What Is a Facelift?
A facelift is a procedure used to reposition the midface (the cheeks) and the lower face (the jawline and the melolabial folds). The incision begins in a crease in front of the ear, travels behind the ear, and then continues into the hairline. The face is elevated by repositioning the deeper fascia, known as the SMAS (superficial musculoaponeurotic system), in a superior and lateral vector. Suspending this deep fascia layer allows for a natural result with minimal tension on the skin. The length of the incision depends on the amount of excess skin; in patients without much excess, a shorter incision can be used. This shorter incision is often referred to as a “mini-lift.”
The platysma is a broad, thin muscle that covers the lateral neck and extends up onto the face. During a facelift, this muscle is accessed through the incision and resuspended, which provides some degree of a neck lift. A facelift is often combined with a neck lift and platysmaplasty, which involves a small incision below the chin to refine the neck contour. Depending on the patient’s anatomy, deep neck structures such as the submandibular gland, digastric muscles, and subplatysmal fat may also be modified. In a platysmaplasty, the edges of the platysma, which form the loose bands beneath the chin, are sutured together centrally to create a smooth contour, while laterally the platysma is elevated to provide additional lift.
Risks and Complications
As with any surgery, a facelift carries risks, including bleeding, hematoma, infection, healing problems, skin necrosis, and facial nerve injury. When the submandibular glands are reduced, there is a risk of sialocele, a collection of saliva that leaks into the neck cavity. Numbness of the face surrounding the incisions can be expected for six to nine months and generally improves slowly over time. As noted, a facelift carries a number of potential complications, and both the surgeon and the patient should be prepared to address them should they arise.
Ancillary Procedures
A face and neck lift rejuvenates the lower two-thirds of the face and the neck. Many patients choose to undergo additional, ancillary procedures at the same time to address other regions of the face, such as a brow lift, blepharoplasty (eyelid surgery), buccal fat reduction, and lip lift.
Dr. Namin’s Philosophy
The deep plane facelift has been well described for decades, and many excellent surgeons have refined the approach and taught it extensively at meetings worldwide. The deep plane technique allows the midface and melolabial folds to be resuspended in a natural, elegant, and lasting manner, while the jawline is also nicely redefined. Facelift surgery is gaining popularity, particularly among younger patients, and the procedure continues to rise in popularity because of the rapid refinement of techniques over the past twenty years. Dr. Namin attends multiple facial rejuvenation meetings each year to continually refine and improve his own techniques. He feels the time is right for a facelift when a patient is bothered by the appearance of the midface and lower face, and when he believes he can provide a significant improvement.