Facelift Facts you need to know

Facelift Facts from Beverly Hills

Continuing with our Face Lift series, let’s talk about the general classes, or types of Facelift techniques and procedures. Remember that even within the same category of facelift types, each plastic and cosmetic surgeon can perform the surgery very differently…so much so that they are not similar surgeries.

General types of Facelifts:

1. Skin only Facelifts:

These older techniques, have a skin incision, the skin of the face and neck is elevated pulled up and back. The excess skin is then removed. They have the disadvantage, in my opinion, of not tightening the underlying muscle layer (SMAS).

2. Skin and SMAS Facelifts:

Here the skin is elevated as well as the underlying SMAS layer which can be sutured, folded or elevated..trimmed and re-approximated into a more youthful position (I believe actual elevation of the SMAS, trimming it and ten suturing the SMAS back together is the best method as folding the SMAS or suture elevation of the SMAS alone can loosen allowing the SMAS to sag)…excess skin is then trimmed and removed.

3. Long Skin Flap with SMAS Facelift:

As above the skin and SMAS are elevated, except here the skin can be elevated all the way to the nasolabial folds. This increased skin dissection can place the skin, of the face, at increased risk of vascular injury and for that reason as well as the prolonged recovery time required from the extensive tissue dissection…these types of Facelifts have fallen out of favor.

4. Extended SMAS Facelift:

In this technique, also called a “deep plane” facelift, the skin is elevated and then the dissection is continued at the SMAS level for an extended amount over the face. Although this decreases, the vascular injury to the skin, the recovery time is quite long for these types of Facelifts and it can be many months before all the lumps and bumps subside….once again, these issues have caused these facelifts to be much less popular.

5. Midface or sub-periosteal facelifts:
Remember pictures of celebrity faces after plastic surgery where their eyebrows are overly raised and the corners of the mouth are arched un-naturally into a “joker” position? These are the results of this type of lift, in my opinion. Unlike the previous facelifts, these lifts are touted as not requiring an incision (this also means that no skin can be removed from the face, so always keep that in mind). Incisions are placed inside the mouth and within the temporal hairline. The tissues of the face are then lifted off the bones. When the facial tissues are moved upward and back, the corners of the mouth and eyebrows are also pulled into that un-natural (again my opinion) appearance. Sadly, once in such a position it’s very difficult to bring these back down. I do not like, have never liked (I recall seeing consults with this odd, operated upon look in London in the mid-late 90’s and first learned of this type of facelift) and do not recommend this facelift technique…but others do and perform these routinely. You decide if you could tolerate the look this faclift can give.

Dr Francis Palmer
Beverly Hills Plastic and Cosmetic Surgery
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