WHAT A FACELIFT DOES AND DOES NOT DO

Most people are unclear as to what exactly is accomplished by a facelift. This is understandable. There are dozens of published techniques so that not all facelifts produce the same results. The following comments are true for the facelift that I perform, which is a deep-plane lift, also called "sub-SMAS," with an element of the composite lift (with reference to elevation of the orbicularis muscle as part of re-draping the tissue of the cheek and lower eyelid).

WHAT DOES A FACELIFT DO?

When combined with a cheek lift (which is part of the deep-plane lift), the facelift really should be called a "cheek, jowl and neck lift" to properly define the areas treated.

The cheek tissue which consists of fat that slowly sags down from the cheekbone, is hoisted back up where it started. Lifting the cheek tissue also helps de-accentuate the smile creases (nasolabial creases), particularly if the lift is combined with laser resurfacing and fat injection into these creases. The connective tissue under the jowls is pulled up, taking up the slack along the jawline. The muscle in the neck, called the platysma, is tightened on each side, helping to define the jawline and smooth the vertical bands that run in the neck. Liposuction is performed under the chin, and the platysma is also tightened in the midline, under the chin, using the same incision in the crease under the chin. This eliminates the double chin and further improves jawline definition.

WHAT DOES A FACELIFT NOT DO?

It is not unusual for a patient to assume a facelift also treats the forehead. Such an assumption is reasonable. After all, the forehead is the upper third of the face. However, by tradition, plastic surgeons consider forehead rejuvenation separately. A forehead lift, also called a "brow lift" or "forehead-plasty" is often recommended simultaneously to treat the forehead at the same time the middle and lower thirds of the face are treated with a facelift.

A facelift does not treat the eyelids. The rejuvenation procedure for eyelids is called "blepharoplasty." Often, blepharoplasties are performed at the same time as the facelift, unless they have been treated previously and do not need revision.

A facelift does not remove the fine lines around the mouth. As you might imagine, pulling up on the cheeks does not affect the upper lip. These vertical lip lines are smoothed with the laser.

A facelift does not restore lost volume to the face. Many techniques elevate the fallen cheek fat (malar fat pad), but this provides no net increase in facial volume. To provide youthful facial fullness, fat transfer is the key. The successful integration of fat injection with face-lifting is an important advance in facial rejuvenation. However, this is still done by only a minority of plastic surgeons.

A facelift restores tone by taking up the slack in the facial skin. Laser skin resurfacing smoothes out surface wrinkles and fat injection replenishes lost fat under the skin, restoring fullness. To use an analogy, a facelift is like pulling up the bedspread, laser resurfacing irons it out and fat injection is the comforter.

In summary, the 4 R’s of facial rejuvenation are: Redrape (facelift), Relax (Botox^® Cosmetic or an endoscopic forehead lift), Resurface (laser skin resurfacing) and “Refill” (fat injection).