are more suitable for a unilateral brow lift (with or without Botox injection), which provides longer lasting results than Botox.
Brow lift typically uses a few small incisions behind the hairline to allow the surgeon to adjust and correct the offending muscles and tissue responsible for the sagging appearance of the brows and/or forehead wrinkles, according to Upland Plastic Surgery Institute.
Despite best efforts, there will always be some level of asymmetry after surgery or Botox, although it is generally mild. The reason is that almost all people have asymmetrical facial bone structure (right vs. left) to begin with.