“So, how do you perform your facelift?”
Many patients who are well read on facelift procedures will ask this question. They have heard such terms as lifestyle lift, quick lift, deep place facelift and composite rhytidectomy. Many of these terms are marketing terms with limited real meaning, yet others are important surgical techniques. Asking how a plastic surgeon performs a facelift is a very valid question that can be critical to a patient’s results and their longevity. Please note this blog post is really geared for those looking for more information and is probably too technical for most. The basics of a facelift are outlined on our facelift page.
Every patient is different, so there is a real variation in technique depending on the patient. In general, I perform a biplanar extended SMAS imbrication facelift with liposuction, platysma plication and the FAME technique. In some patients, all the steps of this technique will be performed. In others, such as those undergoing a mini lift (mini facelift) or tuck up procedure, a much more limited technique will be used. Let’s look at these steps individually.
Step 1: Address the Neck
For most of my procedures, I will address the neck first (if needed), which typically involves liposuction. The platysmal bands are addressed next with a sequence of cutting and suturing to tighten and strengthen (platysma plication) the muscle. All of this leads to a tighter, more refined neckline.
Step 2: Address the Jowls, Cheek, Temple and Lower Facial Tissues
The next step is approaching the jowls, cheek, temple and lower facial tissues. From incisions around the ears, the skin in these areas is elevated. I then approach the deep tissues of the face to tighten the SMAS (Superficial Musculo Aponeurotic System) – this is a key step in a facelift. Addressing the SMAS is what provides a natural and long-lasting facelift result. It is critical this is done in almost all facelifts.
The technique I use to address the SMAS is the extended SMAS imbrication with FAME technique, which allows the development of a healthy deep fascial flap for a more robust lift with minimal risk. Important ligaments such as the masseteric and zygomatic are released and repositioned safely. A healthy SMAS flap is provided for maximal lift of the neck tissues. Areas of jowling are lifted and corrected. The FAME (Finger Assisted Malar Elevation) technique allows me to safely release the zygomatic ligaments without risks of nerve injury, which leads to a lift of the midface tissues and a rejuvenated cheek region.
Using this approach to the SMAS, I am happy to say I have never had a permanent nerve injury and swelling and downtime are much less than that of more aggressive techniques. These elevated SMAS tissues are then lifted and tightened very firmly, which precludes the need for overly tight pulling of the skin.
Step 3: Reposition the Skin
These steps are followed by a repositioning of the skin tissues without tension. The combination provides for a natural, but long-lasting facelift result. In many patients, this may be combined with a forehead lift to address the upper face or a blepharoplasty (eyelid surgery) to address aging in the lower and upper eyelid area – this really depends on each patient’s anatomy and their opinions.
Every patient is different and, thus, so is the technique. However, I have found the sequence described above to be the best combination for providing a natural and long-term lift with minimal risks and the least amount of downtime possible. I look forward to helping you explore your options for your facial rejuvenation.