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When choosing surgery, often patients are bombarding with varies procedures and technical terminology. Facelift surgery is no exception. Often there are clinics who say mini-facelift’s are good for tightening face with less recovery time required. Then there is the midface lift. In this article, we explain the differences.
Before we start on the varying facelift procedures, lets explain what a facelift is. In short, a facelift, will address Cheek laxity, Jowls and the Neck laxity. It usually involves tightening not only the skin, but also underlying fat and muscle.
The most common types of facelift procedures are:
Mini-Facelift:
A mini-facelift is reserved for someone with minimal neck laxity, and usually someone younger or who has had a previous facelift.
Midface lift:
A midface lift repositions the cheek skin and muscle vertically towards the eyes. This is used for someone who has lost fullness in the upper cheek area due to descent of the tissues.
The following are some of the more popular face lift techniques:
Mini-lift – A “mini-lift” refers to a number of different techniques with limited incisions, and usually are best for patients with very early signs of aging, usually in their 30s and early 40s. In most cases, mini-lift equals minimum results.
Some techniques commonly referrred to as mini-lifts are:
S-lift – The so-called “S-Lift” is a type of SMAS facelift (see below) that gets it’s name from an s-shaped incision in the hairline at the temple and in front of the ear. Since the incision does not extend behind the ear, the best candidates for an S-lift do not have significant laxity of the neck skin, and this type of facelift is best for people that are just starting to show signs of aging (in their 30s or 40s) and want a little tightening of the lower face without longer incisions.
An S-lift can be beneficial for mild jowling and very minimal neck laxity. When you hear S-lift, think “S” for small.
Subcutaneous / skin only – The subcutaneous lift (meaning just beneath the skin) is a facelift that addresses excess skin only and does not address aging changes in the deeper structures, such as fat pads, connective tissue, and muscle.
It is used mostly for thin women with some excess skin but good position of the underlying muscles, or for a patient who has already had a deeper facelift, but is requesting a touch up. It does not work well forheavier jowls, sagging muscle, or for neck fullness.
The subcutaneous facelift may have less risk for facial nerve injury, but the results do not last as long as deeper facelifts because the underlying structures still continue to sag and pull on the skin. While the subcutaneous or “skin-only” face lift used to be the most common face lift technique until about 10 years ago, it is not commonly used anymore due to the potential for a “windswept” or pulled look.
SMAS Face lift – The SMAS (sub or superficial muscular and aponeurtoic system) is a sheet of muscle and connective tissue on the cheek that contributes to facial expression. Over time, the SMAS can become lax and sag, contributing to jowls and deepening of the nasolabial folds.
The more common “SMAS face lift” repositions skin and the underlying muscle of the cheek to more adequately correct jowls and skin laxity. This will allow for a less “pulled” look and longer lasting results than a skin-only facelift, but a SMAS face lift does not significantly address the nasolabial area (around the nose and mouth) or a sagging malar fat pad (upper cheek fat pad).
Extended SMAS Face lift – An “extended SMAS lift” goes even further toward the nose to help correct lines around the nose and mouth. This is the same surgery as the SMAS facelift (see above), but with an extended SMAS lift, the SMAS is separated from the underlying structures more extensively toward the nose and upper lip.
This can increase the amount of improvement that is possible in the center of the face, especially the nasolabial area. Increasing the amount of SMAS lifted also increases the risk for complications of tissue death, however, especially in smokers.
Weekend Face lift – The term “weekend face lift” has been used to refer to any limited-incision face lift procedure with a quick recovery time. There is, however, a particular technique, which is specifically called the “weekend alternative to the facelift.” Using this technique, a small incision is made beneath the chin, excess fatty deposits are suctioned from the neck, and then the inside of the skin is lasered with a CO2 laser to cause the skin to contract.
The muscle in the neck can be tightened, if necessary, through the same incision, and a chin implant placed at the same time. The procedure is performed with local anesthesia only.
The weekend alternative to the face lift may be beneficial for someone whose primary concern is fullness and sagging of the neck.
Some doctors advise against the internal laser portion of this procedure due to safety concerns: the laser can burn the skin and cause scarring, fluid accumulation, and sloughing or death of the skin.
