The facelift is one of the main cosmetic surgery options we have to restore a youthful appearance when the lower face and neck have begun their inevitable descent. If you are interested in this cosmetic procedure, you should understand that there is no such thing as a perfect or ideal facelift, and that facelift procedures are constantly changing.
The actual concept of facial rejuvenation has evolved to encompass the concept of remodeling, not just pulling skin more taut. Facial shaping by removing, repositioning, or adding soft tissue, rather than by tightening the skin and muscles alone, is considered the key to achieving optimal results in facial rejuvenation. Some women will have only one face-lift in their lifetime. Others may have another surgery later when the tissues have relaxed again and possibly several more over time. There is no limit on how many facelifts you can have, and it is not uncommon to have more than one in a lifetime.
Here’s what you can expect from facelift cosmetic surgery.
Facelift surgery can be performed under twilight or general anesthesia. Your hair is held back during surgery, but it does not need to be shaved. Traditional facelift incisions generally start above the hairline at the temples and continue along a line in front of the ear or just inside the cartilage at the front of the ear, behind the earlobe, and often stop there. In some cases, the incisions extend back into above and behind the scalp as well. Another small incision may be made under the chin to address the neck. Your surgeon will separate the skin from the underlying fat and muscle. The underlying muscle fascia is tightened along with the platysma muscle in the neck, and excess fat is removed. After the deep tissues are tightened, the excess skin is pulled up and back and then trimmed. The incisions are closed with stitches, and if you have incisions that extend into the scalp, they may be closed with staples. Most people can return home right after the surgery or stay in the hospital or a recovery center as desired.
The superficial musculo-aponeurotic system (SMAS) lift is considered the most commonly performed facelift technique today. In addition to the skin flap face-lift and SMAS technique, there has been a proliferation of new techniques and variations on older methods. Each of these methods has its fans, but no single formula is right for everyone; the surgical plan must be customized for each individual. In some cases the glands located in the neck underneath the chin may be very prominent and need to be removed or repositioned during a face-lift. The traditional face-lift requires a continual incision that starts two to three inches above the ear in the temple, then down in front of the ear for two to three inches around and into the crease behind the ear with an extension into the hair behind the ear.
The modified techniques may cut the scar down to three or four inches in total, usually reducing the scar that extends behind the ear. A modified facelift, also referred to as a “minimal” or “mini”-facelift or “short scar” facelift, may be best for younger women who do not require much correction. It is less invasive, which translates to reduced swelling, scarring, bruising, and risk. The final result replaces anatomic structures where they once resided without changing your appearance significantly.
Smaller scars and even a few days less healing time can make a difference between being able to have a face-lift in the narrow window of time you can set aside and having to delay a lift for a future date. Modified or limited incision lifts have the advantage of a shorter recovery. In general, you will have a better and more natural result at a younger age when the signs of aging are just beginning to appear but are not full blown. The end result is a refreshed appearance.
Methods and technologies for facelifts continue to evolve. These are the most commonly used today:
- SMAS Lift
Excess skin is removed and redraped, the skin and the SMAS, or underlying muscle layer, are elevated and tightened, and fatty tissue under the neck may be suctioned.
- Extended SMAS lift
Excess skin is removed and redraped, underlying muscle layer is freed from the cheek ligaments, and more tension is placed on the muscle layer instead of the skin flap.
- Subperiosteal lift
This lift can be done with the aid of an endoscope and/or via an incision running horizontally across the scalp with or without incisions placed inside the mouth used to free the fat, muscle, and skin layers off the bone so that they can be pulled up and tightened.
- Deep plane facelift
This lift is a total facial rejuvenation, including the upper and lower eyelids, usually an open brow lift, face, and neck; the facial tissues, fat, muscles, and skin are lifted in one continuous section. Deep face-lifts tend to be more invasive than conventional methods and may produce more prolonged swelling.
- Mid facelift
This lift is also referred to as a “cheek lift” because it addresses the triangular shaped section of the middle of the face. This technique does not usually improve the neck or lower face and may be combined with a neck lift procedure.
- Temporal fift (Lateral lift, Lateral brow lift)
This is a more lateral diagonal lift that can produce a youthful swept look to the outer arch of the eyebrow. It can relieve folds and small wrinkles in the forehead, the glabella (between the eyebrows), and the eyes. The temporal lift can also be used to lift the cheek skin and fat to restore a more chiseled look to the cheekbones where fat and loose skin have descended with age. The procedure may be performed open (with a vertical incision in the hairline) or endoscopically (with a small incision using an endoscope to lift the tissues under the skin).
Wendy Lewis is a nationally recognized aesthetics consultant and the author of the Vibrant Nation Health and Beauty Guide, Cosmetic Procedures and Plastic Surgery After 50: Expert Advice for Choosing the Best Option for You.