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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.The following are some of the
more popular facelift 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. Some techniques commonly referrred to as mini-lifts
are the skin-only or subcutaneous facelift, the s-lift,
or the weekend facelift. In most cases, mini lift equals
minimum results.
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 which 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 for heavier 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- 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 - An "extended
SMAS lift" goes even further towards 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 towards 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 facelift - The term
weekend facelift has been used to refer to any limited-incision
facelift 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 facelift 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, cause
scarring, fluid accumulation or 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.
For more information, click
here.
deep plane facelift- 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,
and 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 facelift 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 facelift - The
composite facelift 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 facelift - 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.
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