The 23rd Congress of ISAPS was held at the Miyakomesse Conference Center in Kyoto, Japan from October 23 through 27, 2016. More than 1,650 persons from 89 countries participated and the Congress was a great success. On October 23, basic procedures for aesthetic plastic surgery were presented under the title of ISAPS Course for Residents and Fellows.
Dr Bryan Mendelson has given over 100 presentations to surgeons around the world. His global audience has developed as a result of his 25 years of research into facial anatomy, facial aging and new techniques to provide natural and lasting rejuvenation for patients.
Dr Mendelson is in private practice at The Centre for Facial Plastic Surgery in MelbourneAustralia. He graduated from Monash University Medical School, Melbourne, and Interned at the Alfred Hospital Melbourne, then became a Demonstrator in Anatomy at Monash University for a year. In 1971 he moved to the USA to train in general surgery and plastic surgery at the Mayo Clinic, Rochester, Minnesota for six years. There followed a fellowship at the Institute of Reconstructive Plastic Surgery in Manhattan, New York under Doctors Converse, Rees, Aston and others. He is certified by the American Board of Surgery and The American Board of Plastic Surgery.
Dr Mendelson: Hello. I’m Bryan Mendelson, a plastic surgeon from Melbourne. It’s a pleasure to be here today to talk with you.
PSH: Can you tell us about the difference between a good facelift and a poor facelift?
Dr Mendelson: The difference between a high-quality facelift and an ordinary facelift, there are several components. One is, and the most important overall thing is that it doesn’t look as though the person’s had a facelift, they just look fresh, well for their age. That’s not so easy to obtain because there is a tendency to overdo pulling, for example. The public think they can always pick a facelift. The reality is nearly all the patients that I do a facelift on will say, “You know what? No one has picked that I’ve had the facelift.” I’ll say, “Well, do they give you a compliment?” “Oh, they will say I’m looking well.” That’s really the best compliment you can have.
Now, there are cultural differences in different parts of the world. For example, in Los Angeles, if no one picked you had a facelift you would feel like you didn’t get a good result or Brazil, for example. In more sophisticated areas or culturally sophisticated, there’s not the want to be seen to have had a facelift, which is a status symbol, for us it’s just like a stigma.
Then you look at what is it about the face that’s detectable. Well, disproportionate tightness in certain areas, the windswept look which a good facelift just doesn’t do. Visible deformities like pulling earlobes is a classic thing or the neck underdone for the rest of the face or even overdone. Like, in California, some surgeons tighten the neck more than is natural for someone of a certain age. Usually with a good facelift you’re going to turn the age back eight to 10 years for someone in their late 40s or 50s, not someone in their 30s, otherwise they’d be looking like an infant.
Now, the other thing where patients worry, “How do I know you’re not going to unintentionally pull too tight?” The way to describe that is it’s to do with a technique of surgery. If the surgeon lifts the skin and pulls the skin tight it’s like pulling a piece of elastic. You tend to thin the skin, and pulling it tight often is necessary to get a good and lasting result but the more anatomically correct way of doing the surgery is to tighten the support layer which is … The function of the support layer is to support the skin so if you take the laxity out of the support layer the skin will look toned rather than stretched. Using that technique of surgery, it’s really impossible to be overdone there so you do not have to worry about the windswept look.
I give the analogy it’s like laxity of a chain, a chain necklace, you tighten it until there’s no more laxity and there’s no point in tightening it any more. The key question is what causes the ageing process because it’s a universal thing. Amongst all humans we can, always wondering about people’s age. Whereas if you’re an animal like your dog the only way you can tell a dog’s age is by its behaviour, if it’s acting like a puppy or an older dog and maybe some grey hairs. It doesn’t have the expression on the face of looking tired as humans get with ageing.
The question is what causes it? Discounting skin ageing with is environmental factors like some and other factors like that but there’s a loss of the bone structure on the face. I didn’t realise that until more recent years, particularly the bone around here and maybe some there a little bit along the jaw. As soon as you lose volume on the face the tissues are less tight. If someone loses weight, particularly if you notice it in someone a young age, they just don’t look quite the same. Then once there’s less volume there tends to be a bit of sag. Then when you move the muscles of your face with expression you’ll see older people when they smile, their smile lines, there’s so many more than there used to be. What’s happened with the sag, so the top of the cheek is sitting a bit lower. When they start smiling instead of smiling from there up they’re smiling up there, the ageing, before they start the smile lines so restoring volume is important.
