When Marc Jacobs happily admitted that he underwent a facelift this past summer, people were surprised, but it’s a benchmark of how the perception of such procedures has changed in the last decade. The designer’s openness around a subject that was previously discussed only with close friends, helped lift the veil of secrecy or shame around plastic surgery and encouraged people to be positive about using the tools available to look and feel our best. We sat down with Dr. Andrew Jacono, the New York-based surgeon who performed the procedure, and who also counts Sonja Morgan and Paul Nassif as facelift patients, to understand why he feels he’s in the spotlight. He discussed highlights of his technique, advancements in the field, his tips for a speedy recovery, and a trending procedure.
Can you explain why your facelift technique is getting so much attention lately?
Like Marc Jacobs, consumers are looking for a natural-looking solution to facial aging once they’ve exhausted all options under the care of a skilled and measured cosmetic dermatologist. I think the reason that my extended deep plane facelift technique has gotten so much attention lately is because it lifts the skin and muscle (SMAS) together as one unit and repositions all deep cheek fat pads and musculature. Since the skin is not separated from the deep structure, the lift comes from under the muscle so the surface appears smooth, not tight. This also helps maintain the blood supply to the face allowing for more rapid healing. Key facial ligaments that support the face are lifted rebuilding the beams of the face, creating a longer lasting result. Another tenet of the deep plane facelift is that drooping tissues are lifted vertically against gravity recreating the heart shape face of youth.
Are the incisions visible?
I use minimal access incisions that are shorter and hidden, made possible by endoscopic technology. With this, my female patients are able to wear their hair back in pony tails, and my male patients are free to wear short haircuts or shave their heads because of hair loss. It is a technically complex procedure, but the results are rejuvenating and last 10 – 12 years, on average.
What kind of anesthesia is needed to undergo plastic surgery today?
I find that many perspective patients are surprised when I tell them that I rarely use general anesthesia. In fact, I only use it if necessary – if the patient has some other medical condition that requires general anesthesia or if a patient would prefer general, as I do not have a one-size-fits-all approach. Twilight anesthesia, which I use to perform over 75% of surgeries offers less risk to the patient, while offering faster recovery time. Twilight anesthesia is the same anesthesia given by IV (intravenously) during a colonoscopy and is called Propofol. This medication is like an intravenous Valium, but as soon as the medicine is “turned off,” you wake up without any nausea, headache or “hangover” from general anesthesia gas. Twilight anesthesia also reduces bruising compared to general anesthesia. It is extremely safe, and patients often feel great after surgery, as if they have just had a deep sleep. Anyone who has had a colonoscopy has experienced twilight anesthesia.
What does downtime look like and have there been any advancements in this area?
With today’s advanced, minimally invasive techniques along with hyperbaric oxygen therapy for rapid healing, patients can expect to be back to their daily routine in 10 days on average. Hyperbaric oxygen therapy works to increase oxygen to facial tissue and stimulate the growth of new blood vessels, which in turn, contributes to a faster recovery. These heal time advancements have made facelifts more accessible to those with highly demanding schedules.
How do you know it’s time for a facelift?
Aging is a very personal journey. There is no perfect age or time to undergo a facelift, as it depends on how much improvement you are looking for given the downtime and costs associated. Today in my practice, the average age for a facelift is between 47 and 53 years. Patients desire to look ten years their junior for personal or professional reasons. Now more than ever I see patients in their late forties who want to ‘prejuvenate’ and restore a more youthful appearance before their faces age too much.
How can one be sure to avoid the “plastic” look and why does this happen?
The ‘plastic’ look can be attributed to two main pitfalls: the ‘wind tunnel’ result of over aggressive pulling, or filler fatigue. As people continue to age and volume continues to decrease, the amount of filler used increases to compensate for volume loss, but there comes a point when fillers are not producing the same results as they used to. The tight skin that used to perk up when filler was introduced is now lax and sags when the added weight of filler is introduced resulting in a distorted, overfilled look. In order to avoid filler fatigue, it’s important to be sure you’re in the hands of a well-credentialed cosmetic dermatologist to guide you on your aging journey and help you decide when it may be time for surgery.
Are there any other procedures you are excited about?
The lip lift is just the latest example of patients trading injectables for more permanent solutions to facial enhancements. One in four of my patients today come into my office searching for a permanent solution to lip enhancement – from patients in their 20s to patients in their 80s. My younger patients are most frequently looking for more pouty, fuller lips, which can be achieved with a stand-alone lip lift procedure done under local anesthesia in about an hour. Lip lift surgical techniques have advanced to the point that a well-executed lip lift should be totally undetectable.
As we age, our lips lose their fullness, which makes them appear older. Lips descend because of loss of support. This distance between the tip of the nose and the upper lip gets longer over time as well. Sometimes the lip becomes so long that it hangs over the teeth, while others are born with naturally thin lips. Whether young or old, lip lift surgery creates permanent results, which many of my patients desire.
