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    Determining the best intervention point for Gen-X enhancements


    Dr. Connell
    'Facelift' generally entails something different for people under 40 than for those in the older set. But the concept of surgical facial rejuvenation, either because a person used to look better or never had a youthful appearance because of a physical feature, spans the age spectrum, says Bruce Connell, M.D., clinical professor of surgery (plastic) at University of California, Irvine.


    This 37-year-old patient had a diagnosis of large anterior bellies of the digastric muscles and subplatysmal fat. Only a 2.5-cm long submental incision behind the crease was required. The patient also had a small chin implant. No skin was excised. (ALL PHOTOS CREDIT: BRUCE CONNELL, M.D.)
    The term facelift is too broad to describe what patients young or old have done to correct facial cosmetic concerns, Dr. Connell tells Cosmetic Surgery Times . Facial rejuvenation, which he says is a better description, might mean turning back the years for some or simply looking better for others. "You have to make a precise diagnosis of what patients need and why and help them understand what the limitations are. Then, you have to make a precise anatomical diagnosis of what caused their problem and direct your attention to the cause," he says. "Generally for people younger than 40, it is not so much a problem of sagging of the deep tissues of the face (especially in the middle third of the face), as it is correcting the upper or lower thirds of the face."


    A frequent Aesthetic surgery procedure for young patients is contour correction of neck deformities. No skin removal was required because changing the deep structures from convex to concave uses the excessive skin. This 24-year-old patient had transection of the platysmal muscles at the level of the cricoid and removal of subplatysmal fat.
    THE LOWER THIRD Dr. Connell notes that even patients as young as teens can have unattractive necks, with bulges or a double chin when they look down. "One patient called hers a 'stovepipe' neck. So, that is something that might need to be corrected without doing the face, if the face looks good," he says. "Someone a little older for whom the face has fallen into the neck might require facial correction, as well."

    The double chin that results when some younger men and women look downward is often due not to the SMAS (as it is in older patients) but rather to the fat beneath platysmal muscle or a large anterior belly of the digastric muscle, according to Dr. Connell.

    Dr. Connell recalls one 19-year-old woman who said that if she had a better looking neck, she could make $50,000 more a year modeling. "To correct the problem, we made an incision behind the ear and a small one upfront because the platysmal muscle was too short, which happens a lot in younger people," he explains.

    UPPER THIRD Dr. Connell says that it is also common to come across the under-40 patient who looks angry or sad because of pulled brow muscles. Patients complaining of these problems often feel, he says, that the expressions impede their abilities to land jobs or even dates.

    If, when the patient holds a neutral expression, that patient's medial brows are not level with the eyebrow sides closest to the ears, they will have unintended expressions of either sadness or anger (depending on the slant of the brow), he observes.

    "That can be very simply corrected by elevating the part of the brow that is hanging down, without performing any surgery on the middle or lower thirds of the face," Dr. Connell says.

    SIMPLE GOOD PRACTICE Surgeons evaluating the under-40 patient should use the same practice parameters as they would for the older patient, according to Dr. Connell.

    "If anything, you want to make sure that what you do is going to be an improvement, and the person will be happy with the results," he says. Operating to correct a specific problem can be done late or early in life, he concludes.

    REFERENCE

    Lewis CM. Should face-lifts be performed before the age of 40? Aesthetic Plast Surg.1985;9:47-49.

    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.

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