Some people have fillers as we all know. People who have not lost very much volume yet, a little bit of filler is beneficial. Unfortunately, with more ageing, the fillers become less satisfying and less effective. The loss of volume is partly the bone and partly the soft tissue as well. Then sometimes the loss of volume is come from the sag because with the thicker tissue dropping down it’s lower down on the face and therefore it’s thinner up here. There’s a vicious cycle tends to occur, perpetuate, with more movement, more loss of volume, more thinning of the tissues. Obviously, the key to surgery is restoring the structures to the correct position on the face, restoring the volume of the bone of the face, then restoring the volume of the soft tissue and then it looks natural.
It’s a great cause of anxiety for many people about first day back at work because they’re so worried it’s going to be detected. If they prepare for that which firstly is having sufficient time. I would always encourage someone to put off the surgery until they have the time so that they can enjoy the recovery. The recovery enjoyment or how you feel about it is going to determine your satisfaction with the whole process. If the facelift experience was a good one you’ll always be happy about your appearance rather than you have to struggle because you didn’t have enough time. If you only had three weeks off, well two and a half weeks after surgery you could be looking in front of the mirror and thinking, “How on earth in three days is this going to look natural?” Very important, yeah.
Afterwards is so important and people can’t really discuss this with family members, particular husbands, they really need a good support network. Because they’re not going out to coffee with their girlfriends and others they haven’t got the normal chance to communicate and be part of the world. In the office we’ve got outstanding staff who really love what they do in supporting people. The nurses are really outstanding. I’m always being told, “Never let her go.” Then also we have the physiotherapist, Joan, who does lymphatic drainage and ultrasound. She’s been with me for 30 years, she’s wonderful. Also, she’s experienced so she knows that people are going through and they can chat.
Then we have the skin care specialist, Natasha, who just put the hands on the face because people for weeks haven’t been able to do that. Just to have, knowing someone else is doing it really helps. Then we have the heal light which is LED light that speeds up the rate of healing. It’s nice to know everything is working to support you rather than you having to look out for your own needs which tends to be what happens when people have surgery in overseas places. They’re staying in a hotel and they’re told to come back next week and it’s too much, they need constant support.
I hope this information is helpful to people who were concerned because they didn’t know enough about it and have pre-conceived ideas that might have been incorrect that was discouraging them. Information, it is really important to have information because so much of the fear is because of misinformation. We have outstanding patient advisors in the office. People are most welcome to call my office and come along and speak with a patient advisor, which we don’t charge for that. That’s a complimentary service because that will help people know whether it’s right for them. They can ask questions that they may be a little embarrassed to ask the surgeon. Just nice to know and be reassured. Then if the patient advisor, Jilda or Jennifer, feels that they can help then often they’ll expedite the patient to come to see me a little sooner because they get priority care. Thank you so much for this.
Modern day facelifts are a world away from those overstretched, all-too-obvious ones of the past. We have more knowledge of facial anatomy and how the face and all its muscles, including the skin, works as well as the tools and know-how to work with it. And no one understands this more so than Dr Bryan Mendelson, plastic surgeon from Toorak in Melbourne. Anyone who’s done any sort of research, or has anything to do with the aesthetics industry, should be aware of Dr Mendelson’s skill and ability to make his patients look completely natural, and his book In Your Face has been read by thousands around the country and indeed around the world. We take a look at what makes Dr Mendelson so successful when it comes to facelift surgery in Melbourne and his innate understanding of the face and its spaces.
Skin Deep – Not Any More
We know that simply pulling the skin up and sewing it higher or tighter just does not work. This is the stuff of horror celebrity facelifts of the 80s and 90s.
The way to a more natural looking facelift is to work on the internal support structures of the face. Dr Mendelson tells us, “It might look as if your skin has sagged, but actually it sits on a sagging support layer – and this is where the correction needs to take place.” This technique is known as the SMAS procedure. This method greatly reduces the chances of excessive bruising and swelling which means less downtime and allows you to get back to your everyday life a lot sooner. It also produces a long-lasting, more natural effect without the skin appearing “pulled”.
The Signs of Facial Ageing
The main signs of facial ageing are:
Dr Mendelson states that ideally a facelift will bring clarity around the eyes, attractive fullness over the cheekbones and clearer lines along the jaw and upper neck. He says, “The result of a well-performed facelift is natural, and it’s subtle, and the result is lasting. In addition to which it also slows the appearance of further ageing.”
