I explained why facelift surgery, which is performed to correct facial sagging, approaches the problem by entering from seemingly unrelated areas, and how simpler techniques developed by surgeons who found the original approach technically challenging began to show problems over time in patients who underwent those procedures.
The problem was this: the sagging returned.
Up to about 3 months after surgery, the face appeared very well lifted, and it seemed as though the sagging had been fully corrected.
However, by 6 months to one year, the face often returned to its previous state. I personally had similar experiences while performing these procedures myself.
These were techniques recognized strongly enough to be included in plastic surgery textbooks, yet there were patients in whom the sagging recurred surprisingly within just 3 months.
It took me quite some time to understand the reason.
But as I continued studying and researching, I eventually came to realize something important.
The recurrence of sagging happened because I had performed a “pulling” procedure.
This was the moment that led me to establish the fundamental principle of the surgery I mentioned earlier.
In other words, I had not operated on the actual target area itself, but instead on the neighboring area.
From that adjacent area, I tried to improve the target area indirectly by pulling it upward, and this indirect approach simply did not work.
I should not have been pulling at all.
Do you see what I mean?
I suspect it may not be entirely clear yet.
That is because one essential scientific fact needed to understand this idea
is still missing here.
It is like a puzzle with the most important piece missing.
That missing piece is a fundamental property of human skin.
Once you understand this, the whole picture will begin to make sense.
This fact is crucial: skin stretches.
More precisely,
when skin is pulled, it responds by stretching.
Let me give you an example.
I came to understand this after recalling an experience from my training years as a plastic surgery resident.
Have you ever heard the term congenital nevus?
A nevus is essentially a mole but, in this case, a very large one.
Some babies are born with large moles on their bodies from birth.
To some extent, that can happen.
But what if the mole were the size of a palm?
And what if it were on the face?
During my residency, I encountered a patient exactly like this.
I don’t have the original photo of that child, so instead, I will show you a similar example from the medical literature.
The location of the mole was also very similar to the one shown in this image.
It was a congenital lesion covering nearly 25% of the baby’s facial skin.
As the child grows, this would inevitably cause significant difficulties.
The problem is that large congenital nevi like this have clear limitations when treated with laser therapy.
They usually need to be removed surgically.
But if you remove a palm-sized lesion from such a small baby’s head,
How do you close the defect afterward?
It would be very difficult to simply bring the edges together and suture it closed.
In situations like this, university hospitals use a device called a tissue expander.
Simply put, it is like a balloon.
The small white dome at the lower left is the port through which fluid can be injected into the balloon.
After surgically placing the balloon beneath the skin that we want to expand,
we inject fluid into that port with a needle.
As the gray balloon gradually inflates, it stretches the overlying skin.
Since expanding the skin all at once could damage it, the child is usually followed in the outpatient clinic at intervals of one to two weeks, and the skin is expanded slowly over one to two months while carefully monitoring its condition.
Just hearing this, you might wonder:
How much can the skin really stretch, after all?
So then,
shall we take a look together at what happens when the balloon is expanded to the desired volume?
(Wow…)
It looks more dramatic than you might have expected, doesn’t it?
The skin has expanded almost as much as the circumference of the balloon.
More precisely, when a pulling force is applied to the skin over time—
not strong enough to injure it, but sustained enough to create tension
(what we refer to as tension or stretching), the skin is able to expand while maintaining its overall quality.
Now, let’s take a look at the side view as well.
(If you look closely, you can see that three expanders are being used.)
As you can see, the skin has expanded so much that it almost looks as if another head has formed.
At this point, a natural question comes to mind:
If the skin is stretched like this, doesn’t it tear or become too thin?
Interestingly, the paper includes a statement addressing exactly this point
and it matches well with what I have observed in my own experience.
To paraphrase the idea: when the skin is exposed to mechanical stretch beyond a certain threshold,
The human body creates new skin in order to adapt to that tension.
Isn’t that remarkable?
Can you now sense what the final missing piece of the puzzle is?
Together with the surgical outcome of this child, I’ll share the answer in the next post.
