What Is the Composite Facelift?
The Composite Facelift is a next-generation alternative to standard procedures. It takes longer to perform and longer to heal, but yields longer-lasting, more natural-looking results.
The Composite Facelift is based on the concept that the face ages as one dynamic, cohesive unit, rather than as a series of static, independent parts.
Traditional or conventional facelifts don't take this into account
and do not always age
well, and can result in a “facelifted” appearance.
These photos show how the deep structures of the face — those under the skin — age together, and how they are repositioned together with the Composite. Look in particular at the downward movement of eyelid muscle (orbicularis oculi), and the cheek fat. These major elements must be lifted in tandem with the skin to restore a youthful appearance.
Deep structures age together
...and are repositioned together with the Composite
This drawing illustrates the difference between traditional facelift procedures and the Composite.
While previous procedures only repositioned tissue horizontally, the Composite counters the natural descent of the face with a true vertical lift. The strongest lift direction is upwards, toward the eye.
Composite Facelift
Traditional Facelift
Another important difference between the Composite and facelift traditional procedures is in the treatment of the lower eyelid area.
This progression shows the gradual “skeletonization” of the face that occurs as we age, as the soft tissues of the face relax and reveal the outline of the underlying bone. Notice especially the changes below the eyes.
For decades, surgeons have refreshed the eye area with a blepharoplasty — eyelid lift. Most people are satisfied with the upper eyelid portion of the procedure because it tends to yield predictably good results.
But the lower eyelid is a different story. Traditionally, surgeons removed the under-eye fat pads and lifted the skin and muscle only as far as the orbital rim, the bony ridge below the eye socket. Unfortunately, the skin can eventually collapse into the depression that was made even deeper by the fat removal, resulting in a hollow, gaunt appearance over time.
The Composite Lift preserves most (possibly all) of the fat beneath the eye and repositions it (with its thin but strong cover, the orbital septum) over the orbital rim, smoothing the transition from lower eyelid to cheek.
Composite Facelift
Traditional Facelift
This eyelid-cheek junction plays a major role in a youthful or aging look. A smooth transition from lower eyelid to cheek is a youthful appearance. Anything else is not.
Endpoints of the Composite Facelift
Since a picture is worth a thousand words, let's analyze the before and after photos of a patient who has undergone a Composite Facelift. The patient seen here represents a typical Composite Facelift result. This lady is an attractive 60 year-old woman who desired a primary facelift procedure.
Endpoints of the Composite
Let's look at the normal anatomy and what parts were changed in order to create harmony.
From the neck up, you can see dramatic improvement in every area of her face.
Endpoint: Smooth neck and jawline
Neck and jowl before and after Composite
Extra fat has been removed from her neck, some fat has been removed from along the jawline, and the “muscle bands” in the middle of the neck have been sutured together.
A youthful contoured neck is the result.
Endpoint: High “Cheek Mass”
The “cheek mass” has been repositioned in order to resemble the high cheek mass of youth — a result which cannot be achieved by traditional facelift techniques. The high cheek mass gives a youthful face its beauty.
Notice the repositioned cheek mass
With the Composite Lift, the fat remains attached to the overlying tissues, which have been repositioned and secured to the bone of the orbit.
This assures the long-term position of these elements with very little change observed in this anatomy even ten years after surgery.
Endpoint: Youthful Eyes
The dividing line between the lower eyelid and cheek has been blended and is now as seamless as it is in a youthful face. This is simply the recreation of the same transition between eyelid and cheek that you had in your younger years. This requires both an upward repositioning of the cheek fat and orbicularis muscle along with a “septal reset,” which will be discussed later.
These images show the seamless transition created between the lower eyelid and cheek, and the slight upward tilt to the corner of the eye.
In the Composite Lift, the outer corner of the eye is usually tilted slightly upwards, further reversing the downward movement of the aging lower eyelid.
Most patients like the younger look this gives, although this position can be adjusted to suit your personal preference.
The “vertical height” of the lower eyelid is shortened. This distance, from the pupil to the cheek, must be shortened if you are to see true youthful changes around the eyes.
The vertical lines show the shortened height of the lower eyelid. *Excess eyelid skin was also removed.
This element is a critical component missing from many facelift procedures.
The excess upper eyelid skin has been removed. Removal of this skin may be a once-in-a-lifetime procedure, and is by far the most predictable and longest-lasting part of any facial rejuvenation surgery. This is the key to being able to wear eye shadow — to recreate a crease that serves as a platform for women to apply their makeup.
