What Is the Composite Facelift?
The Composite Facelift is a next-generation procedure that far surpasses facelifts thought to be the best today. The recovery is a bit longer, but it yields longer-lasting, more natural-looking results.
The Composite Facelift is based on the concept that the face ages as one dynamic, universal unit, rather than as a group of isolated and 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.
"Essentials"
We have created a two-minute "Introduction" and a nine-minute video on the "Essentials of the Composite Facelift" to present the details of how and why Dr. Hamra's approach works so well to restore the contours of youth.
The material introduced in the "Essentials" video is also presented in detail below for those who would like to study the elements in a more leisurely fashion.
Why the Composite Facelift?
Deep structures age together...
These photos show how the deep structures of the face — those under the skin — age together. Look in particular at the downward movement of eyelid muscle (orbicularis oculi), and the cheek fat.
Click on the image or the arrows below to see the results of the Composite Facelift
...and are repositioned together with the Composite
The Composite Facelift moves all the major elements, including the eyelid muscle (orbicularis oculi) and the cheek fat in tandem with the skin to restore a youthful appearance.
Traditional versus The Composite Facelift
Traditional Facelift
Composite Facelift
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.
Another important difference between the Composite and facelift traditional procedures is in the treatment of the lower eyelid area.
“Skeletonization”
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.
The Lower Eyelid
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.
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.
Traditional Blepharoplasty
Composite Blepharoplasty
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.
Please click on the image or the arrows below to advance through the sequence.
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.
Neck Lifted
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.
Jawline Smoothed
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.
Cheek Lifted
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.
Smooth Transition Eyelid to Cheek
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.
Lower Lid Lifted
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.
Corner of Eye Lifted
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.
Upper Lid Lifted
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.
Forehead Lifted
Let's look at the normal anatomy and what parts were changed in order to create harmony.
Endpoint: Smooth neck and jawline
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.
Please click on the image or the arrows below to advance through the endpoints.
Endpoint: Smooth neck and jawline
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 high cheek mass gives a youthful face its beauty and must repositioned in order to resemble the high cheek mass of youth
— a result which cannot be achieved by traditional facelift techniques.
Endpoint: High “Cheek Mass”
The repositioned high cheek mass helps restore the beauty of the youthful face.
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
In a youthful face, the dividing line between the lower eyelid and cheek is seamless.
The Composite Facelift recreates this smooth transition by incorporating an upward
repositioning of the cheek fat and orbicularis muscle as well as with a “septal reset.”
Endpoint: Youthful Eyes
This post-operative photo show the now seamless transition between the lower eyelid and cheek, as well as a 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.
Endpoint: Youthful Eyes
To see truly youthful changes around the eyes, the “vertical height” of the lower eyelid must be shortened. This distance, from the pupil to the cheek, is shown by the vertical line.
This element is a critical component missing from many facelift procedures.
Endpoint: Youthful Eyes
The “vertical height” of the lower eyelid has been shortened.
* 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 lift enhances the upper eyelid lift, eliminates frown lines, and can reduce a high forehead.
This is the second factor in creating youthful upper eyelids, since a drooping forehead can reduce the impact of an upper blepharoplasty.
Forehead Lifted
The forehead has been lifted to be harmonious with the newly positioned mid face and cheeks.
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.)
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.
A Bonus: No Ear Distortion
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
Three things set the Composite Facelift apart:
- Youthful anatomy is restored
- No "face-lifted look"
- Long-lasting results
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…
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.
Click on the image or arrows to see the rest of the benefits.
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 & 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 20 years later.
A complete facelift is not always needed for rejuvenation.
The septal reset creates a smooth transition between
lower eyelid & cheek
This photograph records the patient ten-years after a browlift, upper blepharoplasty, and septal reset.
Long-term results of Septal Reset
The septal reset produces excellent results that are still stable after many years.
This is the patient before the procedure.
Long-term results of Septal Reset
The septal reset produces excellent results that are still stable after many years.
This is the patient one year after the procedure.
Long-term results of Septal Reset
The septal reset produces excellent results that are still stable after many years.
This is the patient fifteen years after the procedure.
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 — as seen in this pre-operative photograph are eliminated.
The Forehead: An Extra Measure of 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.
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, as in this pre-operative photograph, it can be reduced to a normal level.
Sticking Your Neck Out
Excess fat is reduced to a normal level.
Sticking Your Neck Out
Some patients have no extra fat, but have prominent bands of platysma muscle visible at the front of the neck. The loose skin and muscle seen in the upper pre-operative image are tightened by the neck lift as shown in the lower image.
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 (head toward the chest) or extension (looking upward).
