Facelift Techniques and Types

We begin a brief explanation of various types of Facelifts, the techniques associated with each, as well as any marketing related hype that may need clarification for each consumer to be able to make informed decisions when pursuing Cosmetic Surgery.

A.) Traditional Facelift: A Facelift treats sagging skin in the lower third of the face, corrects wrinkling, jowling and restores the youthful contours of your face. It may be combined with other cosmetic procedures, such as Rhinoplasty, Cheek Augmentation, Blepharoplasty (Eyelid Surgery), and Lip Augmentation, to provide complete facial rejuvenation.

Some physicians may employ a technique where they move the nasal furrows and lift up the corners of the lips by pulling sideways. This may result in a pulled, tight surgical look. One of the most important aspects of my Facelift technique is that I lift the cheek tissue straight up, the opposite effect of gravity. This results in a more natural, refreshed look.

The results of a Traditional Facelift may last 10 years or more and they have been performed on patients in their 30s through their 80s with success. Your candidacy for the procedure will be determined during your one to one consultation with a Plastic Surgeon. It should be noted that this is a fully invasive, surgical procedure that will require Local Anesthesia with sedation and a recovery period of up to two weeks and more possibly.

B.) Mini Facelift: In addition to the full Facelift mentioned above, there are numerous, less invasive options requiring less commitment and recovery time. The mini facelift is one of them. It is a true Facelift so the results are long lasting (5-10 years); however, it can be performed in about 2 hours or less and only using Local Anesthesia, not General Anesthesia.

This smaller procedure will address the effects of aging on the upper neck and jawline, as well as the jowl area. It is sometimes combined with Liposuction to sculpt the neck and jawline. If the eye area is also a concern it can be easily combined with Upper/Lower Blepharoplasty.

Because there is less bruising and swelling associated with this procedure, it may be a great idea for men, since they don’t use makeup, which can be of assistance during the initial healing period. This procedure is also virtually painless. Due to the fact that it is a Mini Facelift it may not be appropriate for some older patients with more advanced signs of aging.

C.) Mid Facelift: Also considered less invasive than a full Facelift procedure, a Mid-Facelift is performed by tiny incisions placed inconspicuously within the hairline of your temple area and within the mouth. It is focused on the earliest signs of aging, which may appear in the mid-face in people as young as those in their late 30s. These signs may include but are not limited to: Sagging cheeks, deeper nasal furrows, thinner lips and downturned corners of the lips. The procedure once again may be combined with other procedures such as Blepharoplasty for a full facial rejuvenation.

Most people experience little pain after surgery although a bit of swelling and bruising is unavoidable. The procedure can be performed as an outpatient procedure, with just the use of Local Anesthesia and sedation and can be completed in 1 to 2 hours. Despite its mild clinical requirements, you still may see the benefits for up to 10 years or more.

D.) Thread Lift: Once claimed to be the least surgically invasive Facelift solution, the Thread Lift procedure gained prominence in the early 2000s as mainstream media personalities like Oprah Winfrey and Matt Lauer touted the new procedure on their television shows. While Traditional Facelifts involve cutting into, tightening and trimming the skin and muscle layers, the Thread Lift is more simplistic. Utilizing a basic technique involving barbed plastic sutures, the Thread Lift or “Lunchtime Lift” as it is sometimes called, eliminates the cutting and the higher price tag. It does not necessarily reduce recovery time, however. Though some Facial Plastic and Plastic Surgeons may still perform the Thread Lift, I never performed the procedure, due to the lack of positive results and the high incidence of complications. I unfortunately have had to perform numerous Revision Facelifts on unhappy patients who underwent the Thread Lift procedure with another surgeon.

Beginning with the hairline, a long needle attached to a plastic suture (or thread) is inserted under the skin and fatty layer of tissue. This thread contains three-dimensional barbs or hooks, designed to grasp tissue. The needle is snaked down under the skin along the face and is pushed back through the surface of the skin. The needle is then pulled through and snipped off of the knotted thread. In the hairline at the insertion point, a curved needle hooks into the scalp and temporarily holds that end of the thread in place. By pushing and adjusting the overlying skin, the doctor manipulates the thread so that the barbs take hold of the tissue layer underneath. This process is repeated with additional sutures placed along the face. When complete, the threads are pulled tighter and upward and then tied off together at the hairline. The curved needles are removed and the knotted threads disappear beneath the skin’s surface. Over time, scar tissue builds up around each barb, and in theory, that helps to keep the lifted thread in place. Because there are no larger incisions, recovery time is typically only a couple of days.

