Face-Off: What are the differences in facelifts

Facelift surgery has been around for over a century. The first facelift surgery in the early 1900s involved removal of skin in front of the ear to lift the cheek and corner of the mouth. This skin excision technique has evolved to include many different facelift techniques to help rejuvenate the face.

There are numerous types of facelift surgery and it is important to know the differences in terminology and techniques. Ironically, the skin excision technique of the early 1900s is still used, but not recommended.

Different Layers involved in Facelift Surgery:

  • Skin is the usually the majority of the problem in the aging face, but basing a facelift on the skin only will not hold secondary to its elasticity
  • Fat can descend and resorb in the aging face, repositioning and volume replacement can help rejuvenate the face. Volume without repositioning can lead to disharmony.
  • SMAS or Sub Musculo-aponeurotic System, is the tough lining of the face and can be mobilized to help reposition and lift the facial fat and skin. This layer can hold tension and when positioned correctly help deliver a natural facial rejuvenation.

Not all SMAS facelifts are equal, and just tightening the SMAS will likely lead to early failure secondary to a lack of mobilization.

Pull, stretch, tuck, nip are not great descriptions for facelift surgery…..Repositioning is correct which helps to recreate the face and how it looked 10 to 20 years prior to the patient’s surgery.

Not all facelift surgery is created equal.

  • Simple skin lifts undermine the face and neck skin, and place tension on the skin which secondary to its relaxation will likely fail and can lead to an over stretched look. This is similar to the early facelifts before the 1970s or the “renaissance” of facial surgery.
  • SMAS plication involves skin undermining and a skin lift with the bunching of the SMAS with a suture. Without any mobilization, this technique could be prone to early failure.
  • SMASectomy involves a skin lift with suture elevation of the SMAS in the cheek. This is an effective facelift technique when performed correctly and on the mobile SMAS.
  • Sub-SMAS dissection Deep plane, low SMAS, High SMAS and extended SMAS all elevate below the SMAS and differ on the amount of skin undermining and whether the cheek SMAS is included in the facelift flap.

Dr. Trussler in Austin Texas has significant experience in SMAS facelifts and primarily performs a High SMAS facelift for facial rejuvenation surgery.

Differences in facelift results and longevity vary, and may relate to the patient’s tissue, including skin quality, as well as surgeon technique.

  • Look for a facelift surgeon with reproducible results and concise technique that is consistent.
  • Technically simple facelifts may lend themselves to the plastic surgeon without advanced cosmetic experience.

Advanced techniques, such as a sub-SMAS dissection, lend themselves to experienced facelift surgeons. They are technically more advanced and when performed correctly do have advantages.

  • Reliance on fillers and fat transfer, may indicate the simple approach that accentuates volumizing without repositioning. This technique may lack longevity and natural rejuvenation.

Skin treatment is an important dimension to facial rejuvenation, and can start prior to facelift surgery with skin care. Skin resurfacing at the time of facelift surgery and after can help to improve the result of facial rejuvenation and help with harmony of the face.

There is no right or wrong way to address the face, though an individual approach based on the patient’s concerns and goals is important. The facelift surgeon should have facelift techniques to address these issues and not just one technique for all.

Experienced facelift surgeons should have numerous techniques to treat secondary issues, such as early recurrence and repeat or secondary facelifts. This enables the surgeon to work around previously operated areas safely.

Ultimate goals of facelift surgery:

  • Balancing safety with results to help deliver consistent and harmonious facial rejuvenation.

Andrew P. Trussler MD is an experienced plastic surgeon in Austin Texas with advanced training in facelift surgery including secondary correction of facelifts.

Dr. Trussler’s Austin plastic surgery office can help guide you in correcting commonly seen facial aging complaints. Facial rejuvenation with a High SMAS facelift can help you look younger with a natural, long-lasting result.


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