Types of Facelifts

Facelift woman

What are the Different Types of Facelifts?

There are many different names used to describe facelifts. This can cause some confusion. In reality, all these different names refer to very similar techniques.

Mini Facelift

A mini facelift is a facial rejuvenation with reduced incisions and dissection.   The goal is achieve a nice result with less scars, less OR time, and a quicker overall recovery. It typically only involves limited dissection around the ears. There is only a limited dissection into the neck area. Results after a mini-facelift can be excellent although there can be less results in the neck area.

A mini facelift is a good option for younger patients that do not have significant neck aging. It also good for older patients that want a limited procedure with a quick recovery. It is also a good option for patients that have had a prior facelift procedure.

Full Facelift (Face and neck lift)

A full facelift procedure includes access to the neck via a submental incision as well as the periauricular incisions. The dissection into the neck is more extensive than in the mini-lift variety. This allows for the removal of neck fat and suturing the platysma muscle. This adds more time for the procedure.

Full facelift neck procedure
Additional procedures performed in the neck that makes for a full facelift. Medial suturing of paired platysma muscles with partial transection of the anterior border. [Reprinted with permission from Stuzin JM. MOC-PSSM CME article: Face lifting. Plast Reconstr Surg. 2008;121(1 Suppl):1–19.]

Not everyone needs the additional work a full facelift entails. However, if a patient presents with neck fullness and significant neck bands, wrinkles, and fat, then a thorough neck treatment is necessary. Not addressing the neck may not give the best result.

Skin-Only Facelifts

This is most basic facelift technique. The incisions around the ears are made, dissection is performed under the skin, and excess skin is removed.

This is only recommended for younger patients who desire facial rejuvenation. It is also suggested for high weight loss patients with significant skin excess.

The drawback to this technique is that it may not have the longevity of SMAS or deep plane lifts.

Skin only facelift procedure

SMAS Face Lifts

The SMAS (superficial musculoaponeurotic system) is a layer of tissue present underneath the skin in the face. It lies just above the parotid gland. It is also just above facial nerves that power the facial musculature.

SMAS anatomy
The five layers of the face, analogous to layers of the scalp and neck. The facial nerve travels deep to layer 3, becoming more superficial within layer 4. (Reprinted with permission from Mendelson B. Facelift anatomy, SMAS retaining ligaments and facial spaces. In: Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic Surgery. London: Elsevier; 2009:57.)

Although SMAS manipulation may increase the risk of nerve injury, in experienced hands, this is a rare complication. Combining a lift with SMAS manipulation is an excellent way to improve the longevity of the result. The SMAS layer is manipulated in different ways. Sutures can be placed to lift it. The SMAS can be excised the defect sutured closed (smasectomy). Or the SMAS can be raised as a flap and sutured to a higher position.

MACS Facelift

A popular facelift technique that uses sutures to hold up the SMAS is called the MACS lift. MACS stands for Minimal Access Cranial Suspension. It suspends the SMAS to the deep temporal fascia. An illustration showing the minimal access cranial suspension is shown below.

MACS facelift
A MACS facelift technique uses cable sutures on the SMAS to lift the tissue. The skin is then redraped over this. Tonnard PL, Verpaele AM, Morrison CM. MACS face lift. In: Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic Surgery. London: Elsevier; 2009:138.

High SMAS Facelift

In this technique, the surgeon elevates a SMAS flap from the underlying tissue. The surgeon sutures the SMAS upwards to hold facial tissues in a higher position.

SMAS flap facelift
Illustration showing Barton’s “high SMAS,” with cheek soft tissue raised along with overlying skin. (Reprinted with permission from Barton FE Jr, Meade RA. The ‘HIGH SMAS’ facelift technique. In: Aston SJ, Steinbrech DS, Walden JL, eds. Aesthetic Plastic Surgery. London: Elsevier; 2009:133.)

Deep Plane Facelift

The deep plane facelift involves elevation of the skin flap and the SMAS flap together in one flap.  We recommend this technique in smokers who are at high risk for wound complications. It is technically more challenging with higher risk of nerve injury and longer recovery time.

Composite facelift
Illustration showing Hamra’s original composite face lift flap, with orbicularis, malar fat, and platysma raised in continuity with overlying skin. (Reprinted from Hamra ST. Composite rhytidectomy. Plast Reconstr Surg. 1992;90:1–13.)

Subperiosteal Facelift (Ponytail Lift)

This involves elevation of the cheek soft tissues in the subperiosteal plane. It is more of an adjunct to other techniques and helps correct cheek ptosis.

Endoscopic Midface Lift
Via a small temporal hairline incision, dissuction proceeds in the subperiosteal plane of the cheek to elevate the cheek soft tissues.

Visit us at Thomassen Plastic Surgery to learn how different facelift techniques may work for you. You can learn more about this topic at the American Society of Plastic Surgery website.

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