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FaceLift Techniques and Types

Introduction

A transition from a young to an aged face is due to the ageing process, the effects of sun exposure and gravity. Severe changes in weight can also change the facial appearance. The skin of the face and neck progressively loses its elasticity, and there is a loss of volume in the mid face as well as the descent of soft tissues of the face and neck.

The cheeks become flatter; loose skin folds appear on the side of the nose and mouth, the corners of the mouth become droopy. The jaw line sags giving rise to jowls, the tissue under the chin descends giving rise to prominent skin folds, the muscle under the skin becomes loose and gives rise to prominent bands and overall a youthful face and neck with a well-defined jaw line. Good tight long cylindrical appearance changes into an aged face and neck with no jaw line definition, a lack of chin and a short wide neck with loose and lax skin envelope.

These changes can be addressed surgically with a type of facelift and neck lift depending on age and changes. As the knowledge of plastic surgery techniques have expanded, and the technology has improved so have plastic surgery procedures. Several different facelift techniques have evolved to address each patient’s needs more accurately. The actual concept of facial rejuvenation is centred on remodelling and not just pulling skin more taught. It includes removing, repositioning and adding soft tissues rather than by tightening the skin and muscle alone. It is also considered the key to achieving optimal results in facial rejuvenation. Everybody has genetically different skin and soft tissues.

Some people will have only one facelift in their lifetime whereas others may have further surgery later when the tissues have laxed again and possibly several more over time. There is no limit on how many facelifts one can have, and it is not uncommon to have more than one procedure in a lifetime.

Our concept of facial rejuvenation surgery is to correct and tighten loose skin and muscles as well as remove and reposition fatty tissues to give a more youthful appearance. A youthful face is triangular or heart shaped in appearance. The aged face becomes square in appearance. Mr Riaz believes in an artistic approach to rejuvenating the face with a fresh and youthful appearance and without a pulled or an operated look.

The techniques of facial rejuvenation surgery for the face and neck have evolved from very invasive techniques with long scars, possible serious complications and a long post-operative recovery time to less invasive techniques with shorter scars, minimal complications and most importantly a very short recovery time. The age-related facial changes can start from late 30’s and early 40’s. Mr Riaz’s approach is to assess the changes at the time of consultation, advise and suggest the appropriate procedure. He will not hesitate in informing you if you are not ready to have a surgical procedure and may benefit from non-surgical procedures. 


The ‘R’ Facelift

This is a modified method developed by Mr Riaz during the last couple of years. This method was developed in a particular patient who had Ehler’s Danlos Syndrome (EDS). These patients have a tendency of severe bleeding and bruising and poor healing. This technique involves a pre-operative assessment for skin laxity, and the area of skin to be excised is assessed and marked. This technique has a similar scar as in the MACS facelift, which is around the sideburn, in front of the ear and stops behind the ear. 

There is pre-excision of skin and fat down to SMAS without any undermining of skin. Therefore there is no bruising of the skin of the cheek and neck after this type of facelift. It can be combined with liposuction of fat under the chin and upper part of the neck. Deep sutures are used to plicate the exposed SMAS. The central concept of this technique is called the composite lift. 

The soft tissue of the cheek and neck is lifted in a vertical direction by anchoring the lifting sutures to fixed points above the cheek bone to the temple. This procedure is different to a skin excision only because skin approximation is not dependent on skin closure sutures.
This technique does not require any drains or post-operative pressure dressings. There is a very short down time. The technique itself, as presented in the meeting of British Association of Aesthetic Plastic Surgeons in September 2014.


Facelift Techniques

There are several facelift techniques which have been popular at different times. The traditional facelift with a scar inside the hairline at the temple moves the sideburn upwards to an unnatural location. These days one of the more popular techniques keeps the scar around the sideburn and therefore the sideburn does not move from its natural position.

The scars behind the ear can be of variable length and location. Facelifts when combined with an open neck lift usually needs exposure through a small scar under the chin in the skin fold and a scar behind the ear. Another recent popular concept is called “vertical lift” in which the loose and lax tissue of the face and neck is moved vertically upwards to avoid the pulled and operated appearance.

At present people have very busy lifestyles and due to demanding and busy professional and social commitments the procedures with shorter scars, shorter recovery time, minimal swelling and bruising are more popular. Some of these newer techniques provide as good and lasting results as more invasive techniques. These new and less invasive techniques can easily be performed under local anaesthetic as a day-case. 

