Posted on November - 23 - 2014

The “Natural” Facelift

A “Natural” facelift is what it implies–there are none of the unwanted tell-tale signs of a facelift. What are the signs:

  • Draping of the lower face–this is sweeping of the skin from the mouth to the ear, like drapes pulled to one side.
  • Wind-tunnel look
  • The cheek area and hollow under the cheek (tear trough) left uncorrected
  • Earlobes pulled down
  • Scars in front of the ears pulled forward, wider, and very visible

How are these signs avoided? Regardless of the name surgeons call their procedure, the goal of a facelift is to return the face to where it was before the aging process took its toll. This seems so obvious, but a common error with many facelifts, in my opinion, is to pull the skin horizontally toward the ears. But, gravity pulls the face downward. To properly correct the sagging face, the primary direction of the “pull” on the tissues with a “Natural” Facelift is upward– the opposite of the pull of gravity.

In addition, it must be remembered that skin is not a strong supporting structure, so you can’t pull on it and expect it to hold the face up.  For the facelift to look natural and longer lasting, the majority of the “pull” should be on the  SMAS, which is the stronger tissue just under the skin. When SMAS is the main tissue for traction, there is minimal need for traction on the skin. This eliminates the tight skin, pulled, or “wind-tunnel” look, which results from too much pull on the skin. Plus the scars do not widen from excess tension on the skin.

The traction on the SMAS must pull upward and also must begin near the mouth to diminish the signs of aging near the mouth, jowl, and cheek areas. Yes, a “Natural” Facelift can still be less invasive, shorter scar, shorter recovery, and a less extensive facelift, but will last years longer because of the direction of the “pull” on the stronger structures–thus, a “Natural” facelift result.

If there is significant loss of volume of the face, either long-term fillers, such as Sculptra or Voluma, or fat transfer should be performed at the same time as a “Natural” Facelift for convenience, but can be done at a later time. Loss of volume is one of the primary signs of aging, so this is an important step in a “Natural” Facelift.

The expected result of a “Natural” Facelift creates a more youthful looking face without the deep hollows under the eyes; the depression between the deflated cheek and the nasolabial fold (the Tear Trough); a tighter neck and elimination of the jowls. And, without the obvious signs that indicate someone has had a facelift.

Website: Finger & Associates
Phone: 912-354-4411

Posted on October - 30 - 2011

What should I do: get a facelift, fillers, or both?

 Patients ask me this question all the time. While there’s no pat answer, because each patient’s case is different, here’s some overall rules of thumb.

Facial volume loss: one of the reasons you look older

First, think about what happens when you age. Everyone knows that we lose elasticity as we get older and skin sags, but few realize another primary cause of looking older: facial volume loss. Inevitably, our faces deflate – less so, if we’re considerably overweight.  In fact, isn’t it ironic that as we get older we lose the fat around our face and usually gain it around the middle and other places?

A facelift pulls the tissues upward and tightens sagging. The result: the face looks tighter but the shape still isn’t that of a youthful person.

Just consider the appearance of a young person’s face. Their cheeks are plump and circular. In a youthful person’s face, the cheek usually starts at the lower lids, goes to the nose, down to the level of the lips, and then circles back to the eyes.

With time though, a depression in the tear trough forms and deepens. The tear trough starts at the inner area under the eye, goes downward and spreads outward on the face. As a result, the once round, full cheek is deflated and becomes smaller. We also get hollows underneath the lower eyelids and depressions and shadows in various areas of the face. This is where fillers come in: they restore the lost of volume. Often times the result is dramatic, so much so that many plastic surgeons refer to injectables as a ”liquid facelift.

There are many injectable filler options, such as Restylane, Juvederm, Artefill, and Sculptra. As part of the overall procedure, these products are often used in conjunction with each other and in addition to Botox. These products are best used in different ways and in different places, and their specific applications vary somewhat, too.

Surgical Facelift: When a Liquid Facelift is Not Enough

With the passage of enough time, you’ll need to address the problems of lost volume and skin elasticity.

And given enough passage of time, both fillers and a facelift are necessary to look your best and youngest.  

Often when one starts seeing a plastic surgeon at a young age, the fillers are used first, and this may delay a facelift for many years. However, if the sagging is advanced or someone has excessive sun exposure and skin damage, it may be best to start with a facelift first, understanding that fillers will be an excellent complement at a later date or even during the actual face lift. Of course, as I said at the start, everyone is different and their problems should be addressed according to their needs.

Website: Finger & Associates
Phone: 912-354-4411

Posted on October - 26 - 2010

Neck Lift, What is the Latest?

