What is a facelift?

A facelift is a surgical procedure intended to rejuvenate the face and neck but there are many different types of facelifts, and these go by several different names. Facelifts can be broken down by the tissue level where they work; SMAS lift, being more superficial than a deeper Subperiosteal lift. Issues that determine the best approach include age, gender, amount of looseness of the skin, bone structure, ability for downtime as well as other factors. All treatments need to be tailored to your specific needs.

The trend is towards using smaller incisions and tightening the muscle layer (SMAS) to reduce the post procedure scarring. In addition, when extra volume is needed under the skin, fat can be repositioned or added and this results in a natural, softer, more youthful appearance.

Facelifts mainly address the lower two thirds of the face and the neck. For patients concerned about the eyelids and brows, other types of procedures including blepharoplasty and brow lifts can be performed, sometimes during the same day. For deep creases next to the nose and around the mouth, dermal fillers represent the treatment of choice. For issues of wrinkles and problems with skin texture, lasers represent the desirable treatment. It is very common to perform BOTOX Cosmetic in addition to fillers in conjunction with surgery for their mutual benefit and synergistic effects..


What are the different types of facelifts?

1) SMAS LIFT
This type of facelift not only repositions and removes excess skin, but also isolates and tightens the thin but strong underlying tissue layer know as the SMAS. As a result of tightening the foundation beneath, the skin over the cheeks, jawline and neck are more easily tightened to give smooth and improved contours. This surgery is customized to certain facial features, such as the amount of skin laxity and depth of the nasal labial folds.

2) Subperiosteal Lift
A subperiosteal facelift, releases tissues off the bone and is sometimes done through a scope. Swelling and downtime may be greater when performing this surgery. Most don’t believe that the subperiosteal approach adds any advantage over the SMAS technique, which has become the gold standard in facelift surgery today. Some feel the longevity of tightening may be better with this technique.



3) Deep Plane Facelift
This technique is used to reshape the entire face – including the upper and lower eyelids, the brow, and the neck – by lifting the facial tissues, fat, muscles, and skin in one continuous section. It is more invasive than other methods, and may require longer recovery. This technique is used infrequently as most people can achieve very satisfying results with one of the less invasive procedures.


Where are the incisions for a facelift?

Traditionally, an incision is made that starts two to three inches above the ear in the hairline behind temple which extends down in front of the ear for two to three inches and around the ear lobe, and then into the crease behind the ear with an extension into the hair behind the ear. Modified techniques are becoming popular which reduce the length of the incision behind the ear and into the scalp. We prefer to use the modified facelift approach, also known as the “minimal” facelift, “mini” facelift or the “S-Lift”, on younger patients who generally have less skin laxity to correct and are thus able to have a shorter scar. In another modified approach, the incision stops short of the hairline and extends around and in front of the sideburn area to minimize the alteration of the sideburn or temporal hairline location. This technique also works well for men who may not have thick enough hair to cover scars.


4) Mid - Facelift
Signs of aging along the middle section of your face include increased definition between the lower lid and cheek area. It is here, where the hollow of the eye begins to appear more defined and the natural smooth transition between the cheek and the area below the eyelid now becomes very distinct. In addition, the deep folds which extend from the sides of your nostrils down to the corner of your mouth (nasolabial folds) become heavier as the cheek tissues descend. The mid face-lift or “Cheek Lift,” improves loose or hanging skin and soft tissue along the middle of your face but does not improve the contours of your forehead, jawline or neck.

Mid-face lifting has taken on a new focus in the past several years. As the triangle between the lower eyelid and nasolabial folds begins to age, the cheek begins to descend. Plastic surgeons began to notice that despite all efforts at traditional face lifting and correction of the jawline, neck, and side of the face, the mid-face area just to the side of nose and below the eye was not greatly improved by a facelift alone. Detecting the presence of aging signs in the mid-portion of the face and making a plan to correct the problem is more important than which fixation technique is ultimately chosen. When this area is overlooked by you and/or your surgeon and not properly addressed, a satisfying rejuvenation may not be achieved.

Where are the incisions for a mid-face lift?

Traditionally, a midface lift is performed through incisions along the lower eyelids and is often carried out in combination with an eyelid lift and/or facelift. During a traditional face lift, an additional incision can also be made inside your mouth to help to release the mid-face tissues. The tissues are then suspended by use of sutures or dissolvable devices. The Endotine® is an example of one of these dissolvable devices and is made of an absorbable material that acts like a carpet tack in holding up the elevated tissues and then dissolves over the next few months.

During the surgery the skin is separated from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. Next the underlying muscles are tightened, the skin is pulled back and excess removed. Stitches secure the layers of tissue and close the incisions; metal clips may be used on the scalp.