Facelift 101

A Blog About Facelifts by Dr. Loftus

So, you’re thinking about having a facelift. Relax. We will cover the basic information you need to know in this blog. If you have not read, "Let’s face it" yet, make sure you read it first to have a basic understanding of the changes that occur as we age.

Facelift goals

The goals of a facelift may seem obvious. Most people want to look younger. But other goals may also be achieved. Most important, looking natural is a goal for most. Women want to avoid that windswept look that screams bad facelift!

Facelift techniques

There are many facelift techniques. Some even have trademarked names. This has more to do with marketing and much less to do with the techniques being unique or special. All facelift techniques have several goals in common. The first is to reposition fat, and the second, to remove excess skin.

Skin-only facelifts use the skin attached to the fat to pull up the descended volume, and the tension on the skin is used to hold up the fat. Then, extra skin is removed. The procedure is less invasive because no surgery is performed in the deeper tissues. This type of facelift tends to give good results in a small subset of people: those with thin faces and early aging. People with heavy faces or advanced aging will be very disappointed with this procedure.

SMAS Facelifts use the deeper layer of connective tissue, fat and muscle to redistribute facial volume. Sometimes this layer is elevated (separated) to partially separate the layer before it is pulled up to allow it more freedom of movement. Many plastic surgeons feel this facilitates better relocation of the tissues for a better result. Instead, some plastic surgeons prefer to gather (imbricate) the SMAS. This involves stitching the SMAS to itself to gather and bunch up the tissues in the appropriate areas to enhance volume, for example in the cheeks. Once the SMAS is repositioned and the face lifted, the excess skin is removed, and the incisions, closed. The tension of the lift is on the tougher, deeper SMAS layer, not the skin.

Facelift Longevity

How long a facelift result lasts depends in part on the strength of the tissues holding up everything. Skin stretches easily and loses elasticity as we age. SMAS is tougher than skin. Plastic surgeons generally feel that SMAS lifts have better longevity than skin only lifts. Skin care is another important element. If you do not take care of your skin, your result will not last as long or look as good.

Natural Facelift Results

When you look at a young person, you notice that their skin has tone. However, their skin does not look stretched. The advantage of a SMAS facelift is that the volume is held up by the deeper layers. The excess skin is re-draped to remove the extra, but the skin is not closed under tension. This makes it much less likely that your skin will appear over tightened. Skin-only facelifts tend to place excess tension on the skin. This tightness may look unnatural and may create the windswept look. Further, the extra tension on the skin tends to widen scars, making them more visible.

Younger patients with minimal aging may get a good result through a less invasive operation using a skin-only facelift. Many of the mini and quickie lifts out there fit into this category. In general, most patients will probably get a better, longer-lasting result with a SMAS lift. We use both types of techniques and help you make your decision based on your goals and degree of aging.