The term facelift is becoming more confusing as more types of facelift procedures are now available. Modifications to existing surgical approaches as well as the development of nonsurgical techniques have resulted in the pony tail lift, mini lift, lunchtime lift, S-lift, thread lift, liquid lift and energy lift (Facetite, Morpheus) and others. Most of these modified surgical approaches and nonsurgical techniques have been designed to target specific areas of the face and neck, or to provide alternatives to a "full" face lift. In some cases limited overall results or targeted results may be satisfactory depending on age and expectations.
The patient that presents with generalized facial aging has observed the following changes to their appearance - skin that has lost its tone and elasticity and has become droopy, thinning soft tissues that create hollows around the temples, cheeks and under the eyes, downward shift of fat pads from the mid face coupled with volume expansion of the fat in the lower face and neck, loosening and thinning of facial musculature.
The ideal facelift procedure creates a more rejuvenated appearance that looks natural, that provides long lasting results and has minimal risks. To accomplish this, the underlying tissues need to be repositioned to restore more youthful facial contours and the overlying skin needs to be redraped and tightened. At the present time this can only be accomplished surgically.
There are three basic surgical full facelift approaches. They all incorporate a similar incision that starts in the temple, runs down along the front and back of the ear and then into the hairline behind the ear. The difference between these techniques is the degree of deep tissue dissection and the extent to which the deep tissues are repositioned.
The skin only facelift is the most simple and the oldest type. In this approach the skin is lifted off the underlying tissue, redraped, trimmed and sutured. This procedure does not involve any repositioning of the deep tissues and as a result, all of the lift is supported by the skin. Because the skin is under tension the resulting scars can be more noticeable. Also, skin under constant tension will eventually relax, giving very short term results.
The SMAS plication lift additionally involves the tough fibrous tissue (Superficial Muscle Aponeurotic System) that envelopes the face. This tissue is pulled back with heavy suture and does accomplish some lift of the deeper tissues. This takes tension off the skin and does provide more permanence to the results. Because the anchoring attachments of the deeper structures such as the fat pads are not released, complete restoration of youthful contours cannot be accomplished. There is only limited repositioning of the deep tissues, and they remain under constant tension. The extended SMAS facelift involves lifting beneath this fibrous layer allowing for more mobilization and repositioning of the fallen tissues while further reducing skin tension. The SMAS techniques are the most commonly performed types of surgical facelift.
The final approach is called the deep plane facelift. This technique allows for complete freeing up of.the sagging soft tissue structures by detaching the ligaments that anchor them to deeper muscle and bone. The result is a much greater degree of movement and restoration of more youthful facial contours. Additionally there is little to no tension on the skin as well as the repositioned deep structures. This is a powerful technique that can yield very dramatic and long lasting results.
In the end, what matters the most is the final result. A lesser more limited procedure may be appropriate for those with a milder degree of facial aging. As with any elective procedure, a careful and clear understanding of goals and expectations, managed with the proper approach and technique will always yield gratifying results.