Feather lift also called Aptos lift or Suture Suspension lift – Aptos (from the words anti-ptosis) is a patented name for a barbed, blue prolene (nylon) suture developed in Russia in 1999. The Aptos Lift or Feather Lift, as it’s referred to in the United States, can lift sagging underlying tissues (usually the cheek and jaw line) by threading 4 to 12 of these barbed, permanent sutures with a very long needle through the skin into deeper soft tissue structures.
The name, Feather Lift, comes from the appearance of the suture.
Once the suture is in place, it is pulled, anchoring the barbs into the soft tissue and lifting the soft tissue. The end of the exposed suture is then snipped, leaving the majority of the suture buried entirely beneath the skin.
Since no skin is removed and no incisions are made, this technique is not advantageous for people with excess skin. Side effects include bruising, swelling, and tenderness. The most common complications of the feather lift are puckering where the barb is pulling, visibility of the blue thread through the skin, and recurrence of sagging.
Very few doctors in the United States have been trained in the Feather Lift procedure, but it is increasing in popularity. The suture that is used for the feather lift is pending FDA approval.
Deep Plane Face lift – A “deep plane facelift” is especially useful for changes in the upper cheeks and midface because the surgeon repositions the tissues in those areas as well as in the lower cheeks.
Because the dissection is deep, the flap is thicker than in the SMAS or subcutanoues methods, some doctors believe that a deep plane face lift may be safer for smokers because of the greater blood supply attached to the flap; however, smokers have an increased risk of complications, regardless of the technique. There is usually more swelling with the deep plane lift than with more superficial lifts.
Sub-periosteal lift – The “sub-periosteal lift” is another type of deep plane face lift commonly performed with the aid of an endoscope, a tiny camera attached to a probe to allow visualization of the surgical area through very small incisions.
The idea of the subperiosteal lift is to reposition skin, fat, and muscle all at once since the tissues tend to sag together, not individually. To do this, the surgeon goes all the way down to the bone, separating the bone from all of the tissues covering it (the periosteum is the thin sheet of tissue covering the bone, so by definition, a sub-periosteal lift goes beneath that tissue and lifts everything over the bone).
For patients in their 30s or 40s who do not require skin removal, the inicions can be very tiny and hidden in the hair. For patients requiring skin removal, standard facelift incisions will need to be made, and the surgery is thus not done with the endoscope. Facial implants may also be easily placed at the same time, since the implants are positioned directly on the bone which has already been separated from overlying structures.
Many surgeons prefer this techniqe for patients 45 and under who desire facial implants. There is more swelling with the subperiosteal lift than with more superficial lifts due to the depth of the dissection.
Composite Face lift – The composite face lift is essentially a deep plane lift (see above) with the addition of an extra step to include the muscle around the lower eyelid.
This is advantageous to address changes in the upper cheek and midface region, such as a crescent shaped sagging of the fat pad.
To accomplish this, the orbicularis oculi muscle (around the eye) is separated from its attachment to the cheek bone through an incision in the lower eyelid. It can then be lifted and sutured into place. At the same time, the arcus marginal muscle is released (AMR) and repositioned to cover the orbital bone.
The remainder of the procedure is the same as the deep plane lift. There is more swelling with the composite lift than with more superficial lifts.
Tumescent Face lift – This refers to any facelift technique performed with tumescent anesthesia, instead of general anesthesia or local with IV sedation.
Benefits of tumescent anesthesia are less bruising and swelling, less chance of nausea and vomiting, quicker recovery, less risk of anesthesia complications, ability to check nerve function during surgery, possibly reduced fees because there’s no need for a separate anesthesia specialist, and overall greater safety.
Sometimes this is called the Awake Facelift, since the patient is awake during the surgery.
With over a dozen different techniques and types of face lifts, it’s hard to know which one is right for you. A thoughtful discussion and careful examination with your surgeon will help determine which approach you should take.
London Cosmetic Surgery group Berkeley Square Medical , is one of the UK’s leading providers of Aesthetic and Cosmetic Surgery. For more information about Berkeley Square Medical, please visit: https://www.berkeleysquaremedical.com/face-lift
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