This photograph shows an aging conventional facelift.

Please click on the image or the arrows to see the rest of the story.

Because the elements of anatomy of the midface (and forehead) were not corrected in the original surgery, they have continued to move downward with age.

The Composite reverses the progressive downward movement of the tissues of the midface (particularly the cheek fat) by returning them to their original position.

For this patient, the aging of her conventional facelift is most obvious in the under-eye area.

She has developed a hollowness under her eyes...

...and a bulge called the malar crescent.

The Composite corrects the malar crescent by lifting and moving the lower eyelid muscle up toward the eye, bringing with it the malar fat that creates the higher cheek mass.'

The Composite also corrects the gaunt or hollow eye created during a previous surgery by repositioning the remaining orbital fat so the eye socket has the necessary padding.

Problem – The Lateral Sweep

It's the distinctive swept back or stretched appearance between the corners of the mouth and the earlobes that tell friends and family you've definitely had some work done.

Often one sees actual lines or redirected wrinkles from the mouth to the earlobe, curving down and then up, ending at the facelift incision in front of the ear. The look will be especially pronounced if you have dry, sun-damaged skin.

Click on the image or the arrows to advance though the sequence.

Problem – The Lateral Sweep

This tautness occurs because the surgeon only lifted the lower cheeks and jawline laterally...

...and did not lift the upper cheeks and lower eyelids vertically (toward the eye).

Problem – The Lateral Sweep

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.

Problem – The Lateral Sweep

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.

With time, the sweep becomes more and more noticable.

Problem – The Lateral Sweep

The forehead is often left untouched as well in a conventional facelift.

While the initial results can be stunning, as the upper face continues to fall with time, additional problems can surface.

Problem – The Hollow Eye

The hollow eye is a sunken or concave appearance of the eye socket. It's often associated with a traditional procedure because the surgeon has removed undereye fat pads (the standard blepharoplasty) to eliminate the characteristic puffiness of an aging face.

Traditional blepharoplasty (left) removes most undereye fat. The composite blepharoplasty (right) repositions the fat to create a smooth undereye contour.

Problem – The Hollow Eye

As we grow older, our eyelids undergo predictable changes. The skin becomes thinner, leaving the skeletal structure more pronounced and leading to a wider and deeper under-eye space. This usually begins in your 40s; the bony anatomy not seen in youth now shows up.

Fixing the Hollow Eye

In a standard facelift, surgeons typically perform a separate upper and lower eyelid lift or bypass the eye entirely. Even though restoring this area is key to achieving a soft, harmonious look, removing the fat alone often creates an even more abrupt transition between the soft lower eyelid tissue and cheekbone.

The practice of removing the lower eyelid fat began in 1928 in France, and is still commonly done today. I did it myself for years. But without the necessary padding, the skin may eventually collapse into a concave appearance.

This image shows how a conventional blepharoplasty led to a hollow eye.

Fixing the Hollow Eye

In the “septal reset” portion of the Composite Facelift, I correct this gaunt appearance by going beneath the lower eyelid, retrieving more fat and its cover (the septum), and spreading it over the hollow space onto the cheekbone. I have never seen a hollow lower eyelid that could not be corrected, even when the earlier procedure removed a lot of fat. An added bonus is that repositioning the eyelid muscle during the cheek lift gives a thicker cover to this area.

This is a good example of how all of the elements of the Composite Lift work together to rejuvenate the face. I perform a septal reset routinely in all first-time facelifts.

The image shows the results after the composite correction.

Fixing the Hollow Eye

Top Image: After conventional procedure.

Fixing the Hollow Eye

Top Image: After conventional procedure.

Bottom Image: Ten years after the Composite, the eyelid and cheek anatomy still appear youthful.

Problem – The Malar Crescent

A little known part of your facial anatomy, the malar crescent is the lower border of the lower eyelid muscle (the orbicularis oculi). In younger people, it is barely noticeable. But as many individuals age, especially beyond their 40s, the crescent can become an obvious, unattractive fullness along the upper cheekbone.

A traditional facelift not only fails to address this bulge, but the procedure can actually make it worse.

This image shows the malar crescent, made more obvious as a conventional facelift aged.

Problem – The Malar Crescent

The lower image shows that the smooth contour of the upper cheek has been restored with the Composite.

Problem – The Malar Crescent

After conventional and before Composite procedure.

Problem – The Malar Crescent

After the Composite Facelift.

Problem – Earlobe Displacement

Everyone seems to know the ear often betrays a facelift. Pulled-down earlobes may happen at the time of the original procedure, or can develop with time. The most dramatic distortion has been called “the pixie ear.”

Natural contour can usually be restored, but this is often difficult. The earlobe is often not distorted, but simply pulled forward — a tip-off to a facelift.

Click the images or arrows to see how these distortions can be repaired.

Problem – Earlobe Displacement

Everyone seems to know that it is the ear that often betrays a facelift.

Pulled-down earlobes may happen at the time of the original procedure, or can develop with time. The most dramatic of these distortions has been called “the pixie ear.”

The natural contour of the earlobe can usually be restored, but this is often difficult. Often the earlobe is not distorted, but simply pulled forward, another tip-off that a facelift has been done.

Problem – Earlobe Displacement

Everyone seems to know that it is the ear that often betrays a facelift.

Pulled-down earlobes may happen at the time of the original procedure, or can develop with time. The most dramatic of these distortions has been called “the pixie ear.”

The natural contour of the earlobe can usually be restored, but this is often difficult. Often the earlobe is not distorted, but simply pulled forward, another tip-off that a facelift has been done.

Problem – Earlobe Displacement

This "pixie ear" distortion has been corrected and a more natural contour of the earlobe has been restored in this patient.