The ESP Facelift Technique

Dr. Steven Hoefflin developed the ESP Facelift Technique and has taught it in over 80 countries around the world.

For years, it was thought that the underlying cause for “jowling” and “sagging” of the face was looseness of the deep facial muscle layers.  Based on this theory, techniques went deep in an attempt to correct these muscles.  This resulted in long recovery periods with much swelling.   We now know that jowling and sagging are due to gravity causing the fat and skin to droop.  It is not related to loosening of muscle layers.  As with the breasts or buttocks, time and gravity cause a descent of fat and skin, but the muscles may still remain quite firm.

A non-invasive procedure called MRI (Magnetic Resonance Imaging) has been utilized recently to study the aging face.  These studies have shown that it is the descent of skin and fat and not muscle laxity that causes jowling and sagging.

Previously, facelift techniques would merely tighten the skin, leaving the fat in place.  This resulted in tight skin but persistent jowling.  Tightening of the muscle layer alone (known as the “SMAS”) without elevating the fat often results in an unnatural, drawn appearance.    My surgical technique lifts and rearranges all the fat and skin providing a more youthful appearance.  My ESP facelift treats drooping fat of the jowls and cheek folds by elevating them back into their proper anatomical position.  It allows for a more complete lift without having to pull the skin taut rendering a more natural result.  Although this technique is more challenging for the surgeon, it seems easier on the patient.  It provides a more noticeable improvement than other techniques. Patients experience little postoperative pain, a brief and comfortable recovery, and a return to normal activities sooner than with past techniques.

THE SURGERY

The operation is usually performed in a licensed fully equipped plastic surgery facility or hospital.  You will be comfortably asleep and under the constant care of an anesthesiologist.  Before awakened, a long-acting local anesthetic will be administered, so you feel minimal discomfort after your surgery.

Incision lines are usually carried from the mid-hairline above the ear to the crease line just in front of the top of the ear, behind the ear and hidden inside the tragus (the protuberance of cartilage just at the front of the ear canal).  The incision is then carried up hugging the earlobe, curving on the back of the ear, and continuing high into the hairline area.  Although this sounds quite extensive, the incisions are actually inconspicuous once healing occurs.

After the incisions are made, the doctor carefully lifts the loose skin and sagging fat and gently restructures the tissues.  Excessive fat is suctioned, sculptured or repositioned.  The cheeks, cheek folds and neck areas are sculptured and recontoured.   Special attention is paid to the neck during a facelift.  A small incision may be made under the cleft of the chin to sculpt and reposition loose neck muscles (or “turkey gobbler folds”).   A special stitch may be placed behind one ear, crossing the neck, to behind the other ear forming a light corset to restore a youthful neck and jawline.

Once the facial foundation is restructured into a more natural position, the doctor continues much the same way a fine tailor performs alterations on a garment.  The skin is laid back down carefully, removing any excess, and the incisions are closed with very tiny, specialized plastic surgery stitches.

Frequently, one or two small drains are placed to remove fluid that accumulates after the surgery, before it becomes swelling and bruising.  These drains are usually removed the morning after surgery (read “Your Drainage Bulb” in the Checklist section).