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Facelift Types

Facelift Types

Featuring Articles By

James P. Wire, MD

updated

Over the years, facelift has become a blanket term for surgical facial rejuvenation. However, it actually refers to a number of different procedures designed to address the upper, middle, or lower third of the face.

If you are interested in addressing signs of aging with surgery, you should contemplate exactly what you hope to accomplish and meet with several surgeons to best determine the one who can help you meet your goals. By understanding the different kinds of facelifts and their benefits, you can be prepared to have a productive consultation with your surgeon and make a well-informed decision about whether that surgeon is right for you.

Choosing the Right Surgeon

Most plastic surgeons provide treatments for the breast, body, and face. If you are considering a facelift, it is important to find a surgeon who focuses on facial procedures, or performs facelifts frequently. You should explore the surgeon's website and credentials, and read independent reviews to gauge his or her reputation.

When performing facelifts, all plastic surgeons put incisions in the same locations. After that, however, their individual techniques vary

When performing facelifts, all plastic surgeons put incisions in the same locations. After that, however, their individual techniques, which include endoscopic and traditional, vary. I compare this to baseball players swinging bats: the fundamental action is more or less the same among all players, but certain nuances are unique. In the case of facelift surgery, the extent to which surgeons work on underlying tissues can vary between practitioners. You will find that exploring your surgeon's track record in terms of board certification, reviews, and before-and-after photos can reveal a great deal about his or her technique.

Your surgeon should not only make you feel comfortable, but also clearly explain the complex details of surgery in a way that is easy for you to understand. If he or she seems to be hastily steering you toward surgery that you feel might be excessive, that is probably a good indication that you should look elsewhere. However, if the surgeon patiently explains several options and describes how they can complement your existing features to achieve aesthetic harmony, he or she is likely prepared to tailor the treatment precisely to your needs. In addition to checking that your surgeon is certified by the American Board of Plastic Surgery, the American Society of Plastic Surgeon (ASPS) recommends asking whether the surgical facility your procedure will be performed at is accredited by a nationally or state-recognized accrediting agency, or is state- or Medicare-licensed. 

"I think that the most important thing to consider is that your surgeon understands what you see, and what you feel you need for your surgery," says Keith Saxon, M.D., a plastic surgeon practicing in Kansas City, MO. "Even if a surgeon performs a surgery perfectly, if it's the wrong type of surgery, the patient isn't going to be happy. If your surgeon is trying to sell you a one-size-fits-all procedure, you won't get the outcome you're looking for."

Mini Facelift

A mini facelift, also called a mini-lift, focuses on the jawline to restore definition lost due to diminished skin elasticity. I personally call it a "mini facelift" because the procedure is efficient - not because it isn't extensive. To perform a mini facelift, a surgeon creates an incision around the ears, called periauricular incisions. As with any facelift, the procedure requires the surgeon to elevate the skin as well as the superficial muscular aponeurotic system (SMAS), the thin layer of muscle and tissue that lies just beneath the skin. The SMAS provides definition and plays an important role in facial expressions. During a mini facelift, the surgeon lifts tissue up and outward to restore contour and definition. After that, excess tissue is removed and incisions are closed with sutures. In some instances, a mini facelift can include liposuction to eliminate fat deposits or fat grafting to restore volume.

Read James P. Wire, MD's Take:Mini Facelift Surgery

Mini facelift surgery is the most common type of facelift surgery performed today. It addresses wrinkles and sagging skin on the lower third of the face using small incisions placed around the ears. Read Full Article

I personally perform the mini facelift procedure using local anesthesia, which leaves patients conscious, but unable to feel pain in the treatment area. This has many benefits, one of which is that I do not need to use an endotracheal or breathing tube. When patients are under general anesthesia, or completely unconscious, they must depend on on life support. I personally find that the tube, and anesthesiologist,  gets in the way as I try to refine the lower third of a patient's face. I have also found time and again that my patients appreciate conservative anesthesia, which carries fewer side effects than general anesthesia.

Lori is a patient of mine who underwent a mini facelift after she noticed sagging around her jowls that made her jawline look increasingly square.

"It was much easier to come out of local anesthesia," Lori said. "To me, that was the most amazing thing that I didn't expect before surgery."

Neck Lift

A neck lift is a procedure that can provide a powerful complement to a mini facelift. Neck lifting tightens the skin of the neck and its underlying platysmal muscles, which extend from the chin down to the collar  bones. In essence, it addresses everything that is visible from the neckline of a t-shirt to the lower third of the face. Neck lift surgery may be performed through a periauricular incision or separate incisions under the chin. In some cases, patients choose to incorporate liposuction into a neck lift to enhance the definition of their neck and jaw lines.

