Types of Facelifts
A variety of different types of facelifts and facelift techniques are performed today. Several of them are described here. Your surgeon will discuss with you which type of facelift is right for you, or which combination of techniques will give you an optimal result.
Cutaneous, or Skin Only, Facelift
A cutaneous facelift addresses the lower face and neck. It involves an incision made in the hairline, starting above the ear, continuing behind the ear, curving around the ear and ending in the hairline behind the ear. The surgeon dissects the skin from the underlying fat and muscle, stretches it back, trims excess skin, and closes the incisions. This is the oldest form of facelifting, and poses little risk to underlying facial muscles and nerves. Due to the skin’s ability to stretch out over time, this facelift is considered to be less durable than facelifts employing muscle tightening.
Like a cutaneous facelift, traditional facelift addresses the lower face and neck. It involves an incision made in the hairline, starting above the ear, continuing behind the ear, curving around the ear and ending in the hairline behind the ear. The surgeon dissects the skin from the underlying fat and muscle. He will then use sutures to lift and reposition the muscle layer (“SMAS” – superficial musculo-aponeurotic system) toward the ears. This muscle tightening is thought to provide longevity to the surgical result. Next, the excess skin is removed and the incisions are closed.
The SMAS facelift is another term for the traditional facelift. “SMAS” refers to the superficial musculo-aponeurotic system.
Deep Plane Facelift
The deep-plane facelift is modification of the traditional facelift. During this type of facelift, the surgeon will dissect to a deeper plane of the patient’s face before lifting and repositioning the muscle. Additionally, the surgeon will separate certain muscle layers off of deeper muscles and or other facial structures. Proponents of this procedure believe it offers certain advantages to a traditional facelift including a more natural result and improved rejuvenation of droopy skin. On the other hand, this technique has a higher risk of facial nerve injury and many surgeons dispute that it offers a significant advantage to the traditional facelift.
This type of lift targets the eyebrow area. Surgeons will use this type of lift to address patients with slightly drooping or lowered eyebrows since they can use this procedure to give the eyebrows a lift without having to perform a more extensive full browlift procedure. During this procedure, the surgeon will make an incision and lift the skin on the sides of the brows.
Platysmaplasty or Submentoplasty
A platysmaplasty is a procedure which targets the platysma muscle which is located beneath the skin on the neck. As part of the aging process, many people will notice that these muscles begin to protrude from the neck resulting in two neck “cords” or bands running vertically down their necks. During a platysmaplasty, the surgeon will separate the skin from the platysma muscle directly treat these cords. A platysmaplasty is commonly performed with facelifts and necklifts.
As the name implies, a necklift targets a drooping or sagging neck area. Incisions are typically shorter than those made during a traditional facelift and will normally be placed only at the earlobe and behind the ear. A platysmaplasty is commonly needed on necklift patients to remove any pronounced neck cords. Finally, the surgeon will remove any excess fat from the neck area by using liposuction or similar techniques. In patients with excellent skin elasticity, a necklift may be performed alone. More commonly, when skin elasticity is fair or poor, a facelift is performed as well, to remove excess skin that would otherwise remain.
Liposuction is often performed during facelifts or necklifts to remove excess fat from different areas of the face and neck. Oftentimes, fat is removed from under the chin and throughout the neck region. Liposuction may be performed as a stand-alone procedure, however, patients should know that liposuction alone will not address skin laxity or droopiness and a patient’s results will depend on his/her own skin elasticity. When performing liposuction, the surgeon will mike a tiny incision, usually under the chin. He will then use a small cannula attached to a suction apparatus to carefully remove the fat to allow optimal definition of the chin and neck regions. Facial liposuction is much more delicate, and is performed with much finer instruments, than liposuction of the waist, belly, or thighs.
The midface lift is a relatively new procedure. Its goal is to lift soft tissues in the cheekbone area in order to alleviate the appearance of nasal labial folds and hanging skin in the middle of the face. Some surgeons combine the midface lift with traditional facelift. Others may choose to perform cheek implant surgery or fat transfer surgery to achieve a similar result.
The subperiosteal facelift is a facelift which is performed at the very deepest layers of the facial structure. It is deeper than a deep plane facelift. The term “subperiosteal” refers to the area directly on top of the facial bones. Many surgeons question whether this technique offers any advantages to the traditional facelift given the technical difficulty and prolonged recovery and risks associated with this technique.
There are many types of mini facelift techniques. In general, mini facelifts will use smaller incisions than traditional facelifts, and healing times can be proportionately shorter. Because surgeons cannot dissect the skin and tissue as extensively as with a traditional facelift, this procedure is a poorer choice for patients with extensive skin looseness or skin wrinkling. The best candidates for mini facelifts are usually younger patients with good skin elasticity.
An S-Lift is a type of mini facelift which has been modified such that the incision is made in an “S” shape. This face, plus the inventor’s last name – Dr. Zia Saylan – give the procedure its name. The S-lift has the advantages of quick recovery and short incisions, but is only a good choice for those with mild looseness along the jawline.
MACS Lift, QuickLift
The MACS lift and QuickLift are modicications of the S-Lift technique. Their risk, recovery, and invasiveness are greater than the S-Lift, but less than a traditional facelift. They can be a good choice for mild to moderate aging changes of the face, and are often combined with submental liposuction or platysmaplasty.
The Lifestyle Lift® is a branded procedure offered in various Lifestyle Lift centers throughout America. It is a type of mini facelift.
Thread Lift, Feather Lift
A thread lift uses sutures beneath the skin to pull it up. There are a variety of sutures on the market today used for this purpose, such as Contour, APTOS, and Silhouette etc. These sutures differ in how they hook into the facial tissues, but the technique used is generally the same. Results are generally subtle at best, with questionable durability.
Fat Transfer (Lipostructure)
Fat transfer is a technique in which the surgeon uses gentle liposuction to harvest fat from an area of the body, usually the belly or thigh, and then strategically injects it back into the patient’s face in order to restore lost fullness. Fat transfer addresses hollowed areas of the face, commonly, under the eyes, around the mouth and under the cheek bones. Though many injectable fillers on the market also address these same areas of concern, when a patient has a large volume deficit, fat transfer may be preferable economically. Injectable fillers are usually priced per cc, whereas fat transfer would have one surgical fee associated with no limit to the volume of fat placed into the patient’s face. Another difference between injectable fillers and fat transfer that patients may want to consider is recovery time. Injectable fillers have little to no recovery, whereas fat transfer procedures will often result in bruising and swelling that can last from one to two weeks. Finally, because fat is a living tissue, there is some unpredictability in the amount of fat that will survive the transfer, and second or third procedures may be needed to achieve the desired result. Many times, fat transfer will be combined with a facelift to provide a “finishing touch” for a more natural rejuvenation of the face.
Non-Surgical Facelift a.k.a. Skin Tightening and Thermage®
Thermage® is a trade-name for a type of skin tightening which uses a laser. The laser applies radiofrequency waves to the skin’s deeper layers. This causes the collagen in the skin to contract, thereby causing the skin to tighten. Changes from Thermage and skin tightening lasers tend to be unpredictable – not every patient sees improvement – and modest. Patients looking for greater improvement in sagging skin may not achive desired results from this procedure.
Lasers provide an excellent means of reducing skin wrinkling, redness, age spots, broken blood vessels, and unwanted hair. They are not capable, however, of lifting fallen or loose skin, or tightening sagging muscle. Only surgical techniques can provide these, deeper changes. Lasers are often used to treat wrinkles around the mouth and eyes when lifting procedures are done for the brow, neck, and jawline.
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