The reason why modern facelifts are so much more successful than the outdated and almost laughable results of the past is because of our increased knowledge of facial anatomy. Surgeons have a much more detailed understanding of the deeper layers of the face, such as the muscles, tissues, skin and how it all works together. This enables them to better manipulate their appearance and identify how best to do that on a case by case basis. However, if you are considering a facelift, keep in mind that in order to get a natural result, you need to ensure your surgeon is one of the few who actually knows his stuff.
Dr Mendelson is an authority in facial anatomy. His research into the subject is recognised around the world and was included in the classic anatomy textbook, Gray’s Anatomy. His findings have led to the development of the advanced surgical techniques that we see being adopted around the world today. Dr Mendelson performs live demonstrative surgeries in countries such as Milan, Cologne, Barcelona, Madrid, Istanbul, Dallas, Moscow, Taipei and the list goes on, to teach other surgeons his techniques and how he produces such natural looking outcomes.
#Article Source: https://www.plasticsurgeryhub.com.au/understanding-the-face/
You only have to have a look at a few before and after photos of neck lifts to know it can completely change a person’s appearance. Lots of patients mistakenly think they need a full facelift, when in fact a good neck lift can turn back the clock years. Dr Bryan Mendelson, esteemed plastic surgeon based in Toorak, Melbourne, sees many patients each year who benefit hugely from neck lifts and lower facelifts. He helps us to understand why the neck lift or lower facelift is perhaps one of the most underestimated surgeries you can have if you are looking for a refreshed and more youthful appearance.
Jowls, or a lax jawline, is one of the first signs of ageing. Similarly, lines around the nose and mouth also appear before most of us are ready for them (are we EVER ready for them?!) and can make us feel as though we look older than we want to. Smiling, laughing, eating… whilst these are some of the best things about life, they also contribute to downward lines forming, and bring down an otherwise still youthful face.
Neck lifts can also be life changing for those without a defined neck. Whether it’s hereditary or not, having a thicker or less sculpted jaw/neck area can radically affect your whole appearance.
Either way, let’s talk about our options for dealing with the issue.
Premasseter Lower Facelift
The Premasseter Lower Facelift is a new technique that is being lauded as a breakthrough in giving restoration to a part of the face that was previously quite difficult to get significant aesthetic improvement. Dr Mendelson tells us that the technique can even be performed on the patient at a younger age for those with an overly full or poorly defined neck to provide benefits into the patient’s long term future.
Performed only by a few elite surgeons due to the specific surgical skills and expertise in anatomy required by the surgeon, Dr Mendelson says, “The Premasseter Lower Facelift is performed in the deeper facial anatomy along the side of the neck, where it firms the area from the jowls to the corner of the mouth and provides support for any tissue laxity in the upper neck; providing a cleaner jawline, and an improvement across the entire lower face and neck. The result is natural in appearance, and lasting. It also slows the rate of appearance of future ageing in that area.”
Dr Mendelson goes on to say that, “The Premasseter Lower Facelift allows the neck and jawline to be restored to an attractive contour, showing clean definition between the face and the neck. The procedure also tidies the area around the mouth, reducing the creases that make the mouth look compressed and downcast.”
Dr Mendelson’s Difference
In case you haven’t done your research and heard of Dr Mendelson yet, he’s one of the most highly respected plastic surgeons in Australia. His book, In Your Face, is a must read. One of the critical differences with Dr Mendelson and his techniques in surgery is that he performs all surgery beneath the skin. He says this is key in ensuring the quality of any facial surgery. Facelifts that rely on “pulling” the skin are a thing of the past and should remind you of the trend in Hollywood 20 years ago where patients looked like they’d been stuck on a rollercoaster going twice the speed for too long. Pulling the skin also doesn’t last as long as working under the skin with the muscles and tissue and deeper support layers. Skin stretches, so anything that just stretches the skin will need redoing at some stage down the track.
Why Does the Neck Age Quicker Than Other Areas?
The majority of us look after our faces regularly with lotions and beauty products, but many of us don’t extend this care to the neck area. The same goes for sunscreen – how many of you put it on your face but often forget to do your neck? On top of this is the fact that the neck has less fatty tissue so the skin stretches more quickly, and dries causing an ageing effect. Combine this with our enemy, gravity, and there’s more than a few of us experiencing that ‘crepey’ look.
Dr Bryan Mendelson is regularly invited to present his expertise at events all over the world. He is a real leader when it comes to effective techniques to give natural looking and beyond expected results. If you’d like to arrange a consult or find out more about what he might be able to do for you give his super lovely staff a call on 03 9826 0977.