When it comes to surgery there are just as many ways to perform a facelift as there are songs on a radio or fish in the sea. The fact is that however not all facelifts are created equally. Not everyone is getting from point A to point B. So let’s discuss the different types of facelifts and what you need to know from a patient’s perspective. I also describe some of my techniques that I am performing in both my Southlake and Fort Worth TX offices.
Skin Only Facelift
This is the most simple form of lifting the face. Take skin out and close the incisions. Do people do this? Unfortunately yes. What’s the problem with a skin-only facelift? There are a number of issues. First of all, you are putting all the tension on the skin. We know that when there is tension on skin incisions, there is widening of scars. Nobody likes wide scars. Secondly, if all the tension is on the skin but the fat below the skin is still where is was, we can assume the results will be less impressive and not last very long. Both of these things are true.
SMAS folding or “plication” facelift
This technique is fairly simple again but involves suturing the deeper layer of the SMAS (Superficial Musculoaponeurotic System). By using suture to elevate this layer onto itself, it creates some lift of the deeper fat pads and creates less tension on the skin. Do people do this? Yes, it is actually quite common. Why don’t I do this? The results and movement of the SMAS are quite limited in the folding technique because the attachments on the under surface are still there and have not been released.
Extended SMAS facelift
This technique takes the additional step of actually making an incision and releasing the SMAS from underlying structures. There is a gland under the SMAS layer that is a safe surgical layer to dissect. In this surgery, release of the SMAS occurs to the edge of that gland. This allows slightly more mobilization of the deeper fat layers and again less tension on the skin. This technique is quite common. Why don’t I use this technique? I have used this technique and think it is a good one, however there are better techniques that allow for more improvement in the SMAS and fat pad mobilization.
Deep Plane Facelift
This technique involves the release of the SMAS and adds on releasing the ligaments of the face. Ligaments of the face are attachments from deep structures (bone, muscle) into the SMAS and skin. One example is the zygomaticocutaneous ligament. This attaches from the zygomatic arch (cheek bone) to the skin. By releasing the attachments of these ligaments the SMAS is further mobilized and a more dramatic improvement is achievable. There are a number of variations of the deep plane facelift that incorporate other incisions, change the location of incisions, include dissection and release of different muscles in the face. Some of those variations include the composite facelift (popularized by Dr. Sam Hamra) and the High SMAS lift (popularized by Dr. Fritz Barton). This is my preferred method of facelifting due to the amount of mobilization I can achieve in my hands. This mobilization allows repositioning of the sagging fat pads and allows a tensionless closure on the skin. Meaning results are better and scars are almost undetectable! Check out the facelift page to take a look some examples of the scars. You can zoom in as much as you’d like and they’re difficult to find – even in person.
This term is used to refer to nonsurgical techniques of lifting the face. The term liquid is a bit of a misnomer but refers the hyaluronic acid gels found in fillers. These fillers are used to volumize the face and when done properly can support and lift the ligaments and fat pads of the face. The downtime is minimal but results typically last about 1 year.
There is nothing new about thread lifting. This has been around for over 20 years but comes and goes through waves of popularity. The idea is that threads can catch some of the deeper layers of SMAS and suspend them higher. There is no removal of skin, so the excess skin is still there. In general, these procedures are quite disappointing for patients due to the cost of the threads, the short duration of action, and the rather minimal results. Now that you all understand some of the techniques you could see that this technique does not address the layers effectively.
These energy based lifts are utilizing heat (mostly) to create small amount of damage to the subcutaneous tissues. This allows some contraction of the skin and reduction of fat. The effects allows some tightening of the overlying skin which can create a very mild lift. Patient selection is key with these techniques and making sure you have realistic expectations of the results. In some patients a mild improvement is all they need and these techniques may be appropriate. Being too aggressive with these techniques can create damage to the underlying fat which can actually create more issues in the long run.
Did I miss one? Let me know. Again there are a bunch out there. I’ve tried to keep this list short without including too many. Thanks! JR