On occasion, a patient with an inherited deep area under the upper lid may not need to have skin removed.
Endpoint: Forehead Lifted
The forehead has been lifted to be harmonious with the newly positioned mid face and cheeks. This is the second factor in creating youthful upper eyelids, since a drooping forehead can reduce the impact of an upper blepharoplasty.
The forehead lift enhances the upper eyelid lift, eliminates frown lines, and can reduce a high forehead.
The frown muscles above the nose have been removed to prevent deep wrinkle lines. The ability to frown is minimized forever. While Botox® injections will accomplish this as well, it requires an injection every three to four months at additional expense.
The incision in front of the ear is tucked behind the targus (arrow), and the incision behind the ear is completely hidden in the hair.
A Bonus:
No Ear Distortion
To avoid another one of the telltale signs of facelift surgery, the earlobe must hang at the correct angle and not be pulled forward. The incision in front of her ears is tucked inside the cartilage called the “tragus” and therefore should be hard to see.
Advantages of the Composite Facelift
With the Composite technique, we are able to balance every horizontal pull, particularly of the lower face, with a vertical lift, which also counters the natural descent of the face. By also elevating the forehead, this approach ensures that the soft tissues of your face are draped from the highest possible point to guarantee the smoothest possible look. Because of this, the upper parts of the face will never come crashing down over the operated lower parts of the face. This harmony is maintained for years.And those telltale distortions of facelift surgery are nearly a thing of the past…
Lateral Sweep
The End of Lateral Sweep
The “lateral sweep” is the stretching of the lower face that often surfaces after a standard facelift.
By lifting the skin and underlying muscle and fat of the cheek vertically, toward the eye, the Composite
helps prevent this common distortion.
Not all conventional or SMAS facelifts end up with a lateral sweep, but all of them have the potential to develop this “pulled” look.
This is because the tight jawline created by repositioning the SMAS horizontally is stronger and lasts longer than the horizontal repositioning of the tissues of the cheek. The cheek skin and fat can relax in time, while the jawline remains taut. When this happens, the difference in tensions reveals itself as the lateral sweep.
Before and after a Composite Facelift.
Youthful Eyes Stay Youthful
The Composite Facelift restores the original luster of your eye region with a new twist on the standard blepharoplasty. In
1995, Dr. Hamra published the original article on preserving the fat of the lower eyelid instead of the old practice of removing it. Three years later he added the “septal reset” to the procedure, to not only preserve the under-eye fat, but to reset it along with its firm cover (the septum) to a position over the orbital bone.
This creates a natural transition between the soft under-eye tissue and your cheekbone.
The septal reset creates a smooth transition between lower eyelid and cheek.
The septal reset was the “even better” operation Dr. Hamra advanced in 1996 and republished in 2004.
He reports that he is now seeing patients with excellent results that are still stable after up to 15 years later.
A complete facelift is not always needed for rejuvenation.
Right: Ten-years after a browlift, upper blepharoplasty, and septal reset.
Left, before. Center, 1-year later. Right, 15-years post-op.
Long-term results of Septal Reset
The Forehead: An Extra Measure of Lift
As the tissues of the cheek are lifted, they impact the tissues of the temple, which must then be moved in the same direction (vertically) as the cheek. A forehead lift is, therefore, an essential part of the Composite to prevent a bunching of skin to the side of the eyes. By repositioning and tightening the forehead, other signs of aging in the upper face — droopy eyebrows, “hooded” eyelids, and forehead furrows—are eliminated.
Before and after Composite Lift
Incorporating a brow lift with the Composite does more than just do away with the worried, concerned look.
When performed with other Composite maneuvers, the brow lift helps eliminate facial distortions
while ensuring a pleasing, overall even look.
Before and after Composite Lift
Disharmony may result if the forehead lift is not done and a youthful facelift is observed under an aging forehead.
Sticking Your Neck Out
The neck lift is part of every Composite Facelift and is never omitted.
Individual neck anatomy varies greatly, but it can always be improved. If the neck fat is too thick, it is reduced to a normal level.
Some patients have no extra fat, but have prominent bands of platysma muscle visible at the front of the neck.
Excess fat is reduced to a normal level.
Loose skin and muscle are tightened.
Dr. Hamra always tells patients that the neck changes are never as impressive as the face.
This is because the skin of the neck is positioned over a “hinge joint” and, like the knee and elbow, this elastic skin may look tight or loose depending on the way you tilt your head in flexion or extension.
