How can I avoid getting a pulled up look from a face lift?

The windswept look should not happen after a well performed lower facelift procedure. This usually occurs in settings where either just the skin is pulled tight or the deeper structures are not addressed properly. A facelift aims to reverse some of the signs of aging. Part of the aging process is descent of the tissues of the face including the muscles and other structures which live below the skin. The skin envelope will then stretched to accomodate the descent. By pulling the deeper structures back into proper position, the skin can be easily trimmed to create a very natural appearing, but refreshed look.

The windswept look occurs typically in patients with thin faces and varying degrees of bone and fat atrophy. When they get the muscle and skin lifted, there in no volume to shape around and they end up looking flat and pulled.

If you have a rounder, more full face, than you will have minimal risk of getting the pulled look. But if you have a thin, gaunt face, you will need some volumization in addition to the lift.

I like using a patient's own fat to fill up areas of deflation. I also like using facial implants if there are issue of bony loss that come with the aging process. Make sure you surgeon routinely operates on faces so that your results may be optimized.

Good luck. Dr. Shah

The pulled look results from many factors, all of them avoidable. As a lay person, you may not be able to list each one, but you know pulled when you see it.

1. Bad direction of pull. When the facelift is directed very high at the side of the face, pull is created preferentially on the side of the face, and nothing is done for the middle of the face. This yields an unnatural change in direction of the skin. It also sacrifices the sideburn, which in women is not replaceable. How to avoid: Pull should be more gently back. Preserve sideburn. Use cheeklift to simultaneously elevate the center of the face to avoid the "hanging curtain" look.

2. Too much pull. The earlobes pull forward. The tragus, the bump in front of the ear, pulls forward. The mouth and nose begin to separate. Scars are bad and wide. How to avoid: Considerable deep restructuring; skin should be a gentle afterthought, closed firmly but not too tight. Use LiveFill for deep volume restoration. Don't try to solve all problems by pulling extremely tight yet not replace lost volume. Keep the ear and earlobe looking natural and unoperated.

3. Aggressive browlifts. Raises the hairline, causing a high forehead. Artificially raises the center of the brow, causing a startled expression.  How to avoid:  conservative browlifts, concentrating on lateral brow.  Avoid hair elevating techniques in patients with high hairlines

4.  Hollowed appearing eyes with change in eye shape.  How to avoid:  cheeklift along with lower eyelid surgery.  LiveFill grafts to lower eyelids to replace volume.  Fat preserving or fat modifying approach to eyelid surgery.  Careful concealment of incisions.

5.  Non-artistic work.  You know it when you see it:  cat eyes, exaggerated lips, strange expression, visible unsightly scarring.  How to avoid:  look carefully at the before-after pictures of the plastic surgeon you are considering.  You will soon recognize which doctors have an artistic touch and eye.

6.  Cost cutting.  On this website are patient evaluations of their facelifts.  You will see a correlation between patients' satisfaction and the care with which they did their research and the involvement of their procedures.  There is a reason that facelifts are expensive with noted surgeons, and why you can't solve all the problems of aging in one hour over lunchtime with a marginal practitioner.

I prefer the term 'facial rejuvenation' over the more antiquated term 'facelift', as many patients that I see who seek a more youthful and refreshed facial appearance undergo a set of surgical procedures very different from what would have been considered a 'facelift' twenty-five years ago.

The word 'rejuvenation' means, literally, 'to make young again'. In each individual, different facial changes occur with age. One person may be unhappy with 'baggy eyelids', while another has 'droopy eyebrows'. One person may be troubled by 'jowls' in the lower face, while another would like an improvement in their 'floppy neck'.

Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.

Plastic Surgery of the Face in the 21st Century

The specialty of Plastic Surgery has been undergoing a 'paradigm shift' in the approach to surgical treatment of facial aging changes over the last two decades. This shift has consisted of a departure from older 'subtractive' techniques to newer 'restorative' techniques.

Surgery which consists mainly of removing (subtracting) skin and fat and pulling tissues tight will lead, in many instances, to a 'skeletonized' and therefore more aged (or "done") appearance. Facial soft tissues (and even the facial bones) actually lose volume and projection with age, and it is thus inevitable that surgery which focuses only on removing tissue will in some fashion 'age' the face. The contemporary approach to surgical rejuvenation of the face consists more and more of an attempt to restore facial volume and contour, in an attempt to emulate youthful facial features. My personal approach to facial rejuvenation is to first maximize repositioning and recontouring of facial aesthetic areas, and to remove only as much tissue as is necessary.

I also find that structural fat grafting, using a patient's own fat from the abdomen or hips, is an extremely effective means to help restore the facial volume associated with a youthful appearance. The importance of restoring facial volume is readily apparent when I review with a patient a number of photographs from their twenties and thirties. The meticulous addition of soft tissue volume by means of fat grafting is one of the most powerful means now available for 'turning the clock back.'

The wind swept look is an old fashioned looking result of a facelift that results from a hard pull on the skin in an upward direction in front of the ears. Old techniques relied on the pull on the skin to lift the sagging facial features. Modern facelift techniques recognize the unnatural look this creates and lift the deeper tissues of the face in a vertical direction but take the skin excess off in a more natural direction and under less tension than in the old techniques.

Make sure you see many pre and postoperative photos of each surgeon's results to be certain the results you want are reflected in the results that doctor creates. This is an art form and no 2 surgeons are the same and neither are their results!!

The pulled or tightened "wind-tunneled" look comes from stretching the skin too tight and was common practice 20-30 years ago. Now, with modern techniques in face-lifting surgery, the muscles are tightened and the skin is only slightly stretched. Fat is removed from underneath the neck to create a defined jaw line.

A pulled look or 'wind swept' look is a common problem after a facelift that can be easily avoided.

The key word to remember is -"vector."

Most patients believe that a pulled look is due to tension caused by excessive skin removal during surgery. Although that is a possibility, most of the time it is caused by the surgeon who pulled the skin or excess skin in a wrong direction or vector.

If facelift is performed with this natural vector in mind, you will NOT have a pulled look to your face.