InHealth: Do Our Tools Betray Our Vision?

By Sumeet Bhanot, M.D.

Achieving our wishes and desires represents the journey that is life. When tackling aging, this journey may be derailed by a plethora of messages causing us to make the wrong choices. We must filter this noise to find the truth. 

Why does the “simple” desire to look younger leave so many looking plumped, stretched and distorted? The reason is simple. We let the limited available tools dictate the technique as opposed using the right tool for the job. We treat the symptoms of aging as opposed to tackling the complex changes in proportions.  Intensive study of the anatomy of the aging process reveals the truth.  

The face is constructed with a deep skeletal support, overlying soft tissue (fat, muscle), enveloped in fascia and encased in skin. Deep fascial ligaments penetrate all these layers anchoring them to the skeleton. Youth is represented by fullness in the upper face transitioning to a clean jawline, like an egg perched on its point.  This shape, dictated by these proportions, define youth.  

As we age, the soft tissue sags and falls away from the supports. As this transpires, the fullness in the upper cheeks drops to the lower cheek and neck (creating laugh lines and jowls). The egg now sits upside down. The shape has changed, replaced by a hollowing of the mid and upper face with heaviness of the lower face. Aging is this change in shape and proportions, not wrinkles. Given this reality, let us ponder the merit of the tools available.

The first option is to add volume to the cheeks and smile lines to mask this change.  The end result is the hallmark of the filler revolution: a rounded cherub-like face (the fallen egg is plumped so it is perfectly round). I use fillers with a light touch to avoid changing the proportions of the face.  

The second option is a conventional facelift procedure.  The quick mini-lift just pulls the skin tightly and gives a very pulled appearance. The most popular technique tightens the fascia, but due to limitations of the technique and not the surgeon, the volume of the cheeks does not shift. Some talented surgeons are judicious with the fill and achieve a good compromise. However, in my humble opinion, many overfill. I understand because I used to perform this facelift.

The third option—the very rare deep plane facelift—is philosophically different. It is time to “re-tool the factory”. This addresses the true problem by actually lifting the dropped facial volume vertically in the deep layer that is not accessible in other techniques. The results reveal lifting the facial volume from the lower to the upper face and restoration of the facial harmony and the youthful proportions (the egg resurrected).  

By following the anatomy and restoring the proportion, we get a natural, youthful face that appears 15 to 20 years younger. The proof is in the before and after pictures that show a natural beautiful contour.  I have successfully challenged the results with pictures of my patient from two decades ago. I strive to recreate the natural beauty that once was as opposed to a distortion of the reality.  

The three options do not lead to the same result.  Success in this journey takes knowledge of complex anatomy and proportions, perspective, judgement, creativity and execution of the best technique to achieve a “natural youthful beauty”. As in life, anything that is worthwhile is never quick and easy. We only live once. Choose wisely and enjoy life.  

Sumeet Bhanot, M.D.
Bhanot Facial Plastic Surgery
2038 Bee Ridge Rd, Sarasota, FL 34239
(941) 966-3223
sarasotafacialplastics.com