Changes and Choice

There are several procedures which can rejuvenate the face and also bring some changes to the neck. If there are severe age-related changes at the neck then liposuction, or a more invasive procedure on the neck as an open neck lift, has to be combined with different types of facelift. In the face and neck lift operation the scars are designed to be well hidden except in techniques where the scar is placed around the sideburn, in which case the scar is visible in front and below the sideburn. In some people, these scars remain quite pink and prominent for several months, and they have to be covered with a change in hairstyle if required.

In the majority of people, these scars settle down very well, and most people are happy to use a hairstyle exposing these scars. In most facelift techniques the tissue in the cheek is moved upwards giving them a fuller appearance. The facelift techniques do not generally change the look of the lower lids. The prominent and deep folds on the side of the nose and lips are corrected. At times the droopy corners of mouth require separate surgery at a later stage to reposition the corners of the mouth in a more youthful appearance, and this is usually needed in patients of an older age group.

The jowls are well corrected in most of the facelift techniques. The skin of the temples, cheeks and neck, is pulled upwards and backwards. The excess fat under the chin and upper part of the neck are either removed by liposuction or by excision.

At times some fat from deep to the muscle in the neck is removed to have a better angle between the chin and neck. Some patients have a very loose and lax neck with facial changes and they require tightening of the muscle of the neck under the chin and in the midline of the neck and also tightening of the muscle backwards and upwards behind the ear to have a beautiful and tight cylindrical neck. 

Mr Riaz is very happy to assess the changes, explain about different procedures and suggest the most appropriate suitable procedure for an individual patient. The final technique, or procedure, is chosen according to the patient’s requirement and wishes.


Types of Facelifts

Cutaneous (skin only facelift).

The first ever described facelift technique included only skin excision and suturing. The skin is lifted from underlying tissues and is tightened upwards and backwards. It leaves a scar around the sideburn and in front of the ear. Because the skin stretches very quickly and becomes loose and lax again, it therefore does not give a lasting result. 

 

Superficial Muscular Aponeurotic System (SMAS) Facelift

Platysma muscle and its fibrous attachment (SMAS) are sutured tightly in front and behind the ear as an extra sling under the chin

Platysma muscle and its fibrous attachment (SMAS) are sutured tightly in front and behind the ear as an extra sling under the chin

This type of facelift has been popular for many years. Deep to the skin on the face and neck lies a deeper layer which includes muscles and fascia (Superficial Muscular Aponeurotic System – SMAS). This SMAS layer has to be tightened or repositioned to elevate the soft tissue of the face to provide a long lasting result. The result of these techniques does not rely on tightening of the skin. In this type of technique, the SMAS is dissected and then tightened by elevation of the SMAS or part of the SMAS is excised and resutured (Smasectomy facelift). 

Incision lines follow the natural crease, or tagus, in front of the ear and extend into the hairline above and behind the ear

Incision lines follow the natural crease, or tagus, in front of the ear and extend into the hairline above and behind the ear

In other techniques, the SMAS is folded after dissection to preserve the volume of the cheeks. This type of facelift improves the fullness of the cheek bone. It also improves the jowls and also helps to redefine the neckline. The dissection of the SMAS layer is at a deeper plane close to the branches of the facial nerve which move the muscles of the face when we smile or talk, and there is a risk of damage to the branches of the facial nerve. This type of facelift was performed with a classical scar inside the temple hairline in front of the ear, behind the ear in the crease and then into the hairline. 

However, SMAS facelift can also be performed with a short scar approach. The scar can be kept around the sideburn instead of going into the hairline at the temple. Traditionally SMAS facelift used to give a pulled appearance but now if the direction of pull is kept in an appropriate direction a natural looking result can be achieved. 

 

Short Scar Facelift

A scar is placed around the sideburn in front of the ear and a very little scar behind the earlobe. The SMAS dissection and repositioning is as described in the SMAS facelift. This procedure will not be suitable for patients with a moderate amount of loose skin in the neck. They would be better served with a slightly longer scar behind the ear. 

 

Minimal Access Cranial Suspension (MACS) Facelift

This is one of the popular facelift techniques because of the less invasive nature of this procedure and it also gives more natural looking results due to the repositioning of tissue in a more vertical upward direction. The scar is around the sideburn in front of the ear and stops just behind the earlobe. There is no SMAS dissection, and therefore there is a minimal risk of injury to the facial nerve branches. 

