Types of Facelifts – How to Choose the Right Technique for You

Facelift surgery is intended to address laxity in the skin that develops with aging, natural loss of volume in the face in the areas where fullness is desired (such as over the cheekbones), and skin laxity and fullness under the chin that can be present even at young ages. There are various facelift techniques that exist.

The Different Types of Facelift Techniques

Facelift techniques can generally be broken down into facelifts performed under general anesthesia, sub SMAS facelifts, deep plane facelifts, and sub-periosteal midface lifts. Most surgeons will use one of these techniques with their own modifications. Sometimes surgeons will rename one of these basic types of facelifts with their personal modifications to assist with marketing and to differentiate themselves from their competition (Vertical Restore, Auralift, Swiftlift etc).

Surgeons may sometimes choose to give a name to a group of procedures performed together, for example, a brow lift and a facelift are often done together and they may be marketed as one named procedure. It is helpful to know what the different procedures generally entail. At Utah Facial Plastics, we generally use descriptive terms to market our surgeries as opposed to renaming commonly performed techniques.

Awake Facelifts of Mini Facelifts

Awake facelifts involve tightening the deeper muscular layers of the face in addition to the skin in patients under local anesthesia. The incisions are generally shorter than facelift incisions that are made in patients under general anesthesia. At Utah Facial Plastics, we perform the MACS lift which involves incisions under the sideburn and in the creases around the front of the ear. Sutures are used to tighten the deeper muscular layer and extra skin is removed. This is performed without general anesthesia and has a short recovery time. It’s effect is primarily on the jowls and extra skin in the lower third of the face and has little effect on the skin of the neck.

Sub-SMAS Facelifts

Sub-SMAS facelifts involve making incisions under the sideburn in the creases around the front of the ear, up the back of the ear, and then down the hairline. The deep tissue layer in the face is elevated and suspended upwards towards the ear. The deeper attachments to the deep muscle layers and to the bone are not disrupted. The muscle in their neck is elevated from the back end suspended towards the hairline to deepen the neck angle and refine the jawline. Extra skin is trimmed and removed. This procedure is normally performed under general anesthesia.

Deep Plane Facelifts

Deep plane facelifts are the most commonly talked about and performed facelift currently and comprise the bulk of the facelifts that we perform at Utah Facial Plastics. The incisions are the same as for a sub-SMAS facelift. The difference is that the attachments that hold the skin to the deeper tissues and bone are released allowing for more lifting of the tissue of the cheek and jowl. The muscle is elevated in the neck as well. This is then tightened and suspended behind the ear to define the jawline and remove excess from the neck. In both cases the skin is gently re-draped and trimmed.

Patients often question whether they will have a natural look after a facelift. Even though the deep plane facelift gives you a large amount of movement of the cheek in jowls, the face is not tightened excessively to the point that it looks unnatural. Patients find that they get a repositioning of the desirable fat of the cheeks back up onto the cheekbones. This helps to add fullness to the cheeks and contributes to a heart-shaped face. It also helps to blend the area between the lower eyelid and the cheek, helping to reduce dark tear troughs. The jowls are reduced significantly because the deeper tissue layers under them are elevated and tightened.

In some patients, prominent buccal fat leads to fullness of the cheeks and can also contribute to the appearance of having large jowls. During a deep plane facelift, the buccal fat is clearly visible after the tissue has been elevated. If the buckle fat pad is prominent, the fact can be removed without having to make other incisions. This helps to further slim the bottom third of the face and contribute to a more heart-shaped appearance.

Subperiosteal Midface Facelifts

The subperiosteal midface lift is a less commonly used facelift technique. It involves making an incision in the temporal region behind the hairline. The deeper layers are elevated from the cheekbone across the cheek to the nose and down to the corner of the mouth. The fat of the cheek and the jaws are lifted in a nearly vertical direction. This technique can be very useful for patients with severe sagging of the skin and fat of the cheek and for patients who have had trauma or a paralysis of the nerves that move the face. There is a longer healing time involved with the midface lift and generally most patients are better candidates for a deep plane facelift as you get a very significant and natural amount of lift with less downtime.

Any of the facelifting techniques can be combined with work on the fat and muscle under the chin to help deepen the neck angle. In patients with a significant amount of fat under the skin and fat under the muscle that sits under the chin, it can be beneficial to remove some of this fat and tighten the overlying muscles. This is done on a case by case basis on patients with significant fullness under their chin, taking care to remove only enough fat to reduce the fullness in that area without causing hollowing.

Facelift technique selection should be based on the goals of the patient, taking into account their individual anatomy and medical history. A consultation with a surgeon will help define the goals of surgery and set expectations for outcomes and healing time. A thorough review of before and after photos and patient reviews are a good indicator of the quality of the experience that patients can expect with their surgeon.

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