The Evolution of the “Facelift”

When I was training in New Orleans we were proud of our facelift technique and had good short-term results. Our procedure consisted of making a skin incision in the crease in front of the ear and behind the ear, lifting (undermining) the skin to the mid-cheek area, placing a few sutures to tighten the deeper layers and then excising the excess skin.  We then told the patient to come back in a year or so for their “tuck-up”- at which time we basically repeated the same procedure but used the scar tissue under the skin to tighten more.  This procedure has survived as the LifeStyle lift and some other named variations but the underlying problem is that it depends on sutures to hold (they don’t) and doesn’t really address the ligaments that keep the tissues from being elevated.   

Later we began a “SMAS” flap technique.  We made the same incisions, lifted the skin, and made a cut through the “SMAS”.  The “SMAS” is a layer of muscle and fibrous tissue beneath the skin of the face and neck.  It can be lifted as a unit and tightened to support the face. The “SMAS” technique gave better and longer lasting results.

Finally, we progressed to variations of the “deep plane lift”.  Our technique we have termed the “deep vector lift” in our book The Art and Craft of Facial Rejuvenation.  We lift the skin a short distance and then go into the deep plane beneath the “SMAS” and elevate the cheek and jowl as one unit. We cut the ligaments that prevent elevation of the tissues. The cheek is elevated in a vector straight up and the neck towards the back of the ear.  This gives a natural, long-lasting lift that is our experience preserves a youthful experience for well over a decade.

In addition to our deep vector lift there are various lifts for specific areas.  The temporal lift is performed behind the hairline above the ear and raises the brow and forehead on the side.  The midface lift is approached through a similar incision but goes into the cheek area and elevates it directly up.  Our neck lift or submentoplasty uses and incision under the chin to remove fat, tighten the muscles, and remove some skin.  It is somewhat limited but in specific cases can give a very successful neck lift.

We now have many options that can be tailored to each patient’s individual needs and goals.  A consultation with detailed anatomical analysis can help determine the optimal procedure or procedures. Incision placement depends on hairlines, sex and other variables.  Procedures such as laser skin resurfacing can be done at the same time.

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