The skin layer elevation is also minimal, and tightening of SMAS and repositioning is performed by deep sutures which elevate deep tissue to fixed strong bony points at the temple and above the cheek bone. This procedure can be carried out under local anaesthetic and sedation, but it is better performed under a general anaesthetic. Mr Riaz uses his modification in this type of facelift to have a better elevation of deep tissue and a smoother appearance of the cheeks. 

This procedure is more suitable for a younger age group with minimal changes in the neck. It can be combined with liposuction of the neck, but if there are moderate to severe shifts in the neck, then the same procedure can be offered with an open neck lift. In that case, the scar behind the ear extends in the crease and also goes over the bone behind the ear to the hairline to accommodate excess skin of the neck. The open neck lift also requires a scar under the chin in the crease in this group of patients. 


Volumetric Facelift

Loss of fat and volume is part of the facial ageing process in most patients. Fat transfer has become popular during recent years. Patients own fat can be used to increase the volume of cheeks and also to rejuvenate the general appearance of the skin. The concept of micro-fat transfer for fine creases of the skin on the face is also becoming popular, but the long-term results of fat transfer are unpredictable. 
The take, of fat grafting, is also unpredictable. The volumetric facelift with fat transfer can be performed on its own, or it can be combined with different types of surgical facelifts. It is likely that due to recent advances the fat transfer will become a more predictable and reliable option than was previously the case. 

 

Sub-Periosteal or Endoscopic Facelift

Some surgeons believe that this procedure gives patients a more sustainable facelift because it deals with the tightening of the deeper tissues of the face. This procedure is performed endoscopically and can cause more swelling and bruising. Some surgeons believe that it does not give us a significantly different result than from other common techniques. 

 

Mid Facelift's or Cheek Lift

The mid facelift also known as cheek lift focuses on the area beginning below the eye to the lower cheek area. As the area between the lower eyelid, cheek and nasolabial fold ages this area descends and cannot always be improved by a regular facelift procedure. The technique Mr Riaz uses for lower eyelid surgery (blepharoplasty) includes the cheek or mid facelift. 
The cheek lift concentrates on improving the loose skin.

Excess fat from eye bags is re-draped on the inferior bony orbital margin. The descended fat of the cheek is repositioned, and the whole soft tissue of the cheek is elevated by using deep sutures fixed to the bone and also to deep tissue above the cheek bone. This procedure rejuvenates the lower eyelids and cheeks and gives the cheeks a nice, full and youthful appearance. 

 

Thread Lift or Feather Facelift

This recent procedure is considered to be the least invasive of facelift methods. This technique uses self-anchoring non-absorbable synthetic sutures. These contour threads lift suspended tissue in the facial area by self-anchoring threads with barbs that attach the underlying tissues. This method is less invasive with minimal scarring. 


It is said to yield conservative natural results in patients with minimal facial changes. Because this is a newly approved technique, it may take several years to determine the long-term effects of this type of cosmetic surgery. This kind of method is not suitable for patients with moderate to severe changes. 


Face (rhytidectomy)and Neck Lift

As part of the ageing process, which happens to all of us sooner or later, our skin progressively loses its elasticity and our muscles tend to slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces.

The folds and smile lines deepen, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows droop and the skin of the eyelids gathers in loose folds.

In the skin the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression.

The rate at which this happens varies from one person to another and is probably determined by our genes.

Ageing of the skin of the face does not necessarily reflect the rate that the rest of our body and mind is ageing and many people feel frustrated that the face they see in the mirror is not the one they feel should be there.

Substantial weight loss can produce similar changes in facial appearance to those of the ageing process.

KEY FACTS:

  • People benefit most from a facelift when their face and neck has begun to sag
  • Facelifts work better for the lower half of the face, particularly the jawline and neck
  • If you are overweight and intend to lose weight, do so before the surgery to increase the effect of the facelift
  • If you smoke, you should stop smoking at least two weeks before the operation
  • Facelifts can be carried out under either general or local anaesthetic
  • Facelifts do not stop the clock, but does put the clock back

Which facelift is best for you?

There are now a number of options for effective facial rejuvenation surgery, and the various types of facelift will be discussed with you to decide which would be most appropriate to produce the result you desire. 

All are designed to give a fresh, natural look and will not produce a tight, mask-like appearance. The focus of this kind of surgery should, for the most part, be upon facial shape. A youthful face will have full, high cheekbones with a well-defined jawline and neck contour. As the face ages, it tends to become more square in shape. Effective facial rejuvenation surgery reverses this trend. 

Mr Riaz will discuss and help you to choose the most suitable type of facelift for you. 


For more information please see our FAQ Section or make a direct enquiry below, we are always glad to help.