The relatively simple technique allows many physicians who lack training in surgery or facial anatomy to learn and perform the procedure. This can be seen as an advantage since the increased availability of practitioners and the low technical skill required makes the procedure more affordable; however, even good results, should they be had at all, will not last. At best, the Thread Lift could last 3 years. More likely, the results of the Thread Lift will last 1 year or less. Over time, what once was an extremely popular procedure has proven to be very unreliable. At its worst, the Thread Lift can leave patients with poor or no results, visible plastic sutures, threads poking through the surface of the skin, chronic pain and disfigurement. In the photo below, I am shown removing a Thread Lift plastic suture.


Thread Lift plastic suture removal.


E.) SMAS Facelift: As was previously mentioned in our short history of the Facelift procedure, the SMAS technique was innovated by Dr. Skoog in the late 1960s. SMAS is an abbreviation that stands for Superficial Musculoaponeurotic System, which is a layer of tissue that surrounds and attaches to the deeper tissues and structures of the face and neck including the entire cheek area. Typically, the SMAS is folded back on itself to lift it to a higher level. This in turn lifts many features of the face to give an overall, more rejuvenated appearance to the face. Addressing the SMAS is a more advanced Facelift technique than those that simply deal with the removal of excess skin.

F.) Short Scar Facelift: A Short Scar Facelift (SSFL) is becoming popular with much younger women in their late 30s to early 40s who would like to avoid going the non-surgical route possibly resulting in the over plumped look of fillers and BOTOX®. Also known as a MACS or often called a mini facelift, a Short Scar Facelift takes less time and requires a shorter recovery period than a Traditional Facelift. As its name implies, Short Scar Facelifts produce smaller, thinner, and less visible scars than Traditional Facelift procedures.

Medically the biggest difference between the Short Scar Facelift procedure and Traditional Facelift Surgery is where the incisions are made and how the skin is positioned. Unlike a traditional Facelift, the Short Scar Facelift technique does not separate the SMAS (the muscle and tissue under the skin) from the skin, so does not give the same result.

The Short Scar Facelift is ideal for patients who do not have extensive wrinkling or sagging and is particularly useful for patients with laxity in the skin on the upper cheek. It is also good as a Secondary Facelift for patients who already had a Traditional Facelift, but may need a tuck or touch up. While it works well for someone with moderate softening in the jawline, I believe a Traditional Facelift is a better procedure for addressing quite significant loose or sagging skin on the lower face and neck.

G.) Deep Plane Facelift: The Deep Plane Facelift is more than just a slight variation on the popular SMAS Facelift. As opposed to the traditional approaches to Facelifting, where tissues are raised above the SMAS muscle, this technique goes beneath the SMAS. It differs from other procedures in that sagging fat from the cheek area is included in the lifted flap. Deep Plane Facelifting is specifically designed to target the midface, including the triangular area below the eye, to the side of the nose and the small area above the mouth. Volume loss and descent of the fat pads in the midface is a significant part of facial aging that is not well treated by traditional techniques. By targeting a deeper plane, access to these midfacial fat pads is accomplished. Theoretically, increased midface rejuvenation is possible via the Deep Plane. Unfortunately, there are much greater risks associated with this technique due the higher probability of hitting facial nerves when a surgeon cuts beneath the SMAS area.

H.) SLUPlift™ mini facelift: My proprietary SLUPlift™ accomplishes many of the same goals as a conventional Facelift, but with a more effective and less invasive technique. Instead of the long incision around the entire ear used in a traditional procedure, the SLUPlift™ employs a small incision around the earlobe. I insert instruments in that smaller incision to locate the SMAS and the Platysma Muscle (found in the lower jaw and upper chest).

I then insert sutures through those tissues and pull them tight. The sutures aretied off behind the earlobe, the excess skin is removed and the incision is sealed with fine skin sutures.

The SLUPlift™ procedure typically takes 2 hours or less. The results are a defined more youthful appearance to the face and neck, with a much smaller incision, shorter time in surgery, no General Anesthesia and a reduced recovery period of approximately one week. Results last for 5 – 10 years, depending upon the patient’s initial degree of aging and lifestyle.

I.) Vampire Lift: Another Facelift procedure that has received a lot of publicity due to its Hollywood following is the Vampire Facelift. This procedure however, is not surgical, it is non-invasive and involves injections similar to BOTOX® or fillers like Juvéderm®, except in this case, it uses the patient’s own blood.

