The techniques for facelifting have evolved over the years. At a recent meeting of the Australian Society of Aesthetic Plastic Surgeons, tailoring the technique to the age, facial shape and desired look was debated.
Patients who are returning for their second or subsequent facelifts may require modification of surgical techniques. The SMAS (Superficial Musculo-Aponeurotic System) is a layer of muscle and fibrous tissue than runs from the neck into the face, and fuses to the cheekbones and the scalp. During a SMAS facelift, the skin is separated from the SMAS layer. The SMAS has fixed posterior and mobile anterior components. The mobile SMAS is dissected and tightened, so that the patient gets a full, lifted result that is long lasting. Any excess skin is also trimmed and re-draped.
Another facelift technique is known as deep plane lift, which is suitable for heavy skin, where the soft tissue is lifted off the bone.
An SMAS facelift can improve otherwise permanent signs of ageing such as:
- Sagging jowls around the face
- Sagging in the mid facial area (cheeks)
- Fat that has fallen lower on the face
- Loose skin and fat deposits underneath the chin and neck
- Deep creases caused by pulling of excess skin around the mouth
- Deep creases below the lower eyelids (may also benefit from eyelid surgery)
A ten year study published in 2009 showed there is longevity for ten years for both SMAS and deep plane techniques.
For the younger patient with a full face, and who would like to have a more chiselled look, trimming of the mobile SMAS layer is a good recommendation.
For the patient with a rectangular face, who wishes to have more volume in the cheeks, an extended high SMAS technique which hitches to the temporal area would move soft tissue to the cheeks.
For the older patient who needs to have soft tissue preservation and who feels the face has “dropped”, application of the SMAS would add soft tissue bulk to the face.
Another facelift technique with less dissection is the MACS lift. The MACS lift focuses on central facial rejuvenation and would suit the 45 to 50 year old patient with good skin.
Fat injection is gaining popularity as it replaces soft tissue volume. Low pressure harvest of fat with minimal processing enhances viability of fat cells. Fat has longevity and gives natural results but areas may need to be overcorrected to allow for some absorption.
Fat injections can be used in various areas of the face:
- Filling in deep facial wrinkles and creases
- Plumping up sunken areas and deep folds
- Adding fullness to the lips and cheeks
- Creating an overall better balance to facial symmetry
Unattractive necks are characterised by loose skin, fatty deposit under the chin, and platysma muscle bands. If the fat deposit is minimal and the muscle bands are not severe, the skin and platysma muscle can be tightened overall.
If there is a large fatty deposit under the chin, it can be removed surgically or by liposuction.
Muscle bands are either underactive or overactive. Thick bands may have to be trimmed. Pulling on the playtsma from both sides will indirectly improve the vertical bands in the midline, and also improve the jawline. The platysma will need to be released horizontally to disrupt the tendency of the muscle to pull vertically. Stitching the platysma muscle in the midline to just above the thyroid cartilage will create a sharper chin-neck angle that adds to the attractiveness of the neck.
Patients who undergo facelifts aim to stop the clock and hold the look at the age that they are comfortable with. On average, patients feel that they look about eight to ten years younger than their chronological age.
Maintenance after surgery cannot be ignored, to mitigate against further ageing. It is worth considering prevention of further skin damage with good skin care, sun protection, changing your lifestyle such as decreasing sun exposure and stopping smoking.