Mid Facelift

A mid facelift addresses the area that extends from the cheekbones to the jaw. Using incisions similar to those used in a mini facelift, the surgeon  tightens the SMAS and skin tissue, pulling outward horizontally toward the ears to achieve a lift of two to four centimeters. This flattens folds around the mouth. The tissues are held in place with permanent sutures under the skin. Your surgeon can also redistribute the fat tissue in your cheeks to enhance your contours during this procedure. Once your skin and underlying tissues are redraped to achieve a natural-looking refinement, excess tissues are trimmed away and the incisions are closed with sutures.

Brow Lift (Upper Facelift)

A brow lift, also known as an upper facelift or forehead lift, reduces wrinkles and lines in the upper third of the face. Brow lift surgery subtly tightens the skin and underlying muscle tissue of the forehead, reducing wrinkles between the eyes and across the brow. It can also lift the eyebrows.

Surgeons perform brow lift surgery using incisions created in the hairline, which result in subtle, easily concealed scars. The procedure is commonly combined with blepharoplasty, or eyelid lift surgery. The combination of these surgeries can create a rejuvenated, more rested appearance.

Full Facelift

A full facelift combines elements of lower, mid, and upper facelifts. When an experienced surgeon with advanced knowledge of facial anatomy performs a full facelift, it can restore definition to your features, reduce wrinkling and sagging skin, and rejuvenate your appearance in a way that looks natural.

"When patients have sagging across their face, the combination of a brow lift with a lower facelift can maintain aesthetic harmony," Dr. Saxon said. "If a patient simply undergoes a lower facelift when he or she also has sagging in the brow area, it can draw more attention to the imperfections in the untouched area. Combining these procedures creates equal lifting across the face."

Combining one or more treatments is more common for older patients who want a fully rejuvenated look. As always, patients should be prepared to discuss their goals with their surgeon, and they should expect the surgeon to thoroughly explain how different refinements will result in a harmonious overall enhancement.

Branded Facelifts

Two types of facelifts that are prominent brands today are Lifestyle Lift® and QuickLift®

Two types of facelifts that are prominent brands today are Lifestyle Lift® and QuickLift®. They have become especially popular in recent years. Both are marketed as less invasive variations of facelift procedures. Your plastic surgeon will have undergone specialized training to perform these procedures, and he or she can tailor either to suit your specific needs.

The Lifestyle Lift® is performed using local anesthesia. It requires the surgeon to place incisions in front of the ears that extend beneath and behind them. Through these incisions, the surgeon can lift the SMAS and skin.

The QuickLift® involves tightening the skin and SMAS of the jowls, jaw line, neckline, and cheeks, as well as removing excess tissue. It is designed for patients over 40. QuickLift® is performed using an S-shaped incision that begins at the sideburn area, and extends along the area where the ear meets the cheek and then continues around the earlobe toward the nape of the neck. Unlike Lifestyle Lift®, QuickLift® surgery employs a technique in which a suture comparable to a purse string is attached to the SMAS, and then pulled close to the incision. This provides an instantaneous lift. Several purse-string sutures may be used, depending on the extent of treatment needed.

Facelift Alternatives

Many patients want to reduce signs of aging, but do not feel ready for a surgical facelift. A "liquid facelift" provides an alternative that can help these patients achieve their goals. It is performed using a customized combination of dermal fillers and other injectable treatments to reduce the appearance of wrinkles across the entire face, and enhance contours in specific areas.

The most popular type of dermal filler is made from hyaluronic acid, a protein that exists naturally in the body and, together with collagen, gives skin its elasticity. Widely known brands of hyaluronic acid include JUVÉDERM®, Restylane®, and Perlane®. These are injected directly into areas that have deep lines or wrinkles. They add volume beneath the skin, reducing the prominence of imperfections. Many practices also provide collagen injections and fat injections (using your own tissue, removed from areas of the body through liposuction) to restore youthful volume.

In addition to dermal fillers, your liquid facelift may also include botulinum toxin injections. BOTOX® Cosmetic and Dysport® injections are the most popular types of botulinum toxin used today. These injections block certain nerve impulses, preventing muscle contractions that cause wrinkles and other signs of aging.

