Facelift

Your will hear many names and types of facelifts in your research.  It isn’t as confusing as it may seem at first.  They are all variations of the basic facelift.  The goal of the facelift is to remove excess tissue and improve the contour of the cheeks and neck.  A full facelift is required if there is significant excess tissue of both the cheeks and neck, a mini-facelift for cheeks alone, and necklift for isolated neck excess.  Simple.

Full Facelift

A full facelift is chosen when there is significant aging of both the cheeks and neck.  It requires a well hidden incision in front of the ear and then extends behind the ear.  The length of incision (and hence, the scar) is determined by the amount of excess skin to be removed.  The skin is lifted, the deeper layers of tissue (SMAS) are tightened and excess skin removed.  How exactly that is accomplished varies from patient to patient depending on individual anatomy.

The key element of the facelift is tightening of the SMAS layer; removing excess skin without addressing the loose SMAS layer is inadequate.

Liposuction of the neck and tightening of the neck muscles (platysma), limited skin resurfacing and fat injections are commonly performed at the time of the facelift.  Combinations of procedures including facelift, blepharoplasty (eyelid surgery) and browlift are frequently performed at the same time, safely.

Mini-Facelift

A mini-facelift is performed to tighten the cheeks.  We use a shorter incision (well hidden in front of the ears) rather than the full facelift incision extending behind the ear.  The skin is lifted off the underlying structures.  The SMAS layer is tightened in the cheek and excess skin removed.  Liposuction of the neck is performed for excess fat.  The platysma muscle is sometimes tightened through a small incision under the chin crease.

A mini-facelift is especially useful in the younger patient with early signs of aging and minimal neck excess.  Fat injections for the cheeks and area around the mouth and blepharoplasty are commonly performed at the same time.

Necklift

Just as the mini-facelift can be thought of as “the front part” of a full facelift, the necklift can be thought of as “the back part” of a full facelift.  The necklift incision is focused behind the ear and can be extended into the scalp.  It is used for patients with excess skin and fat localized to the neck.  This is a frequent option for men.

Again, the incision is made, skin lifted and fat removed.  The SMAS and platysma is tightened below the ear and sometimes in the central neck (platysma plication) through an incision hidden below the chin (submental incision).

Mid-Facelift

Don’t confuse this with a mini-facelift; it is a very different procedure.  Mid-facelift is also referred to as a Vertical Cheek Lift or Cheek Lift.  The mid-facelift raises the bulk of the cheek tissue which is suspended in a higher position.  An incision is made behind the hairline at the temples and an incision is made in the mouth (or sometimes, the lower eyelid).  Through these two incisions, the cheek is lifted off the underlying bone.  The cheek tissue is elevated and suspended in an uplifted position.

The mid-facelift does not remove excess skin; rather, it repositions the cheeks vertically and softens the lower lid – cheek junction.  It is reserved for early aging changes without excess skin.

COMMENTARY ON FACELIFT (Dr. Anson)

My patients often ask what the difference is between a full facelift and the mini lifts that are extensively advertised and performed in one hour under local anesthesia.  The answer is one of degree.  There is nothing wrong with choosing a ‘smaller’ procedure but results will not be comparable to a more extensive facelift.

In our office, we perform the full spectrum of facelifts.  The most extensive would be a full facelift performed in a surgery center under IV sedation or a light general anesthetic.  This is likely to be performed in conjunction with other procedures (blepharoplasty, browlift, fat injections, etc).  The simplest procedure would be a mini-facelift or necklift performed under local anesthesia.

In my opinion, which direction a patient will go should be determined through a detailed consultation with a plastic surgeon that is capable of performing all types of facelift.  Then, that decision should be based on what a patient truly needs physically, what they will be satisfied with, and what they are willing to do to achieve that goal.

Smaller facelifts are commonly done in the younger patient (50ish).  Because there is less aging and less to tighten, a mini-facelift is often in order.  I encourage my patients to do smaller lifts early rather than waiting until more surgery is required.  At a younger age, surgery “re-sets” the age, and then you will continue to age at whatever rate you were pre-programmed to age.  However, you will always look better than if you had never had surgery.  If a patient wants to continue to look great, she / he will require further small procedures down the road.

There is more and more confusion regarding facelifts in the media due to branding of facelift names to catch the attention of the public.  The “liquid facelift”, “stem cell facelift”, and others are not facelifts!!  They are still very worthwhile rejuvenation procedures but please don’t confuse them with surgical facelifts.  Both of these rejuvenate by providing volume to the face.  One is with fillers (see Fillers) and the other with fat.

Volume loss is very much a critical part of aging.  It begins early (30’s, 40’s).  We very commonly use fillers to rejuvenate the face by restoring volume to the cheeks, around the mouth, nasolabial folds and marionette lines.  We also commonly use the patient’s own fat for volume enhancement.  Volume is important with or without a facelift.  Volume enhancement alone can be a rejuvenation procedure in the younger patient.  It will also be an adjunct to the facelift in the older patient.  (See Fat Injection)