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What Are the Different Types of Facelifts?

The desire to maintain one’s youthful appearance continues to be more popular than ever.  While men and women have always wanted to look younger and maintain their youth, current society pressures make this goal even more prevalent.  One reason is we are living and working longer.  Despite loud arguments for eliminating age discrimination, the unfortunate reality is people who look younger, more heathy, more attractive, and taller will tend to get jobs.  Another strong influence is social media and the pressure to look young and beautiful.  Advances in nutrition, healthcare, and skin products have made great impact on helping us look younger, but there are limits to what these can do.  That is why we’ve seen the explosion of procedures aimed at making us look younger.  Overwhelmingly, these are non surgical because the public tends to want quick results without the risks and fears of surgery.  Unfortunately, these procedures typically can’t achieve the long lasting, effective, natural results you are looking for.  In my opinion, in order to get noticeable natural youthful results, most people will benefit the most from a facelift.  

If you’ve decided a facelift is the best option, you may likely be confused by the myriad of different facelift procedures that are advertised.  I can’t recall a time when I haven’t heard of another “unique” facelift that is advertised to achieve superior results.  Examples include the “S lift,” “Y lift” “MACS lift”, “Deep plane facelift” etc.  No wonder the average person gets confused!  Honestly, when you look closely at all these “innovative” facelifts, they are simply clever marketing terms because ultimately, all facelifts address certain key anatomic structures in already published techniques.  The key question when you consult the surgeons is ask them to describe what they do with the key structure—the SMAS, or superficial musculoskeletal aponeurotic system.  This is the muscular-facial tissue that must be addressed in any effective facelift.  This tissue is under your facial skin and is continuous with the platysma—the superficial muscle in  your neck.

In my view, there are basically three major versions of a facelift.  Remember, these must address the SMAS.  If the surgeon just pulls the skin, that is an extremely limited procedure that will not achieve any long lasting results because skin stretches.  The surgeon can choose to 1) plicate the SMAS, 2) imbricate the SMAS, 3) Undermine the SMAS as a flap and do something to that .  Outside of these key maneuvers, there are numerous variations of what a surgeon can do tailoring the skin incision, excision, as well as vector of pull and excision of the SMAS.  

The first type just plicates the SMAS.  In other words, the surgeon will simply pull the SMAS until the desired effect is attained.  After the skin flap is developed, the surgeon uses sutures to pull the SMAS onto itself to get the effect desired.  The variations are in the pattern of suturing.  After the SMAS is plicated, there will be extra skin that will be pulled up and this must be carefully cut and sutured.

The second type involves cutting out an area of SMAS, and then pulling the cut edges to sew together.  This pull of the cut edges is what achieves the lift the surgeon wants to get.  The variations are seen in the various patterns of designing what to remove from the SMAS.  For example, one could just remove a strip of SMAS from the cheek to the mandible angle.  Another popular pattern is to remove a hockey shape or L shape strip.  The biggest advantage of the first and second types of facelifts is the relative simplicity as well as lower risk of injury to the facial nerve.

The third type is the more technically challenging, but also achieves a more robust lift.  Most facelift master surgeons do some variation of this technique.  In this technique, the plane under the SMAS is lifted and the SMAS and platysma are freed up from key retaining ligaments of the face in order for the facial structures to be lifted more aggressively.  The most popular variation is the “Deep Plane facelift.”  In this technique, an incision is made in the SMAS going from the cheek bone to the angle of mandible.  The surgeon then develops a plane under this SMAS to mobilize this tissue and the platysma layer in the neck.  The extent of mobilization is what differentiates different surgeons’ experience and goal.  Once the flap is well mobilized, it is pulled in particular vector the surgeon wants and then the SMAS is anchored to the posterior tissue.   Another technique in this category is termed the high SMAS lift, or extended SMASplasty, which is the technique I prefer.  Like the Deep plane lift, the key mobilization is the SMAS flap.  In this variation, the incision is made high on the SMAS, at or above the cheek eminence, but instead of carrying that incision diagonally to the jaw, it is carried horizontally along the zygoma bone towards the ear.  Then the incision is carried vertically going towards the neck.  Then the SMAS is lifted in same manner as the deep plane.  The two key differences are that this requires a bit more extensive dissection compared to the deep plane lift, and this technique allows the surgeon to rejuvenate the face using two vectors: one for the SMAS and the second one for the facial skin.  Both techniques achieve fantastic natural results that will last up to ten years.  The major disadvantage of the high SMAS lift and deep plane facelift is marked increased difficulty in doing these techniques.  Another potential disadvantage is relative increased risk of injury to the facial nerve.  

The best way to determine if you are a candidate for a facelift and what type is best for your specific anatomy and goal, is to see  a board certified facial plastic or plastic surgeon.  An in-office consultation allows the surgeon to carefully examine your face and neck and see whether you are a good candidate for surgery.  

For more information about San Antonio facelift surgery, please visit our interactive website at Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (866) 574-1719 or