As we age, the soft tissues of the face (skin, fat & muscle) tend to sag, creating deepening of certain creases of the face. Jowls form along the lower jaw and the tissues of the neck tend to sag as well. In addition to the effect of gravity and sagging tissue, faces also tend to lose volume over time. Many procedures have been develop to improve this aged appearance. As is common with many cosmetic procedures, fads have come and gone that promise maximum results with minimum recovery or incisions. In general, time has proven what most Facial Plastic Surgeons have agreed that the more extensive the surgery, the better and more long-lasting results that are produced. That being said, there are still a range of options for each individual that must be tailored to your anatomy, preferences, and expectations.
Contrary to some surgeons opinions, we feel that a one size fits all approach does not apply when considering any cosmetic procedure, especially facelifting procedures.
One basic principle in facelifting is that the soft tissues of the face have begun to sag and created deepening of facial creases and descent of fat pads in the cheeks, jowls and neck–the goal of facelifting is to re-suspend those tissues into the natural position where they started, thereby recreating a more youthful appearance. The method by which this is accomplished is the main difference between the following procedures. They are listed in order of least invasive (minimal incision/recovery time) to the more invasive procedures. Again, in general, the more invasive the procedure the more significant and long-lasting the changes.
In addition to the skin, muscles and fat pads in the face and neck, there is a structure referred to as the SMAS (superficial musculoaponeurotic system). This structure serves as the basic underlying structural framework of the tissues of the face. Suspension of the SMAS into a natural position is the key to any successful facelifting procedure.
Of note, these procedures address the sagging of tissues. Another key issue in most aging face procedures involves restoration of facial volume. This is often performed concurrently with some of the lifting procedures. More details can be found here.
Threadlifting (AKA Suture Suspension, Non-Surgical Facelift, Contour Lift)
Threadlifting™ was developed in order to minimize the recovery of a facelift procedure. It is accomplished by placing barbed sutures underneath the skin and then pulling the soft tissues up into a more youthful position. This procedure is performed under sedation, avoiding general anesthesia in most cases and has a minimal recovery period. Unfortunately, because this procedure does not re-suspend the SMAS, the effect is only temporary, with most experts now agreeing three to six months is the maximum time period during which any improvement may be seen.
Significant complications have also been noted with this procedure, with abnormal “bunching” of the skin, infection of the threads themselves and significant difficulty with removal being among the primary issues noted. For these reasons, most experts in the field (including Dr. Pero) have abandoned this procedure. Dr. Pero has experience in the past with this method but does not perform it any longer, due to the excessive risks with no significant lasting improvement seen. Threadlifting™ serves as a cautionary tale to prospective cosmetic surgery patients. It held much promise when initially introduced but time has proven its limitations.
In other words, the latest and greatest procedure often is too good to be true after all.
Traditional Facelift Techniques
The remainder of the variations on facelifting primarily differ with respect to the length and design of the incision and the amount of dissection (and therefore amount of tissue suspended) performed on the deeper tissues of the face, especially regarding the management of the SMAS tissue.
Limited Incision Facelifts (S-Lift, J-Lift, Weekend Lift, Minilift, Lifestyle Lift, etc.)
The limited incision facelifts describe just that, a minimum length incision in front of the ear and extending a variable length below the earlobe, behind the ear and into the hairline. Limiting the incision length also limits the amount of dissection of the soft tissues of the face, including the SMAS, thereby limiting the amount of lift that may be achieved.
Some of these procedures do not include any suspension of the SMAS and are essentially just a lift of the skin. When performed in this manner, it may provide for a quick recovery but limits the long-term results, and, more importantly, risks wide, highly visible scars.
Depending on each patient’s anatomy, a shorter scar may be possible while still allowing for adequate exposure to address the areas needed to provide for the patients best possible result safely.
The traditional approach to a facelift employs an incision that begins in front of the ear with extension into or around the sideburn and extends below the earlobe, behind the ear and into the hairline posteriorly. Dissection is performed with the skin elevated and the SMAS is suspended via one of several techniques.
The Deep-Plane Facelift
The deep-plane facelift is an extension of the traditional facelift dissection of the deep tissues into the cheek. By performing a more extensive dissection, there is a more complete lift that is able to be performed with longer-lasting results. This procedure may be associated with longer recovery and has a increased risk of nerve weakness or paralysis of the facial muscles that is almost always temporary but in a small percentage of cases, can be permanent.
Correction of sagging tissues in the neck is performed through a limited facelift incision. It can correct mild to moderate jowls as well as sagging skin and excess fat in the neck. In some patients, sagging muscle produces a characteristic “turkey gobbler” appearance. This may be able to be corrected via a small incision hidden beneath the chin or may require a limited facelift incision as well.
In some younger patients it can achieve a significant improvement in neck contour, especially when see from the side view.
Liposuction of the neck and face are often combined with some of the above procedures in order to achieve a more complete rejuvenation. This is performed through the same incisions as described for the facelift and/or necklift.