Modern approaches to the traditional facelift

Data gathered by the American Society of Plastic Surgeons shows that, aside from a small dip in 2015, facelift surgery has consistently been one of the top five cosmetic plastic surgery procedures in the United States. This is especially significant considering the popularity of minimally invasive, nonsurgical procedures such as Botox, dermal fillers and lasers.

As we age, the diminishing production of fundamental building blocks such as collagen and hyaluronic acid can lead to the gradual breakdown in skin firmness or elasticity, volume and texture. This process can vary from person to person in how quickly or slowly it occurs, depending on both genetic and environmental factors.

Nonsurgical facial rejuvenation

The nonsurgical procedures mentioned above can address these concerns to a significant extent—in fact, skin tone and texture imperfections cannot be corrected surgically—but when it comes to achieving more dramatic, longer-term improvements in age-related shifts to skin, fat and other tissue in the face and neck, a facelift or rhytidectomy surgery is still the most effective option.

Some plastic surgeons even note that minimally invasive procedures have served as a gateway to a facelift, as it piques the interest of patients who may have previously been intimidated by the concept of a cosmetic procedure – especially a surgical one. Minimally invasive procedures seem easier for patients to approach, and help to introduce them to the idea of cosmetic surgery.

Surgical facelift

At a certain point, patients tend to find that nonsurgical procedures are not enough to get the results they are looking for – or they may simply grow weary of the discomfort, inconvenience and expense that come with repeat treatments to maintain or better their results. There's even a name for this sort of patient concern: needle fatigue!

Until the 1960s (and in some cases, even later), facelifts consisted of simply tightening and pulling the skin taut to a new position, then cutting the remnants off. But relying on a one-dimensional approach resulted in the well-known, unnaturally stiff and mask-like appearance that many individuals outside the medical community have come to associate with the procedure.

A much longer-lasting and more natural approach to facial rejuvenation is to incorporate techniques that also work on the fat and sheaths of tissue underneath the skin. Making a small flap through incisions in the skin allows a surgeon access to the stronger, deeper layers of tissue between muscle and fat, known as the SMAS (superficial muscular aponeurotic sheath). Precise manipulation of the skin flap can reposition the SMAS to achieve a multi-dimensional result that both tightens and lifts the face to result in better volume and contour of the cheeks, definition of the jawline and firmness of the neck. This type of procedure is sometimes referred to as a high-SMAS or deep plane facelift.

Additional processes or modifications may be incorporated into a facelift to address the volume loss that comes with aging. These include the use of grafts from the SMAS tissue and/or from the patient's own fat extracted from another area of the body. Grafts may be placed in areas that typically exhibit volume loss, such as the cheeks, under-eye areas and lips. Facial fat pads may also be repositioned or replaced, as they can slide down from their original locations over time.

Modern facelift techniques

Less extensive versions of a facelift, such as an S-lift, mini facelift, neck lift or endoscopic facelift may be considered for those patients who would like to receive longer-term results in certain areas, but do not require a complete facelift to achieve their goals.

What is most important to note is that each facelift case is distinct, and procedural steps can vary significantly from patient to patient to address each of their concerns and accommodate facial characteristics. Such individualization is, in fact, the cornerstone of a well-performed facelift procedure today.

Your surgeon may also opt to include complementary procedures such as a blepharoplasty/eyelid surgery and/or brow lift to address the upper face or forehead area, or laser skin resurfacing to improve skin texture and minimize any scarring.

While many doctors perform facelift surgery, patients should ensure at the very least that their surgeon of choice is board certified to perform plastic surgery (as opposed to only general surgery) and has extensive experience performing facelifts with successful results.