Dr. Little’s Techniques
Facial Rejuvenation (Everything Together)
A typical patient having facial rejuvenation with Dr. Little would be a woman between forty and seventy years of age, with early to fully-developed jowl formation and deterioration of the jawline, under jaw, and neck. The orbital area would present an overall emptiness, with or without apparent fatty excesses or “bags.” And the outer eyebrow region would crowd the eye, perhaps to the point of “hooding.” Paradoxically, the inner eyebrow might well be elevated compared to early photographs, further emphasizing upper orbital hollow or emptiness.
The lower lip would have likely lost some volume compared with the same early pictures, as the upper lip would have flattened and mouth position settled, exposing the narrow lower teeth instead of upper teeth, both during relaxation (repose) and speech. There would likely be present a downturn at the corner of the mouth, perhaps extending into an early or fully-formed marionette line. There would likely also be an enhanced crease or fatty fold extending from near the wing of the nose down toward the corner of the mouth, the so-called “nasolabial fold.”
For this typical patient, Dr. Little would most likely recommend a straightforward, superficial, short-scar facelift (XJ lift), with micro structural fat grafting to the lids and lips and conservative laser resurfacing to the eyelids. Neck surgery would probably be recommended as well, most likely with a “platysma hitch” suture to the back of the neck muscle, and perhaps with a division of that same muscle, but almost certainly without the need for a neck or under-the-chin scar. The odds favor that he would not recommend eyelid surgery (blepharoplasty with scars) for either the upper or lower lid.
Three Key Goals
The correction of her jowl complex would be actively pursued, as such correction remains a key challenge in facelift surgery that is too often under-realized (here, there is almost no danger of “over-correction”). Dr. Little believes that reversal of the jowl, with return to an “inverted-cone-of-youth” facial architecture, brings more fundamental rejuvenation (vitality, health, beauty, and youth) than any other single maneuver. The filling of her lower lid “tear-trough” emptiness would also be pursued to its fullest degree, as this remains a second challenging area in facial rejuvenation that is also typically under met. Dr. Little’s goal would be to blend away any under-eye hollowness, as well as any fat-bag puffiness or apparent fatty excess, leaving short, full lower lids that appear healthy and youthful. The same would hold for any emptiness within the upper eyelid region. Also, all six optional but hidden, rapid steps of stomapexy would likely be added to encourage elevation of the mouth (without lip scars), a third elusive goal in facial rejuvenation (again, with virtually no chance of “over-correction”). Dr. Little believes that the accomplishment (or not) of these three “difficult” goals is what most often sets apart the convincing–even exciting–result in facial rejuvenation from the indifferent one; he therefore pursues all three with determination in most patients.
Remaining “Personal” Goals
But the remaining rejuvenation goals would be pursued in strict moderation and in close consultation with the patient. This typical patient would therefore receive conservative laser treatment to her eyelids, as well as a modest kick to her outward eyebrow position. And her inner eyebrow, if it changed position at all, would more likely lower rather than rise. When redraping her relaxed facial skin, tissue glue would be used with Dr. Little’s “reversed gradient” approach, further limiting the chance of any tight or pulled quality. For the remaining rejuvenation goals concerning the upper eyelid, the lips, and the cheeks, Dr. Little would likely recommend that these features be treated in a way that would move their appearance–to a greater or lesser degree–toward that apparent in the early photographs. But the ultimate goal for each of these areas would reflect primarily the tastes and desires of the patient at this time of her life. While each of these areas remains important in the overall picture of rejuvenation, each can be readily addressed in a matter of minutes by skillful micro and standard fat grafting. This “typical” patient, by the way, would not receive fat grafting to her cheeks, as the XJ lifting of the jowl would adequately restore her to the healthy cheek of an earlier time, without the need for further addition or exaggeration.
Illustration: detail from Leonardo da Vinci, “Head of a Young Woman,” ca. 1495, Galleria degli Uffizi, Florence