Another non-surgical alternative gaining recognition in today's market is the Vampire FaceLift®. This treatment is thought to rejuvenate  through injections of a patient's own platelet-rich plasma (PRP). To derive this, doctors draw a small amount of the patient's blood and place it in a centrifuge to isolate natural growth factors. Doctors often use PRP therapy in sports medicine and bone grafting surgeries to expedite healing. PRP can spur collagen production and increase blood flow, which results in firmer skin. When injected into specific areas of the face, PRP injections reduce the appearance of wrinkles and result in a vibrant, youthful appearance.  However, to date, there are no clinical studies which substantiate the efficacy of PRP injections in facial cosmetic surgery.

Recovering from Facelift Surgery

Today, advances in techniques and technology have resulted in shorter recovery times following surgery of all kinds

In general, the more extensive the facelift surgery, the longer the recovery period will be and the more extensive the side effects. Today, advances in techniques and technology have resulted in shorter recovery times following surgery of all kinds. Nevertheless, a recovery phase remains as crucial as ever to the success of any treatment. By following your surgeon's explicit pre- and post-operative instructions, you can expect to experience the full benefits of your facelift. For example, the American Society for Aesthetic Plastic Surgery (ASAPS) recommends that you stop smoking at lease six weeks before the procedure to promote healing and reduce scarring. 

After any type of facelift surgery, patients initially wear dressings that cover incisions as they heal. In some cases, surgeons may recommend compression garments to facilitate healing. Some surgeons place drainage tubes at incision sites to prevent fluid buildup, but my approach to facelift surgery eliminates the need for them, or the need for shaving hair or the use of staples.

Your surgeon will schedule follow-up visits. I usually see my patients the day after surgery. For at least a week after surgery, you will need to avoid any activities that raise your heart rate. You will experience some bruising, swelling, tightness, and tenderness after surgery. After resting for a specified number days, you can slowly return to normal activities that aren't strenuous. Depending on the complexity of the facelift procedure you receive, you may require one to two weeks off from work or school following surgery. Your doctor will specify the duration of downtime necessary, but patients are typically authorized to resume all normal activities after one month.

Your results will become more apparent during the weeks and months that follow your surgery. The American Board of Cosmetic Surgery points out that the results of a well-executed facelift should not only look natural now, but also age naturally with your appearance over time. And comparing patients' appearance before and after facelift, a study published by the ASPS found that three-quarters of patients looked younger more than five years after their surgery.

My patient Judy underwent a mini facelift to address changes that occurred from hormonal fluctuations following a hysterectomy. She said it took about a year for the results of her surgery to become fully apparent.

"I felt that my results looked pretty good after a month, really good after three months, even better at six months, and my ultimate results were apparent after a year," Judy said.

My patient Lori said that after she completely recovered from her mini facelift, her coworkers seemed to notice that she looked different - but none suspected that she had undergone surgery.

I didn't want to look like somebody else. I wanted to look like me

"Truthfully, everybody thinks I got a new haircut," she said. "I work with several hundred people, and they just say they like my new hair. To me, that was the most important thing. I didn't want to look like somebody else. I wanted to look like me."

Combining Procedures

Today, many patients choose to combine procedures to achieve their goals, and continue with nonsurgical or minimally invasive treatments after surgery to enhance and maintain their results.

Some treatments commonly used in combination with a facelift, or to maintain the results of a facelift, include fat transfer,  Exilis treatments (radiofrequency technology used to spur collagen production and skin tightening), and ablative and fractional laser treatments. These treatments can help to keep your skin looking healthy for many years, and also reduce or delay the need for additional surgery.

Before her mini facelift, Lori underwent a chemical peel. After her facelift, she received Exilis for facial tightening.

"I enjoyed my previous results from Dr. Wire," Lori said. "Then, I wanted a more permanent solution. The combination was a good fit."

Tailoring Facelift Surgery to Your Needs

Facelift surgery has helped millions to experience greater self-esteem, a rejuvenated appearance, and overall improvements in their quality of life. The procedure is not only popular among women, but the ASAPS notes it was among the top five cosmetic surgeries for men in 2014. Procedures have become dramatically more sophisticated over the years, producing natural-looking enhancements through precise treatments tailored to patients' specific goals.

Your choice of surgeon will have a major effect on the success of your surgery. Meanwhile, patients themselves can increase the likelihood of a successful facelift by spending plenty of time thinking about exactly what they hope to accomplish, and entering consultations prepared to ask informed questions about the surgeon's recommendations and approaches to surgery. Remember, "facelift" may be a generic term, but you are unique, and you owe it to yourself to pursue the treatment that will best reflect your individuality in a beautiful, natural way.

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