The patient’s blood is first drawn, the platelets are then separated from the red blood cells and are blended together with a fibrin mixture. This substance is then injected into the area that requires enhancement. Allergy testing is not necessary because the patient’s own blood is being used.

The results of this procedure are temporary and last approximately 15 months.

J.) Stem Cell Facelift (Fat Grafting): Due to the non-stop media controversy treatments in medicine, this is another procedure that has received a great deal of publicity over the past decade. The Stem Cell Face Lift has been marketed as a cutting-edge, Non-Surgical Facelift; however, many do not know is that this is essentially a fat grafting procedure.

Fat Grafting, also known as Fat Transfer or Fat Cell Transplantation, has been used for over 15 years in Cosmetic Surgery to rejuvenate areas of both the face and body. Fat Grafting is a non-surgical procedure involving a patient’s own fat being transplanted to the face where volume has been lost due to aging. The patient’s fat is harvested from the abdomen or another part of the body and is then injected (transferred) into the face. Stem cells are found naturally in adult tissue and human fat. Doctors performing Stem Cell Facelifts theorize they are introducing adult stems cells into the patient’s face encouraging collagen regrowth. While fat injections can add back lost volume to specific areas of the face, there is no clinical data to support the effectiveness of stems cells in reversing facial aging.

In past years, the viability of fat cell survival during and after a fat grafting procedure has been typically 50%, which means half of what is injected gets reabsorbed; so you may have to undergo subsequent procedures to get your desired results. My proprietary fat transfer technique delivers viable fat cells with reduced reabsorption with results showing 85% to 95% permanency.

I have successfully performed fat cell transfers for over 10 years and use a new and advanced method for fat cell transfer, which employs a proprietary fat grafting technique This technique ensures high quality fat cell within the harvested and transplanted fat. The fat cells are also harvested in smaller quantities and are purified quickly for the use in the face. Fat cell viability is maintained, which is crucial to longer lasting results.

Not all patients are candidates for fat grafting and many will require surgical intervention such has a Facelift, Neck Lift and/or Blepharoplasty (Eyelid Lift) to address their extent of facial aging. Every patient has varying degrees of facial aging based upon their genetics, health and lifestyle. Fat grafting is an excellent adjunct to facial surgical procedures to rejuvenate those areas, which have lost volume and definition.

K.) Non-Surgical Facelifts: (BOTOX®, Fillers, Chemical Peels, etc.) The use of injectibles like BOTOX® and Restylane® to obtain the look of having had a surgical Facelift is much less expensive and carries a much lower risk; however, it cannot replace what surgery can accomplish in reversing facial aging. It is also important to note that the results are temporary and sometimes only last a few months. You will need regular maintenance, which over time can become more costly than a one-time experience of a Traditional Facelift or innovative SLUPlift™ earlier in life.

L.) Laser Lifts: Also in the non-surgical category these are facial rejuvenation procedures, which reduce the appearance of wrinkles and lines using a carbon dioxide laser.
The laser heats the dermis of your skin and then creates a healing response that promotes the production of collagen. Many people choose the Laser Face Lifts because it provides visible results that make the face look younger at a reasonable price range.

Although many people enjoy the results of their Laser Treatments, the longevity of a Laser Lift is not comparable to a Surgical Facelift procedure. There are no short cuts to attaining the natural and long lasting results of Facelift Surgery.

M.) Thermage: Frequently referred to as ThermaCool treatment this is also a non-invasive procedure, which utilizes radio frequency energy to simultaneously heat up the deep layers of skin and cool off the top layers of skin. As with BOTOX®, there is no downtime associated and frequently people may request to combine the two treatments. A number of anti-aging benefits will be seen immediately and over a period of months of repeated treatments including smoothing of the forehead lines, scowl lines and crow’s feet.

N.) Ulthera: Ultherapy uses a patented device called Ulthera to lift and tighten loose skin on areas such as the eyebrows, jowls, and jawline and it all can improve wrinkles on the chest as well. This is a non-invasive procedure using ultrasound energy to heat targeted tissue under the surface of the skin. This heating of the skin apparently increases the natural production of collagen. Results are not always immediate and patients typically see results after 2 to 3 months. The ultrasound sensation is not the same as that one women experience during pregnancy. Patients may feel discomfort during treatment, due to the heating process that the procedure employs.

Ultherapy targets small areas of soft tissue, heating it below the surface of the skin to a point where the tissue will contract and new collagen is created. Lifting may be achieved with the right amount of heat going to the right depth in the tissue.