Facelifts
If you’re researching facelifts, chances are you’ve been on several different websites (perhaps even met with a few surgeons), and been given lots of different information. Some of it may have been misleading, or unreliable, or simply skipped over the most important question – what exactly is a facelift? And perhaps, more importantly, what is the “gold standard” facelift technique that will give you the best cosmetic result – a natural, youthful rejuvenated look.
Keep reading for a definitive guide to clear all doubts and help you make the correct decision.
THE COMMON “SUPERFICIAL” FACELIFTS
A facelift surgery is done to treat sagging of the lower face and upper neck. However, to achieve this goal, surgeon’s use different techniques which can have a dramatic impact on the result.
Most surgeons use a similar skin incision; a concealed cut running from above your ear within the hair, running down along the front of the ear and then curving behind the ear to end within the hair. However, what a surgeon does after making this skin cut varies drastically. It’s no wonder the results from a facelift in the hands of different surgeons can be entirely different though they may all call the procedure a facelift.
Most surgeons will elevate the skin to expose SMAS, which is a sheet of tissue that envelops the muscles used to express emotions on the face. This SMAS continues as a thin muscle called Platysma in the neck.
Once the SMAS is exposed, almost 90% of surgeons will tighten the SMAS by either folding a bit of SMAS over itself, or by removing a strip and suturing the cut edges together. Once this is done, they then tightly stretch the skin and remove as much skin as possible before closing the skin incision. A limited version of the above technique, with a smaller skin incision, is usually called a mini facelift.
LIMITATIONS OF THE COMMON “SUPERFICIAL” FACELIFTS
After reading the above description you may quite rightly ask – why would you need a more in depth procedure than this? The problem with superficial face lift is that this technique fails to address the main problem – the laxity of the SMAS layer and drooping of the fat pads in the face! Without a complete mobilisation of the SMAS layer in the face and the Platysma muscle in the neck, one cannot get the best possible outcome or a long-lasting result.
In addition, a “superficial” face lift relies on unnatural excessive stretch on the skin and an artificial direction of pull; both leading to a tell-tale sign of an “operated upon” facelift look. In addition, the results seldom last beyond a year or two.
Having said the above, a limited superficial lift may be appropriate in younger (30s or early 40s) patients who have very early signs of facial sagging limited to jawline or part of upper neck.
DEEP PLANE FACE-NECK-EYEBROW LIFT
To treat the sagging cheeks and jowls, excessive skin laxity and prominent bands in the neck; in my experience an in my opinion, the only facelift technique that can provide a natural, effective and long-lasting result in most patients is the DEEP PLANE COMPOSITE FACE-NECK LIFT.
Deep because I go “deep” to the SMAS layer to release the anchor points (deep ligaments between SMAS and deeper muscles) and Composite because I elevate and lift the SMAS and the attached skin as a single unit. The skin just comes along for a ride with the elevated SMAS – the excess skin after the deep tissue/SMAS lift is removed and the skin incision is finally closed without any tension on the skin.
As I mentioned above, SMAS and Platysma are continuous and therefore both parts need to be operated upon as a single unit. Therefore, a facelift should always have a neck lift at the same time. In fact, most of my patient’s will also get a lateral eyebrow lift in addition to the face and neck lift, at the same time, as most of us will also have drooping of the side of the eyebrows as we age. For this reason, the accurate term for my facelift surgery would be a “DEEP PLANE FACE NECK EYEBROW COMPOSITE LIFT”.
If there are prominent neck folds (Platysma bands) and or excessive fat under the chin, I will also treat these with a Platysmaplasty and remove excess fat from under the chin at the same time.
To summarise, the DEEP PLANE FACE NECK EYEBROW COMPOSITE LIFT is the only technique that in my opinion, can give a natural, long lasting result because it
Lifts the neck, face and the lateral eyebrow as a single unit.
Divides the deep anchors (ligaments) below the SMAS to allow complete mobilisation of the SMAS to maximise the lift.
Lifts the deep SMAS layer and anchors the SMAS along natural directions to the deeper tissue without causing unnatural pull on the skin. The skin is lifted “along” with the SMAS layer as a composite unit.
WHY IS DEEP PLANE LIFT SURGERY SO RARE?
Naturally, you might be wondering why this procedure is so rare, if it’s the most effective option. There are two main reasons…
A true deep plane face/neck lift is a technically demanding complex surgery. The nerve that powers the face, the facial nerve runs, just underneath the SMAS. Naturally, any surgeon operating in the “deep” layer must be technically proficient, experienced and precise to prevent any injury to the nerve and its tiny branches. The surgeon needs to know how the nerve is related to the anchor points (ligaments) before dividing those ligaments. The surgeon needs to know how to mobilise the SMAS extending from eyebrow to the neck and have experience in deciding the correct direction and extent of lift.
Some younger patients with limited droop could get good results with a superficial limited face lift.
As a UK trained ENT surgeon, I specialise in head and neck surgery, and from my early training days, I have routinely operated on the face and on the facial nerve. In addition, I have perfected my facial cosmetic skills with a clinical fellowship in the USA and have further gained experience with Dr Jacono who is widely recognised as one of the best surgeons for facelift. Furthermore, I have limited my cosmetic practice to the face to ensure high volume practice with super specialist skills. The above combined, allows me to offer the best possible results from face lift that a patient can expect.
The gatekeeper for certifying cosmetic surgeons for specific cosmetic surgeries in the UK is the Royal College of Surgeons. As of 2022, I am amongst a handful of cosmetic surgeons whose practice and logbook has been evaluated by the Royal College of Surgeons to certify for provision of a facelift operation.
RESULTS FROM A DEEP PLANE FACE NECK EYEBROW COMPOSITE LIFT
With a deep plane comprehensive face neck and eyebrow lift, there are no signs of a facelift surgery. There is no unnatural stretch or tightness of the skin, there are no unusual skin folds, the lateral eyebrow is elevated, the neck bands are gone, the excessive volume under the chin is resolved. In essence, you end up looking a younger, fresher, and energised version of yourself. The invigorated look gives you the confidence to live your life feeling secure and happy in your own skin.
