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A Facelift Primer

By Daniel Baker

Every face is unique in the way it will age over time. Patients eager to experience the benefits of facial rejuvenation will consult with a surgeon to determine which of the many facelift procedures will deliver optimal results for her—or him. Some of the many options are discussed below.

Deep Plane Face Lift

The deep-plane facelift is a modified version of a traditional or SMAS facelift. During a deep plane facelift, the surgeon dissects to a deeper plane of the patient’s face before lifting and repositioning the muscle. As part of the procedure, the surgeon will also separate certain muscle layers from deeper muscles and/or other facial structures.

Advocates of the deep plane facelift say it provides a more natural looking result and improved rejuvenation of droopy skin than a traditional facelift.

Fat Transfer

In this procedure that restores volume for facial rejuvenation, the surgeon uses gentle liposuction to harvest fat from a fat-rich area of the body, then strategically injects it back into the patient’s face. A fat transfer addresses hollowed areas of the face, commonly under the eyes, around the mouth and under the cheekbones.

Afat transfer is often combined with a facelift to provide a “finishing touch” for a more natural looking rejuvenation of the face.

Fat transfer procedures often result in bruising and swelling that can last from one to two weeks.

Thread Lift

A thread lift is a minimally invasive, non-surgical procedure. It uses sutures beneath the skin to pull it up. These sutures differ in how they hook into the facial tissues, but the technique used is generally the same.

A thread lift may be used to lift sagging eyebrows and cheeks, tighten soft tissue of the mid and lower face and neck, and smooth ageing skin. Results are generally subtle and last three to five years.

Laser Lift

Lasers designed especially for cosmetic enhancement use audio-frequency waves to affect the skin’s deeper layers. Lasers provide an excellent means of reducing skin wrinkling, redness, age spots, broken blood vessels, and unwanted hair.

Lasers cannot lift fallen or loose skin, or tighten sagging muscle. Additionally, changes from skin tightening lasers tend to be unpredictable. Not every patient sees improvement, and those that do experience only modest enhancements.

Liposuction

Liposuction is often performed during facelifts or necklifts to remove excess fat from different areas of the face and neck. Facial liposuction is much more delicate, and is performed with much finer instruments than liposuction of the waist, belly, or thighs.

Frequently, facial fat is removed from under the chin and throughout the neck region with liposuction. However, this procedure does not address skin laxity or droopiness, and a patient’s results will depend on his/her own skin elasticity.

MACS Lift

The MACS (Minimal Access Cranial Suspension) lift is related to S-Lift surgery. It is done through a shorter scar, so less dissection is required and therefore less risk of bleeding and other problems associated with lifting the skin from the face.

The MACS-facelift procedure is quicker than the S-Lift, taking an average of two hours versus the four to five required for a traditional facelift.

Mid-Face Lift/Cheek Lift

This type of facelift elevates the fat pad in the cheek (called the malar fat pad) to provide fullness to the under eye area and cheeks, leading to a more refreshed, rejuvenated look.

Results are more permanent than those offered by injectables, and recovery from a mid-facelift is quicker than a traditional facelift.

Mini Facelift/Mini-Lift

Mini facelifts use smaller incisions than traditional facelifts, and healing times can be proportionately shorter. They are effective at reducing minor sagging around the cheeks, jawline and neck. A mini-lift focuses on specific target areas, and cannot affect the forehead or eyes.

Because surgeons cannot dissect the skin and tissue as extensively as with a traditional facelift, this procedure is a poor choice for patients with extensive skin looseness or wrinkling. The best candidates for mini facelifts are usually younger patients with good skin elasticity.

Platysmaplasty

A platysmaplasty is a procedure which targets the platysmamuscle, located beneath the skin on the neck. These muscles can protrude from the neck, resulting in two neck “cords” or bands running vertically down the neck. During a platysmaplasty, the surgeon separates the skin from the platysma muscle to directly treat these cords.

Platysmaplasty is often performed in combination with facelifts and necklifts.

S-Lift

The S-Lift is a type of mini facelift. It gets its name from the incision the surgeon makes, which is in the shape of an “S”. The S-lift can treat the lower third of the face and neck but will not affect the position of the brow and forehead or the appearance of the eyelids.

The S-lift has the advantages of a quicker recovery and short incisions, but is only a good choice for those with mild looseness along the jawline.

Skin Only (Cutaneous) Face Lift

The skin only facelift is the oldest form of cosmetic surgery and addresses ageing skin in the lower face and neck. An incision is made in the hairline through which the surgeon dissects the skin from the underlying muscle and fat,and then stretches it back to make it more taut and firm. Excess skin is removed and the incisions are closed.

Due to the skin’s ability to stretch out over time, this facelift is considered to be less durable than facelifts employing muscle tightening.It also can result in a stretched or “done” look.

Subperiosteal Facelift

A subperiosteal facelift is a very precise procedure which provides a vertical lift to the soft tissues of the face. It allows soft tissue remodelling and repositioning at the level of their bony origins. Its popularity for rejuvenation of the upper two thirds of the face has increased.

Because of the technical difficulty, prolonged recovery, and risks associated with this procedure, many surgeons question whether the subperiostealfacelift offers any advantages to the traditional facelift.

Brow Lift

A brow lift is used with patients who have slightly drooping or lowered eyebrows. The surgeon makes an incision and then lifts the skin on the sides of the brows to increase the space above the eye and beneath the brow.

A brow lift canimprove the appearance of the eyes without the need for a more extensive facelift procedure.

Traditional/SMAS Facelift

This procedure addresses ageing skin in the neck and lower face. An incision is made in the hairline through which the surgeon dissects the skin from the underlying muscle and fat.  In this way it is similar to the skin-only facelift. In a traditional lift, however, the surgeon uses sutures to lift and reposition the muscle layer. The muscle layer is the body’s Superficial Musculo-Aponeurotic System that gives this surgery its name.

Next, the excess skin is removed and the incisions are closed.SMAS muscle tightening is thought to provide longevity to the surgical result.

The decision regarding the best facelift procedure for you will be made in consultation with your surgeon. Together you will discuss

  • The specific areas that you want to improve
  • Your feelings about surgical vs. non-surgical procedures
  • Your expectations regarding the outcome
  • Recovery time
  • Finances