The Diva Lift: Got Curves?Facelift for Full Figured Females
Click above to view article
In this day and age, it is a bit disgusting that some surgeons go out and makes a minor change to a procedure that has been around for a century and “invents” some new miracle procedure. There are bunches of these types of docs out there.
I recently detailed some of my work that involved modifications of traditional facelifts in patients with high body mass index (BMI) in an article in Cosmetic Surgery Times. The Body Mass Index is a formula that gives a number based on the height and weight of the patient. Full-figured or plus sized patients present many differences when compared to the average facelift patient. This magazine goes out to cosmetic surgeons from multiple specialties and frequently details new or innovative approaches to cosmetic surgery. The editor, Teresa McNulty, and I discussed a modified facelift that I was performing on full-figured women with great results. She was impressed with my surgical results and suggested the name of the article be the “Diva Lift”. So there, that is how the name came about and not as a self anointed marketing ploy on my behalf.
Why is there a need for the “Diva Lift”
For 13 years, I have had patients (mostly female) that presented to my practice for facelift consultation that were turned away from other plastic surgery practices because they were “over weight”. They were told to lose 50-75 pounds and come back for surgery. This is, in my opinion, a surgeon turning away a patient because the surgeon is not sure how to treat them, or is not energetic enough to perform a technically difficult facelift, or simply does not think they can get a predictable result. Don’t get me wrong, there are in fact sensible reasons not to operate on over weight patients if they are not healthy, but being over weight is not a contraindication to facelift surgery for the healthy patient.
As I began to see more of these “rejected” full-figured patients, I began to think about why this group was being denied facelift surgery and how could it be done to be safe, effective and with natural results. I began performing facelift surgery on these patients, but with numerous modifications from my conventional facelift technique. Immediately it became apparent that these full-figured facelift patients had extremely impressive results. They were among my best before and after cases. The more I did, the more I refined my technique for this type of patient and the results became better and better.
What is the “Diva Lift”?
First of all, the word Diva, until the past decade when it became descriptive of any star female singer, was commonly used to describe full-figured opera singers. Facelift surgery is a very large part of my cosmetic facial surgery practice and one of my favorite procedures. I enjoy facelift surgery because I think it is the most dramatic cosmetic surgery procedure that exists for several reasons. A surgeon can hide mediocre surgery on boobs, bellies and butts, but you can’t hide facial surgery. Secondly, as we age, big changes occur in our cheeks, face and neck that cannot be disguised with clothing. Another important thing about facelift surgery is it is probably the most noticed surgery as patients look at their face daily more than any other body part and those we interact with see our face more than other parts of our body. Facelift is the ultimate rejuvenation procedure. Patients simply feel bad when their face ages and feel better when it is firm and tight.
Facelift patients come in all size, shapes and genders and unlike some operations, no two are the same. Also many surgeons perform different variations of facelift surgery. Like anything else, there is a right way and wrong way to perform facelift surgery. Many surgeons perform time-tested “textbook facelift surgery” while others get lazy and adopt shortcuts that affect the results and longevity. Worst is the current rage of “minimally invasive facelifts” that are merely marketing ploys of corporate franchises. These lifts claim to be revolutionary or miraculous and lure patients with promises of maximum results with minimum downtime and cost. Note to consumers! You get what you pay for. I don’t mean this only in terms of cost (because some of these miracle lifts cost more than my larger lifts) but in terms of recovery. If a patient over 40 years desires comprehensive facial rejuvenation that will last over 10 years, then they need a longer recovery. Two weeks of recovery is not too much to endure to reverse decades of aging and skin sagging. To truly address the deep tissues of the front of the neck and cheeks, incisions must be made under the chin and in front of and behind the ears. These incisions are well hidden and almost unnoticeable when performed by experienced surgeons. These trendy “minimally invasive” facelifts only use a smaller incision in front of the ear and this severely limits the effect of the lift. When you perform facelift surgery correctly and comprehensively, it requires tightening of the neck muscles under the chin (called the platysma muscle). It also requires tightening of the deep layers of the cheeks (known as the SMAS which stands for superficial musculoaponeurotic system) with numerous sutures for a secure and lasting result. Finally, the incision behind the ear (which is hidden in the hair) is absolutely imperative to truly address the excess skin of the chin, face and neck. When a surgeon shortcuts any of these incisions or approaches, the patient gets short-changed. The result will simply be less dramatic and for sure will be less long-lasting. A three to five-day recovery may sound like a great thing, but it is a short cut. To address all the important structures, a recovery closer to two weeks is necessary. Most facelifts with short recoveries will unfortunately also have short results and will begin to relapse within the first 2 years.
