Dr. Little’s Philosophies
Volume in Facial Rejuvenation
Dr. Little has held a pioneering role in architectural reshaping of the face for rejuvenation and in the replacement of lost volume during facelift (see: about Dr. Little / abbr. C.V. Part II: publications #100, #101, #112 and #114). However, he understands that unfocused volume addition throughout the face only serves to create a larger and different face.
Volume Addition with Restraint
While Dr. Little adds precise volume to the eyelids and lips of almost all of his patients, he adds nothing to the face in the majority, relying instead on redistribution of the fallen jowl volume to return that patient to their earlier, youthful facial shape. In thinner patients for whom he adds extra facial volume, he does so with restraint (if the patient then wishes more cheek contour after surgery, this can be readily added in the office under local anesthesia, thus removing any temptation to “push” the original addition). The most important component of volumetric resculpture of the face itself, therefore, remains the resuspension or “jowl lifting” inherent in Dr. Little’s basic facelift. Such resuspension empties out and smoothes the neck, jawline, and jowl zones, as it simultaneously refills the lower (submalar) cheek. Typically, such lower cheek filling blends to the upper cheek in a way that requires no further cheek enhancement. Dr. Little finds that extensive fat grafting to the face itself during routine rejuvenation is not only unnecessary, but often wrong; such over-grafted faces may not only age more rapidly, but they may do so in a unnatural manner, as well.
Lifting and Filling
Dr. Little remains convinced that neither surgical suspension (facelift) alone nor volume augmentation (fat grafting) alone is as effective and natural in overall facial rejuvenation as a combination of both modalities. Such a marriage of techniques is implicit in the term “sculptural rejuvenation,” under which Dr. Little has presented most of his philosophical and technical teaching. Happily, there is a growing number of plastic surgeons world-wide who have mastered both the “lifting” and the “filling” aspects of recapturing a youthful facial appearance.
Illustration: detail from Leonardo da Vinci, “Portrait of Ginevra de’ Benci,” ca. 1478-1480, National Gallery of Art, Washington.