All facelifts are not created equal and there are numerous described techniques performed that often confuse patients when searching for a facelift specialist. High SMAS, Deep Plane, Skin Lift, Extended SMAS, MACS lift, Short Scar Facelift, Mini-facelift, Omega lifts, and SMASectomy are all common facelift techniques which differ in numerous ways but all have a common goal of rejuvenating the face
Facelift techniques differ in the incision patterns, the plane and depth of the facelift, and ability to rejuvenate the neck and the cheek.
- Facelifts typically do not affect the brow, upper eyelids, lower eyelids, and perioral region (around the mouth) and a browlift, blepharoplasty and midface lift may all be additional components of facial rejuvenation surgery.
Facelift incisions can include: an incision under the chin, in front of the ear, behind the ear, into the hairline or down the hairline behind the ear, and in the temple region.
- The incision under the chin or submental incision gives access to the platysma muscle for a midline platymaplasty, which brings the two central edges of the platysma muscle together with suture techniques. This will typically help eliminate central neck bands and help refine the angle of the neck. This incision allows for skin release and fat excision to help define the neck and jaw-line.
- The incision in front of the ear helps to release the skin from the jawline and cheek and can vary with male and female facelift techniques.
- The incision behind the ear may be limited in a short scar facelift, but is necessary to give access to the post-auricular region where the neck skin is released and the SMAS may be sutured.
- The incision in the post auricular hairline is variable and helps to eliminate excess neck skin. There are advantages and disadvantages to post-auricular scar patterns but they are necessary to eliminate excess skin.
- The temple incision is designed to accommodate for a vertical lift of the lower face and cheek
The planes of the face include: the skin, the subcutaneous plane, the SMAS layer and the sub SMAS plane
- Skin has a significant amount of elasticity and has limited efficacy in face-lifting as it will typically relax and reform.
- The subcutaneous plane is utilized in the SMAS plication and MACS lift techniques, which gathers the mobile SMAS with sutures.
- The SMAS is the Superficial Musculo Aponeurotic System, which is a fibrofatty layer above the facial muscles. It is a durable facelift plane to rely on for repositioning and lifting the face because it is not as elastic as the skin.
- A sub-SMAS plane helps to release the deep attachments of the face and helps to reposition the face without tension.
A sub-SMAS facelift plane does take significant experience to develop safely especially as the elevation of the SMAS is beyond the parotid gland and into the cheek.
A central platysmaplasty helps to unify the platysma and break up the central neck bands. A defined angle of the neck can be created and a release of the jawline can be performed through this access. When the central neck is stable, the SMAS and the skin can be repositioned behind the ear to give a smooth jawline.
Low facelifts will not have any effect on the cheek. The cheek can be lifted with a SMAS plication to the lower eyelid or through a High SMAS facelift, which will re-position the cheek vertically after a horizontal SMAS release.
There is no right or wrong facelift technique. It is important to discuss which technique your facelift surgeon utilizes and it will be evident how comfortable they are with their technique during this conversation. Facelift specialists should have a primary technique that they utilize, but should be able to alter techniques to individualize facial rejuvenation for their patients. Facelifts should be individualized for the patient and the techniques may be altered in secondary facelifts to accommodate for scarred facial planes.
Andrew P. Trussler MD is an experienced plastic surgeon in Austin Texas with advanced training in facelift surgery including High SMAS facelifts, lower facelifts and necklifts.
Dr. Trussler’s Austin plastic surgery office can help guide you in correcting commonly seen facial aging complaints. Facial rejuvenation with a facelift can help you improve your jawline, cheek, and neck with a natural, long-lasting result.