What I have learned from Dr. Sandy Pritchard

Facelift procedures are some of my favourite procedures to perform, in all its many forms, be it:

1. the mini-facelift,
2. the short scar facelift,
3. the deep SMAS (Superficial Musculo-Aponeurotic System),
4. the MACS (Minimal Access Cranial Suspension),
5. the lower facelift,
6. the mid-facelift,
7. the full facelift,
8. the vertical facelift
9. the forehead/brow lift,
10. facelift with fat grafting, the isolated neck lift,
11. etc.

Facelifts are likely the most precise of all plastic surgery procedures where the margin of error is zero and for this reason, performing these procedures commands respect, technique, precision, meticulousness, focus and artistry.

I have learned the foundation of facelift procedures during my residency training in Plastic, Aesthetic and reconstructive surgery at the University of Toronto.

But I really developed my finesse in facelift surgery when I travelled abroad, to Paris, France, and to California.

Paris is where I visited Dr. Daniel Marchac, a highly-esteemed French Plastic surgeon known for Facelift and cranio-facial surgery.  From him I have learned the vertical facelift.

I subsequently went to visit “THE” SMAS Facelift surgeon, Dr. Bruce Connell, south of Los Angeles, in Newport Beach. Tadam! I learned from him the true benefits of lifting and mobilizing carefully the SMAS unit and to create various flaps of SMAS for a 2 and 3 vectors of lifting forces, creating a beautiful, natural and more-lasting facelift results.  From Dr Bruce Connell, I also learned how to disguise better our facelift scars (paying attention to subtle skin colour changes, curves, hair pattern, and more) and how to hide it “inside the ear canal”.  I’ve learned from him too how differently we approach a male facelift compared to a lady facelift.  Men have beard that will shift up and back which must be taken into consideration.  This latter has become a very precious learning since I have 18-20% of males in my Toronto practice.

Then I have learned several “facelift pearls” during my regular travels to seminars, conferences and meetings.  This is why I travel so much: to learn “pearls of knowledge” to incorporate in my practice and to enhance my results.

A very important pearl came from Dr. Sandy Pritchard, a Toronto colleague and well-respected plastic surgeon: the adding of a chin implant in most facelift procedures, for men and women!

I had already learned a few things from him, such as the tips on how to control blood pressure during a facelift procedure (facelifts are prone to post-operative bleeding called hematoma so plastic surgeons pay a lot of attention to hemostasis) and some pearls about tumescence liposuction.

But the most important pearl I got from Dr Pritchard several years ago is the addition of a chin implant for our facelift patients.  This has improved tremendously my aesthetic results and the longevity of my results.  Many will say: “I don’t need a bigger chin!”. And I will reply: “Let me show you”.

Then I bring my 13 different models of chin implants, all coming in several sizes:

1. some to augment projection,
2. some to augment the vertical height of the lower face (to better achieve the rules of 1/3rds),
3. some will fill the pre-jowl depressions,
4. some will “ovalize” a square chin,
5. some will “square” and masculinize a round chin,
6. some will widen a chin, etc, etc, etc.

Most of us will lose volume in the chin region over time, with a reduction in bone mass, muscle mass, skin thickness and the fat gets redistributed so adding a small implant is important to balance this volume loss.

Adding this volume is crucial for:

1. the optimal nose-chin harmony in profile (science of Profiloplasty).
2. adding a chin implant also helps in addressing the excess skin one develops over time under the chin, in the neck area.
3. finally, many chin implants have outer “extensions” (aka little wings) that blend into the prejowl areas and prevent the premature reappearance of the jowls after a facelift, hence the patient’s facelift results last longer.

Adding a chin implant to a facelift and neck lift uses the same identical incision under the chin needed for the anterior neck lift (anterior platysmaplasty aka “turkey neck muscle repair”) and neck liposuction.  So no additional scar required. A small pocket is created of the chosen size using sizers over the chin bone.  The implant is then implanted precisely in this pocket under the chin muscle (mentalis).  Creating an exact pocket keeps the implant in place until the body makes the protective capsule of collagen around it over the first 3 months.

Voilà!

Adding the chin implant during a facelift and neck lift procedure adds perhaps 30 minutes of surgical time but so many more years of happy facelift results.

Thank you Dr. Pritchard!

Dr. Marc DuPéré, Aesthetic Body and Facial Plastic Surgeon, Toronto