The “Diva Lift” (and I must admit that I hate to “name” a facelift) is far from a short cut. In fact, it is a more aggressive facelift because these overweight patients have more fat and skin and need more surgery to obtain a natural and long-lasting result.
How is the “Diva Lift” different from conventional facelifts?
Like average facelifts, the Diva Lift can be performed on healthy patients with IV sedation in the accredited ambulatory office surgery center. The main differences of the “Diva Lift” are modifications of traditional facelifts to address the excess fat and skin. The first difference is that these procedures require a higher level of liposuction of the superficial and deep fat when compared to a normal weight patient. Also, deep fat accumulations are addressed under the chin and the front of the neck. By reducing or sculpting this deep neck fat, the surgeon can obtain a much more defined neck after the facelift compared to facelifts that don’t involve this deep fat. After the superficial and deep fat are reduced or removed, the neck muscles in the front of the neck (platysma) are tightened. The “Diva Lift” also involves a higher level of “liposculpture” where instead of just removing the fat under the skin; it is sculpted to provide youthful contours of the jaw line, jowls and neck. Full figure patients also have much more fat in their cheeks and neck and the “Diva Lift” specifically address this to a greater level than the conventional facelift. The fat cannot be simply removed or an unnatural contour will result. Instead, the fat is sculpted to gently taper from the cheeks to the neck. Enough fat is removed to slim the face and neck, but not to look unnatural.
Besides the deep fat in the neck, the way that the deep tissues of the cheeks are managed is critical in larger patients. In many patients, a common surgical technique called “plication” involves tightening the deep tissues (know as SMAS) in the cheeks by folding them over. In a thinner patient this technique may be desirable as it add some facial volume, whereas in the full figure patient the goal is to reduce some of the cheek volume. With this in mind, the “Diva Lift” involves a more comprehensive method of treating the deep tissues in the cheeks called “SMASectomy”. Instead of folding the tissue over on itself like plication surgery, some of the deep tissue is actually removed which not only tightens but slims the face, which is very important in this type of patient. In the “Diva Lift”, much more time is spent dealing with fat excess than in the conventional facelift. Also important in this type of lift is the tightening of the backside of the neck muscles (posterior platysma). Many surgeons omit this step and again, it improves the result and longevity of the lift. Why doesn’t every surgeon do all of this? The answer is simple. It takes time and expertise to competently perform these procedures and some surgeons don’t want to devote the time or do not have the surgical expertise. The “Diva Lift” is not a facelift for beginning or inexperienced surgeons.
The last step of the “Diva Lift” that varies from conventional facelifts is the excess skin management and incision patterns. Since the full-figured patient has more skin than the average patient, incisions must be slightly larger (but still well hidden) and performed in a certain manner so there is no bunching of the tissue. These incisions are specially designed as not to be noticeable or make big changes in the patient’s hairline, specifically the sideburn region and the hairline behind the ear.
So, the “Diva Lift” is not a smaller, but rather a larger type of facelift. It embodies a little more aggressive treatment at each step of the facelift when compared to the average facelift. It definitely requires more work on the part of the surgeon and perhaps a few more days of recovery for the patient, but the results are worth it.
Some surgeons may read this and say “this is nothing new and Dr. Niamtu is merely doing a larger facelift”. In some ways they are correct, but it is not simply a larger facelift. It is a combination of procedures that must be addressed in a specific way with careful attention to details as the full-figured facelift patient requires a different type of surgery. I have modified common facelift techniques to better serve the full-figured patient and have obtained impressive results with this technique that have been natural appearing and long-lasting.
After surgery, the patient wears a partial facial bandage for the first 24 hours and generally does not wear any dressings after this time. Since full-figured patients may have a higher incidence of blood clots, the patient is encouraged to walk and move around as soon as possible after the procedure. They are also prescribed compression stockings which help reduce blood clots.
As some overweight patients have medical problems such as high blood pressure, diabetes, and other problems that could affect anesthesia safety this class of patient must be very carefully screened with medical and anesthesia consultation. For the healthy full figured patient, they are treated exactly the same as the low BMI patient.
There may be nothing new under the sun, but there are surely ways to innovate existing procedures to better benefit selected patient populations.
To find out more about facelift surgery by Dr. Niamtu in Richmond, Virginia visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery