What is the Best Facelift Technique?
This is a common question my patients ask when considering facial rejuvenation surgery. In the era of social media and aggressive marketing, you may hear about various techniques, some branded with catchy names, that promise the best results for everyone. While these trending techniques can be enticing and convincing, they are often misleading and not evidence-based. No studies prove one technique is better or longer-lasting than another. The most important factors to consider are the surgeon’s experience and their proven results.
Below, I review some of the terms and techniques related to facelift surgery and explain what they mean. Remember, most experienced facelift surgeons, like artists, use some or all of these techniques in their clinical practice. I prefer to use various methods to customize each procedure to my patient’s individual needs.
SMAS vs. Deep-Plane Facelift
The SMAS (Superficial Musculoaponeurotic System) is the fascia of the face that envelops the muscles and deep fat pads. It is part of the deep plane, so any modification of it is technically deep-plane work. Lifting and tightening this layer has been proven to prolong the results of facelift surgery, and there are numerous techniques to achieve these results.
A SMAS facelift usually refers to a technique where the skin and SMAS layers are separated and lifted in potentially different directions to customize the tightening of various areas of the face. The Deep Plane facelift typically involves minimal separation of these layers, so most of the surgical dissection is deep to the SMAS and facial muscles, and around the nerves that move the face. Some surgeons do separate the layers and still go deep below the SMAS, in a variation of this technique.
Deep plane dissection is not new. It was popular 25-30 years ago and recently made a comeback among ENT-trained facial surgeons, who claim it is superior to other SMAS techniques. This recent popularization is mostly due to marketing, while clinical studies have shown no significant difference in outcomes between these various techniques.
Therefore, the terms SMAS and Deep Plane facelift refer to deep work to lift sagging muscles and fat pads, not just skin, and they address the lower face, jawline, and upper neck. They are often combined with an open neck lift that can address excess fat and loose muscles under the chin. The most crucial factor in a successful outcome is the surgeon performing the procedure, not what they call the technique.
Vertical Facelift
Vertical facelifts are integral to every facelift I perform. A SMAS or Deep Plane facelift can be done as a vertical lift because this term refers to the main direction of pull when repositioning sagging tissues. This approach helps to avoid a wind-swept look and does not distort or widen the mouth.
I often perform a short scar vertical facelift, lifting the SMAS and deep tissues using the state-of-the-art HARMONIC® scalpel to reduce swelling, bruising, and recovery time, allowing for a quicker return to everyday activities. The short scar refers to confining the incisions to the area around the ears and not extending along the hairline behind the ears, enabling patients to wear their hair up or in a short style without exposing the scars.
Mini Facelift
Also referred to as a “weekend facelift,” the mini facelift is a less invasive technique aimed at rejuvenating the lower face in younger patients with mild aging changes. It primarily targets the jowls and jawline, lifting the skin only without any SMAS treatment.
Recovery time may be shorter compared to a facelift that includes deeper work, making it a popular option for those seeking subtle improvements with less downtime. However, the results tend not to be as long-lasting and can be disappointing for patients with more advanced aging changes.
The Importance of Fat Grafting in Facelift Surgery
A facelift discussion would not be complete without mentioning fat grafting. The aging process in the face results not just from sagging tissues. We all lose volume as we age at all levels, including our bones, muscles, fat, and skin. Pulling the face tight without restoring lost volume does not look youthful; it just looks tight. Strategically placed fat grafts are essential to re-inflating the aging face and achieving a soft, natural, and youthful result. The goal is never an overfilled, fat face. Fat cells are living tissue that lasts for years and prolongs your rejuvenation. I fat graft the majority of my facelift patients for optimal results.
So, Which Approach is Best for Me?
Ultimately, the best facelift for you will depend on your individual goals, anatomy, and preferences. It’s crucial to have a thorough consultation to evaluate your concerns, discuss your options, and get recommendations to determine the most suitable technique for achieving your desired results. My goal is to “set back the clock” by making you look like a younger, natural version of yourself.
As far as techniques go, the reality is that one method is not better than another, and the data supports this. However, studies confirm that both deep plane and SMAS facelifts can provide excellent outcomes. The most important factor is the surgeon performing the procedure.
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