Clearing the Confusion About Facelift Surgery

Face and neck lift surgery, also known as cervicofacial rhytidectomy, is a procedure that has been performed for more than 100 years. It is the ultimate facial rejuvenation and is a result that no other type of procedure, surgical or nonsurgical, can duplicate. Advances in surgery, instrumentation procedures, and anesthesia have made face and neck lift procedures easier and more predictable than ever. Still, this procedure is fraught with fear of having unnatural results or a “windblown” appearance. With today’s techniques and an experienced surgeon, this is not an issue.

WHAT FACE AND NECK LIFTS DO

Figure 1 demonstrates how facial aging is a universal situation that is a result of changes in all the tissues of the body. Although most patients don’t want to hear “the F word” (facelift), no other procedures can comprehensively address the changes that occur in the fifth decade and beyond. A face and neck lift addresses the lower face and neck and does very little to address the central part of the face, such as brows, eyes, nose, or mouth. The main areas improved with a face and neck lift are the jowls. Figure 2 visualizes the results of a patient who underwent deep plane face and neck lift with buccal fat reduction and jowl liposuction. You can clearly see the aging from her lower face was squared off for a more youthful, tapered appearance. In Figure 3, the results from removing excess neck skin, also known as “turkey gobbler deformity,” are dramatically different. Understanding what a face and neck lift is or what it does is muddied by social media and misunderstandings. Many times, a patient will say they want a facelift but not a “full facelift.” There’s no such thing as a full facelift; otherwise, a “partial facelift” would become a procedure. This request from patients is a reference to older techniques whereby an incision was made all the way in front and behind the ears and over the top of the head, in an attempt to lift the brow as well. Modern facelift procedures do not include such aggressive incisions. Contemporary brow lifting incisions have become dramatically more conservative and are frequently performed with facelift procedures.

Fig 1. Even royalty experiences aging skin. These pictures were taken over the lifetime of Queen Elizabeth and show common aging changes of the face and neck. (Photos taken from public domain.)

Fig 2. A patient who underwent deep plane face and neck lift with buccal fat reduction and jowl liposuction. Her squared off, aging lower face was restored to a more youthful, tapered face. (Photo courtesy of Dr. Joe Niamtu III.)

Fig 3. The results from a deep plane facelift in which significant excess skin and turkey gobbler deformity were addressed. (Photo courtesy of Dr. Joe Niamtu III.)

Individuals marketing nomenclature to personalize or promote a trend-sounding procedure that may, or may not, be close to what a facelift is or does causes confusion about the word “facelift.” There are vampire facelifts, thread lifts, filler facelifts, and a vast myriad of other descriptive terms that may or may not have anything to do with the surgical procedure done today for lower facial aging. Personally, I think this is unfair and confusing for the public and its perception of the true procedure.

FACE AND NECK LIFTS TODAY

Contemporary face and neck lifts include incisions under the sideburn that extend in hidden portions of the front of the ear and traverse around the earlobe to a hidden incision behind the ear with an extension into the hairline. Figure 4 visualizes two common variants of facelift incisions based on surgeon preference.

Fig 4. Two common variants of facelift incisions based on surgeon preference. (Photo courtesy of Dr. Joe Niamtu III.)

After the incision is made, the skin is separated from the deeper tissues. This is common in all true facelift procedures. The main difference exists with how the deeper tissues are treated. There are many ways to treat the deeper tissues in the superficial musculoaponeurotic system (SMAS), which is a fibromuscular layer that must be addressed for longevity and natural results. There are many ways to tighten the SMAS, including application procedures that tuck the layer, or SMASectomy, a procedure in which a portion of the SMAS is removed and the edges are sewn back together to tighten the deeper tissues.

DEEP PLANE FACELIFTS

The current landscape of face and neck lift nomenclature focuses on “deep plane” techniques. Deep plane facelift procedures have been performed for decades but have been refined and gained significant popularity over the past decade. The word “deep plane” refers to the way the SMAS (and neck) is treated. The other procedures that address the SMAS are superficial, while the deep plane technique is performed under the SMAS layer to provide a longer lasting and more natural appearing result. Operating in this layer beneath the SMAS is an advanced technique that involves the surgeon working in closer proximity to the facial nerve branches, submandibular glands, and other significant structures that are usually not encountered in more conservative types of face and neck lifts. In Figure 5, the left image shows the dissection occurring under the SMAS and the right image shows sub-SMAS connective structures.

Fig 5. The dissection occurring under the SMAS (left) and the subSMAS connective structures (right). (Photo courtesy of Dr. Joe Niamtu III.)

I have performed hundreds of deep plane face and neck lifts, and I am very happy with the improved results of this technique, especially in the neck and profile region. Many of my colleagues feel the same way.

One area of confusion, however, is the notion that any other type of facelift besides the deep plane technique is inferior. This is not true as other techniques done by experienced surgeons in accredited facilities can provide excellent results. Experienced surgeons should be able to show a patient hundreds of before-and-after picture sets that validate their expertise. Surgeons of numerous specialties are qualified to perform facelift surgery based on their training, experience, safety, and outcomes.

I have performed more than 1,700 face and neck lifts—usually about 100 per year. Every facelift patient has concerns about looking unnatural, but researching the surgeon’s experience and outcomes should put such fears to rest.

Figures 6 and 7 show contemporary facelift procedures that were accompanied by other procedures such as blepharoplasty, brow and forehead lift, facial implants, fat injection, and skin resurfacing.

Fig 6. This patient underwent face and neck lift with upper and lower eyelid surgery, cheek implants and laser skin resurfacing. Combining simultaneous procedures can improve decades of aging. (Photo courtesy of Dr. Joe Niamtu III.)

Fig 7. This male patient underwent deep plane face facelift with submandibular gland reduction and a chin implant. (Photo courtesy of Dr. Joe Niamtu III.)

THE IMPORTANCE OF CLARITY

On average, a facelift procedure requires approximately 2 weeks for primary recovery before patients can return to work. Complete recovery can take several months. If my patients are anticipating an important affair such as a wedding, vacation of a lifetime, or class reunion, I recommend they have surgery 6 to 8 weeks prior to the event.

Patients can be confused about facelift procedures that are minimally invasive. These may work for a select group of patients, but if a patient has jowling and excess neck skin, it should be recommended they undergo a traditional face and neck lift with the incisions described above. Attempting to address moderate to advanced aging with minimally invasive procedures often leads to unhappy patients and wasted dollars. Ensure your patient understands the differences, show numerous results, and address expected longevity.

Younger patients with minimal or minor aging may respond well to less invasive procedures as a holdover to when surgery is a requisite.