There are three main variations of the face and neck lift:
Each is defined by the layers of facial tissue and muscles that are shifted to attain "the lift."
The skin or subcutaneous (under the skin) lift focuses on removing excess skin and redraping the remaining skin while sculpting the excess fatty tissue of the jowls and neck below the jaw line. This is the venerable and most traditional of the procedures.
The SMAS lift focuses on the anatomically defined layer of covering tissue below the fat and intimately related to the muscle covering. The aim is to "lift" the deeper layers, beneath the skin and fatty tissue. This technique was first performed in the late 1970s after anatomists discovered the significance of this layer of tissue called the SMAS and its implications for face-lifting. The hope invested in this procedure was that it would have greater longevity; however, a solidly researched recent journal article concluded that this variation added no greater lifespan value to the classical skin/ subcutaneous lift.
A decade later, the deep plane lift techniques evolved. Attempting to release the lift burden from the skin, and hoping for the longer lasting result, surgeons began burrowing deep under the skin, fat, SMAS, and facial muscles of expression.
Lifting these, as a unit, would hopefully reduce the chances of skin overstretching with its negative consequences and yet give a more durable result. Some consider this the most radical of the face-lifting options because of the risk of the overtightened, overlifted, "always surprised" appearance, usually due to the overly aggressive repositioning of eyes and brows. Each procedure and its minor modifications have advantages and disadvantages. Each has its own set of potential complications, problems and dissatisfactions.
Face-lifts for aging have to be subtle . . . you can''t have total rejuvenation and still keep the integrity of the face.- Joan Kron, author Lift: Wanting, Fearing, and Having a Face-lift
Be sure to ask each surgeon you interview to recommend the technique appropriate for you in his handsand why. Then, make sure you understand what will be done. And, do not leave that office until you see many before and after photos of patients whose befores illustrate the same types of dissatisfactions that you want solved.
Finally, please remember that face lifts of any variety cannot transform wrinkled, lined, weather-beaten, aged-spotted skin to youthful, smooth, fresh skin. Only resurfacing chemical or laser does that. Surgery to "pull out" wrinkles never works.
It can even nullify the success of an appropriate lift. And, when you see that unfortunate man or woman whose face is in a perpetual smile, or suggests they just ended a ride strapped to the tail of a 747, you will know they were never told that surgery is always the wrong solution for wrinkles. And you will know they never had the opportunity and the wisdom to read this article.
A Face Lift Every Three To Four Years? Get RealI am astonished when some well-heeled, Beverly Hills matron proudly announces she has had multiple face lifts. My guess is she has confused quantity with quality. It is no badge of honor to have the major facial cosmetic surgery that often. There is no value there either. We expect our face and neck lifts to last ten to fifteen years or longer. Just recently, we did a "second lift" for one of our patients whose first was 21 years earlier. She is not unhappy about having the second lift; she had a good run with the first. And after surgery, she kiddingly said, "Well, if I get 21 years out of this one, I''ll be back when I''m 81 years of age. I''ll probably still be around because my mother''s in her 90''s. Dr. Johnson, will you be here?
I sure hope so, Mary Anne. -DJ
Poorly performed surgery of face and neck can announce itself in one of two ways. The first will be a consequence of undertreatment of jowls: a double chin, vertical neck folds, or sagging cheeks, brows and temples. Complaints from patients might be that "my face and neck dropped again, only several months after surgery." Usually, this is a result of the original surgery doing little more than tightening the skin, the so-called "minilift." Incidentally my motto is "minilift equals miniresult." More aggressive, modern techniques correct the beneath-the-skin muscle sag and fat accumulation yielding better results that last far longer.
The second possible advertisement of a poorly performed face and neck lift will be that overly tight distortion of facial features. The artificial look. Patients will complain of a "plastic" or "drum-like" appearance. Too much was done; the opposite of the minilift. This unfortunate appearance is the consequence of inappropriate, over-zealous, mis-directed face tightening. Usually, an unrealistic, vain attempt to erase wrinkles and lines about the cheeks, mouth and eyes. The "nasolabial fold," between the cheeks and the upper lip and nose, is very difficult to eradicate even by the most aggressive techniques.
While drastic tightening temporarily smoothes out these wrinkles lines and grooves, the effect is short-lived. The skin is elastic, like a rubber band, and will contract, causing all such dissatisfactions to return. Further, vigorous tightening is risky since the incisions can break down or later can heal with thick unattractive scars.
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