Dr. Little’s Philosophies
Rationale for Facial Rejuvenation
The two parts of the human body that age most rapidly in disproportion to the rest are the breast (especially after pregnancy) and the face. But while the aging breast can be conveniently camouflaged in supportive undergarments, there is no such easy remedy for the aging face.
One obvious cause for such disproportionate facial aging is the regular exposure of the face to the sun and the elements, as contrasted with the rest of the clothed body, bringing wrinkles and age spots to the exposed facial surface. But a much more important cause remains the life-long activity of our specialized (mimetic) muscles of facial expression, our uniquely human signature of individuality and silent communication. A part of this activity adds to the aging texture of our facial skin, with further wrinkles and creases. But the far greater part sets in motion changes in our facial shape and architecture that evolve under the influence of gravity over the course of our lifetime.
Structural Facial Aging
This structural or shape-based aging brings hollow eyes with lower lid bags, flat cheeks, creases along the nose and mouth, jowl formation with disruption of the jaw line, and a sagging neck. Our dogs, cats, and horses (which enjoy no such complex facial musculature) do not undergo visible facial aging; when assessing an animal’s age the veterinarian first examines the teeth. This phenomenon cannot be explained by facial fur alone, as the young man with a beard remains readily distinguishable from the old man with a beard. Thus our particular brand of disproportionate facial aging is just as uniquely human as are our specialized muscles of facial expression. Those wishing to better understand this new (and controversial) theory of facial aging based on muscle activity may consult the seminal paper of French plastic surgeon Claude LeLouarn, M.D. (LeLouarn, C., Buthiau, D., and Buis, J. Structural aging: the facial recurve concept. Aesthetic Plast. Surg. 31:213, 2007) and its subsequent discussion by Dr. Little (see: about Dr. Little / abbr. C.V. Part II:publication #133).
A primary rationale (or key reason) for facial rejuvenation then becomes the desire to restore harmony and balance between our overly aged faces and our more youthful bodies (and minds). And, of course, as we have embraced healthier life styles over the recent past (reflecting both healthier bodies and minds), this same facial disharmony or imbalance has only increased. Not everyone of adequate means will elect to have a facelift, of course, but as we enjoy ever longer, more productive lives, an increasing number will. It is Dr. Little’s personal conviction that if a person determines to go through their one life with their “best foot forward” or their most vital, energetic, and healthy personal appearance…someone, somewhere, at sometime during that lifetime will need to redistribute their lower facial aging excesses back to higher, more youthful positions, as well as to replenish their hollowed eyes. Dr. Little presents himself as a particularly understanding and effective “someone,” a widely-recognized facelift expert offering straightforward suspensory surgery of the face (performed in its most superficial plane), combined with precision fat grafting to the lids, lips, and, when appropriate, cheeks.
Can Less Be Done?
Many patients ask whether less can be done? Why can’t they look healthier and fitter without a “full facelift?” While Dr. Little performs a range of lesser procedures, including two distinct facelifts requiring only 30 minutes each, these measures are appropriate as first-time interventions in only a limited range of patients. While man-made fillers (such as Restylane™), skin resurfacing (with lasers, peels, or abrasions), and paralytics (such as Botox™) may help for a time, there is an ultimate limit to the effectiveness of such nonsurgical treatments (which may bring their own particular brand of unnaturalness). To reverse the structural, shape-based aging that accumulates over the span of one’s young, middle, and later years, something more substantial must be embraced for most such “established” aging. Fortunately, such a fundamental restoration remains surprisingly straightforward and uncomplicated for most patients.
Illustration: detail from Leonardo da Vinci, “Profiles of an Old and a Young Man,” ca. 1495, Galleria degli Uffizi, Florence