The iGuide Neck Lift is the answer.  Who over forty likes their necks?  Very few people.  It’s one of the most common complaints that I hear as a plastic surgeon.  Our choices for treatment have been many, from lasers to face lift surgery, which includes the neck.  However, for those who are in their thirties and forties and those who are not ready for major surgery, the options have been the following:

  • Lasers, such as the Fraxel’s.  These do tighten the necks, but not dramatically.
  • Liposuction—for those with mostly excess fat in their necks.  This is very successful   and the recovery time is minimal.  Also most can be performed under local anesthesia.
  • Removal of the excess skin, and fat, if necessary, through a vertical excision in the front of the neck. This is an excellent procedure, but leaves a visible vertical scar in the front of the neck.  While the scars are not usually that obvious, no one likes the idea of the scar, including your plastic surgeon.
  • The iGuide Neck Lift—an ingenious technique which takes about an  hour to perform, requires only mild sedation and local anesthesia and requires a dressing for three days, which is minimal recovery.  Bruising is usually none to minimal, and swelling virtually absent.  If liposuction is done at the same time, there may be more swelling and bruising. but not usually significant.  The procedure basically is creating a trampoline effect with a single suture that goes from one side of the jaw to the other, across the neck.  It tightens the neck much like a shoe lace tightens your shoe.

Even though the iGuide Neck Lift is relatively new, I expect the demand to be high because of its simplicity, local anesthesia and short recovery time.

Before and after iGuide neck lift procedure (2 months)

E. Ronald Finger, MD
Finger and Associates Plastic Surgery Center, PC
Savannah, GA

Website: Finger & Associates
Phone: 912-354-4411

Posted on April - 04 - 2010

My new book, “Why Grow Old,” now available!

I have finally placed my experience, research and knowledge of both plastic surgery and anti-aging between two covers, a six year effort.  The name of the book is Why Grow Old, published in 2010.  So far, it can be purchased at the New Youth Medical Spa in Savannah, GA.

New Youth Medical Spa
5356 Reynolds Street
Savannah, GA 31405.

Email: or complete this form.
Phone: 800-868-9301 or 912-354-4411

Price:  $24.95.

Why should you read this book?
This is a scientific health book for the non-scientist, non-physician.  This is not a diet book, but is a comprehensive book on why we grow old from our cells to our bodies as a whole, and how we can thwart and even reverse the aging process. It is a guide to nutrition, supplements, hormones, skin care, exercise and plastic surgery toward feeling and looking your best. Discussed are many important aging processes that are related to how we live and our habits that most people have never read about or heard of.

Subjects discussed in this book:

  • Causes of aging on a molecular level
  • How to turn back the clock
  • Effects of poor nutrition and bad habits on health and appearance
  • Anti-aging supplements and foods
  • How to grocery shop for health
  • Skin and how to keep it youthful forever
  • A hormone guide for both men and women
  • Exercise—how and why
  • Plastic surgery—a thorough discussion of all procedures, both surgical and non-surgical and information to help assure your best results.

Chapter Titles

  1. Causes of Aging
  2. Nutrition and Supplements
  3. Hormones and Aging
  4. Aging and Your skin
  5. Exercise—How and Why
  6. Plastic Surgery: a comprehensive review of both surgical and non-surgical procedures

Appendix 1: Choosing effective nutrient supplements
Appendix 2: Whole for sources for each nutrient and the nutrient’s function
Appendix 3: Now to grocery shop for optimum health

Who is Dr. Finger?
Dr. E. Ronald Finger is a plastic surgeon in Savannah, GA.  He was born in Marion, South Carolina and is a graduate of Emory University, Atlanta, GA. and Medical College of South Carolina in Charleston. After an internship at Grady Memorial Hospital, he completed his general surgery residence at Tampa General Hospital and his plastic surgery residency at Wilford Hall Medical Center, Lackland AFB while in the USAF. In 1973 he was discharged as a Lt. Colonel, became certified by the American board of Plastic Surgery, married his present wife, Cheryl, and moved to Savannah, GA. Shortly thereafter, he opened the first outpatient plastic surgery center in Georgia and became well known, nationally and internationally, for his plastic surgery. Dr. Finger then opened the first medical spa in the coastal area in 1998 and developed the New Youth Skin Treatment System, a cosmeceutical line designed to make your skin look like a child’s.  New Youth products are sold nationally and abroad.

E. Ronald Finger, MD

912-354-4411/ 800-868-9301

Savannah, GA

What are people saying?

I picked up your book, Why Grow Old,” over the weekend and could not put it down as I am totally of the belief that we can age without growing old. I have been practicing ant-aging for many years. I find it fascinating to learn about and read all that I can to stay up on the latest findings. I found your book very enlightening and comprehensive. It covers all areas and in great detail. This an invaluable tool for anyone on the path to slowing down the aging process and getting and staying healthy. I found it easy to read and understandable, I finished it today. Thank you so much for taking the time and energy you invested in this magnificent book.


Educational, informative and as Dr. Finger says, “Good health is beautiful.” A must read for everyone concerned with their health and well being.

Barbara A.

I found Dr. Finger’s book interesting and understandable from a lay persons view. With his book as my guide, I have developed a health improvement plan I am confident will help me maintain a high quality of life for many years to come.

Henry H., Retired VP
Age 77

It is so informative and interesting. I especially enjoyed reading about how to eat right and to execise and how to protect yourself from sun damage and how to take care of your skin. It is always important to get a reminder of how to do things right. We may know how, but we become lazy or forget. There is so much information in the book that you can’t remember it all, but it is a great book to keep coming back to for looking things up. I know I will.

Kerstin Clark
Savannah, GA

Website: Finger & Associates
Phone: 912-354-4411