American Society of Plastic Surgeons
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Facelift fundamentals: Types, techniques and transformations

facelift fundamentals

One of the best-known and most commonly discussed procedures within the world of plastic surgery is undeniably the facelift. A procedure sought out by men and women alike, this surgery offers the unique ability to turn back the clock on one's age by tightening the skin of the face. While we all may be familiar with what a facelift is in general, there is a wide variety of techniques that can be used to create optimal results for patients.

We reached out to two experts in the field – Aviva Preminger, MD, and Sara Dickie, MD – for insights on types, techniques and transformations. Keep reading for an in-depth discussion on the topic.

The beauty of facial rejuvenation

There are so many wonderful things that come with aging – wisdom, confidence and stability. Yet, there is one change that so many of us look to avoid – the signs of aging in our skin.

"When we age, what happens is that we get loosening of the various layers of the face," said Preminger. "The most superficial layer is the skin, then the subcutaneous fat and then the muscular layer as well."

While there are several things that happen to our skin with aging, the most common and most often addressed issue with facial rejuvenation is skin laxity. Skin laxity is due to a lifetime of experiencing gravity, which loosens the skin and layers of the face. In general terms, a facelift is a lifting and tightening procedure with the goal of rejuvenating your appearance.

"Basically, a facelift is aiming to restore volume and shapeliness to the face in its more youthful form," said Dickie. "It reduces deep wrinkles, corrects jowling and it can improve the nasal labial folds. Usually, it addresses the neck as well, but it varies between different surgeons."

Each facelift procedure is fully customized to the needs of the patient and can address a wide variety of issues.

Patient age and facelift procedures

There is no clear guidance on when the right age is to have a facelift.

"Some people who are more genetically predisposed may develop facial aging or aging of the neck early in life, as early as their 40s, while some people have skin that holds up better," said Preminger. "Some of it also has to do with environmental factors, such as sun exposure and fluctuations in weight."

According to the latest statistics from the American Society of Plastic Surgeons, facelifts do become increasingly popular with each passing decade of age.

"Typically, it's patients that come to me around ages 50-70," said Dickie. "Oftentimes, their first complaint will be, 'I feel like I look old. When I look in the mirror, I don't see the person that I feel I actually look like looking back at me. I don't like what I look like.'"

This change in appearance can range from something subtle and minimal to very dramatic, all depending on what the patient sees and is interested in correcting.

Different facelift types and techniques

When it comes to facelift procedures, there are a few different types of techniques – superficial versus deep.

"The deep facelift involves elevating below the muscle of the face rather than above it to address laxity," said Preminger.

On the other hand, the superficial facelift involves elevation of the layer above the muscle to address laxity. Both techniques are successful – which one is used largely depends on the preference of the surgeon performing the procedure.

"Essentially every technique that's out there will manipulate the SMAS (superficial musculoaponeurotic system) layer," said Dickie. "The SMAS is extremely important – it's the foundation of the face. It's the structure of tissue that has integrity to it and can support other tissues. When you move it, you can really shift everything on top of it, such as fat and skin."

Traditional techniques for facelifts often relied on purely manipulating only the top layer of the face – the skin. And while this worked temporarily, the skin would eventually become loose and lax again over time.

"Over time, we've discovered that it's not just the skin that causes signs of aging," said Preminger. "Now, we not only address the skin layer but the muscular layer underneath and the neck muscle that can cause visible bands in the neck."

Another innovation in facial rejuvenation and facelifts is the introduction of fat grafting.

"In more modern facelifts, almost everyone also uses fat grafting as an adjunct to their procedures," said Dickie. "This involves replacing some of the fat that has been lost from the face to create a more youthful appearance."

Maximize your facelift results

As with any plastic surgery procedure, there are key steps to take and advice to follow in order to maximize your recovery and the results of your facelift procedure.

Go for a board-certified plastic surgeon

Going to a board-certified plastic surgeon is always of the utmost importance when considering facial rejuvenation or a facelift.

"If you think you need a facelift or are interested in learning more, talk to a board-certified plastic surgeon who specializes in facial plastic surgery," said Dickie. "You'll be talking to someone who has seen a lot, done a lot and can point out the nuances of things that you may be interested in. They not only give you the noninvasive and minimal options but also the fully invasive and maximal."

Don't be afraid to seek out a second opinion

Taking the plunge to undergo a facelift procedure or another facial rejuvenation procedure is a big decision to make. To ensure that you have all of the available options and understand the outcomes, it's important to consider getting a second opinion.

"See more than one person to feel out personality, how you get along with the staff and office and to get more than one opinion." Said Dickie. "This helps build confidence in the decision you're going to make and helps you ask better questions to each surgeon."

Talk to your friends and acquaintances

One of the best ways to get advice or find a surgeon for facial rejuvenation is to talk to your friends or acquaintances who have had this procedure done.

"If you have a friend who had a good experience, ask that they recommend a surgeon," said Preminger, adding that if you don't have anyone in your inner circle who has had a facelift, you can also consult your trusted physician for a recommendation.

Avoid shopping for price

We all want the best deal possible but don't opt for affordability when it comes to a facelift procedure.

"The best value is not in the cost alone," said Dickie. "It's in the outcome, the longevity and the follow-ups you'll get from the procedure. A lesser cost is going to be a lesser procedure – you may not be getting the follow-up you need afterward."

Consider your whole face

For some patients and surgeons, it's easy to get caught up in small details about the face. Instead, look at your entire face and consider what other procedures could be done simultaneously to complement the facelift.

"Is it going to benefit you to have eyelid surgery at the same time? Or a brow lift? What about a hair transplant? There are so many things that can be adjunct to the facelift that round out the whole package," said Dickie.

Remember, it's a lifelong investment

Don't forget – just because you've recovered from a facelift procedure doesn't mean that you're done. It's an investment and involves long-term care and attention.

"Don't just focus on the recovery period," said Dickie. "Focus on ongoing maintenance such as skincare that will help the facelift results last long into the future."

Getting the facelift result you desire

When thinking about popular plastic surgery procedures, the facelift is undeniably one of the most common. Though we may think of it as a single procedure, there are a variety of methods and techniques used to achieve the goals and ideal results of any given patient.

By understanding the different facelift types and techniques used, you can set yourself up for success and maximize the results of your facelift procedure.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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