Facelift Techniques And Complications
Choose the technique, which addresses your concerns
Historically, facelifts originated by “correcting” an aging face by pulling on the facial skin.
As you may anticipate, these techniques are associated with the “wind tunnel” or French curtain look, as the extent of skin resection, especially in older individuals with sun damaged, thin skin was considerable.
The next technique to be addressed was the SMAS (fat and muscles) and variations included folding, excising and elevating this layer.
Diving deeper, some surgeons proposed a subperiosteal plane (above the facial skeleton) as the appropriate place to elevate and reposition sagging facial structure.
Thankfully briefly, the “string” or “feather” lifts concentrated on hanging the sagging skin and fat on a series of barbed, permanent or nonpermanent sutures, which were placed under the skin with endoscopic assistance. There will always be variations on a theme, including “short scar” facelifts, of which the MACS (Minimal Access Cranial Suspension Suture)and LifeStyle lifts are examples.
Try not to get enamoured by the marketing aspects. Find a PS who can explain why one technique would be preferable in addressing your concerns. (Lavinia K. Chong, MD, Orange County Plastic Surgeon)
Facelift – Which type?
There are many different names for face lifts, as there are many different types. It would be quite extensive to note the differences to you, but the most important thing you should do is to evaluate the surgeon you desire to do that Facelift.
Many different things happen anatomically to the facial skin as well as the underlying muscles, and sometimes bone, and only a thorough examination by an experienced surgeon can determine what your changes are. Your surgeon should spend a lot of time with you in this consultation, and maybe even see you back if there are continued questions.
He/she should ask you your motivations as well as your goals and expectations. The surgeon should basically ascertain, from a psychological viewpoint whether you are being realistic and explain the process to you. A board certified plastic surgeon is well trained in all aspects of body image and the psychological aspects of cosmetic surgery, especially in the face.
Your surgeon should explain the different procedures to you, in depth, explain the pros and cons of each, the potential risks and complications, the expected results, and what he could do if problems do arise post-operatively.
Your surgeon can also advise you as to what would be best for you based on these anatomical changes from aging and sun damage along with your goals and expectations.
If you are not comfortable, get a second opinion (even a third if necessary) until you are comfortable. See before and after pictures and ask lots of questions. (Theodore Katz, MD, FACS, Philadelphia Plastic Surgeon)
Names of procedures should be the result of analysis
Names of procedures should only be used for convenience sake. Any procedure should service the anatomical goals. Thus, what you end up getting should not be pre-determined by a name or preconceived concept of a procedure, but by your individual anatomy and your desires.
Start with an anatomical diagnosis of your face. Determine what will make you happy. Then, a specific procedure can be devised to produce, as closely as possible, the results you want. You can then call this procedure by any number of names that might apply.
Different things can be done within a “traditional” facelift and different procedures might all qualify for a “short-scar” nomenclature. (Robin T.W. Yuan, MD, Beverly Hills Plastic Surgeon)
Traditional Facelift vs Macslift
The Traditional facelift uses longer incisiones that can reach up into the hairline and extend behind the ear and the back of the neck. This facelift is more aggressive, more risky and a much longer recovery because the dissection goes under the muscle and also be extended to the mouth and neck.
Macslift which means Minimial Access Cranial Suspension Lift. This procedure tightens and lifts the neck, removes jowels and redefines the jawline and also pins the muscles of the midface back up taking 10 – 15 years off the face with natural long lasting results.
This technique offers a shorter incision that runs slightly above the ear along the hairline, around the ear and sometimes extended behind the ear. The underlying muscles are pulled up but not dissected. The downtime is minimal and there is a very low risk of complications. (Alfonso Gonzalez Cepeda, MD, Mexico Plastic Surgeon)
“Traditional Facelift” usually refers to a SMAS lift, where the support layer of the skin is undermined and elevated to achieve the desired results.
However, there are many ways to do a SMAS Lift and some surgeons still do a mostly subcutaneous facelift. Therefore, even for this term, it is hard to know exactly what procedure is being done.
The trend recently has been to elevate the tissues more vertically and to reduce the scar as much as possible. “Short Scar Facelifts” are attempts to accomplish these goals. The “MACS Lift,” as originally described, is one of these “Short Scar Lifts”
As we all learn what works best and get more comfortable with what we do, we modify how we approach the particular procedure in order to achieve ever-improving results. Thus, what is actually done by each of us using the same name may not be the exact same procedure.
I am a perfect example. I started doing the “MACS Lift” for very specific patients. What I discovered was that the elevation was more vertical, the neck results better and the overall results superior. I have now converted to the basic principles of the MACS Lift for all my facelifts.
To do this, I have had to modify what I do, especially for those with very lax necks. Therefore, although the “MACS Lift” was originally a short scar facelift, and still is for a great deal of my patients, it utilizes a scar extending behind the ear frequently.
I have also modified it to make it applicable to other specific problems. I still call it a “MACS Lift” since the principles are all the same, though it may not be such technically. (Robert T. Buchanan, MD, Highlands Plastic Surgeon)
Different facelift techniques
There are many different variations of facelifting techniques. A short scar facelift is a technique that attempts to remove excess skin through a short scar.
If there is excess skin and significant aging process, then a full face/neck lift has to be performed.
Otherwise, excess pleats of skin will result with a short scar. A MACS facelift is a more vertically oriented facelift, which does not address neck issues. It does not address excess skin in the neck, muscle bands, cords or subplatysmal and submental fat.
A traditional facelift addresses the jowling process, excess skin, muscle banding in the neck, subplatysmal and supraplatysmal fat as well as tying the muscles in the front part of the neck, the back portion of the neck, and tightening the SMAS layer. (William Portuese, MD, Seattle Facial Plastic Surgeon)
More Facelift Techniques than there are Faces to Lift!
While there is clearly science involved in achieving a good facelift result, there is a whole lot of art as well. Every time one of my colleagues manages to get a good result with a slighlty shorter scar, or performs a facelift in a different plane it tends to get press.
The truth is that you need a surgeon who understands your specific needs should tailor an operation for you. Of course, the trick is the find a surgeon who shares your basic philosophy about how invasive you want to be and how natural you should look when the procedure is done. (Thomas P. Sterry, MD, New York Plastic Surgeon)
Traditional and Mini Facelift Procedures are not different procedures but a part of a continuum
Many patients seeking facial rejuvenation desire natural but noticeable results from a safe, affordable procedure with a reasonable recovery time. The most effective procedure for each patient can vary depending on the skill level of the surgeon and the individual goals, facial structure, lifestyle and overall health of the patient.
There is no specific technique or method that separates the Mini Facelift from what is called a traditional facelift. Being more aggressive with mini facelifts brings us closer to a more traditional lifting procedure and being more conservative with a traditional lift brings us closer to a Mini Facelift.
The possibilities for available facelift techniques are seemingly endless. While some more complex procedures aggressively lift and tighten the skin with additional fat grafting and laser skin treatments for effective results, these may cost upwards of $30,000 and require several weeks of recovery.
Some centers offer minimally invasive procedures that can be performed in under an hour but lift only the skin and do not offer adequate deep tissue support. Most patients can benefit from a happy medium between these two types. (Boris Volshteyn, MD, MS, East Brunswick Plastic Surgeon)
Differances between Traditional, MCAS and short scar facelifts.
There are many “names” given to the the facelift procedure. Most are done for marketing purposes.
The most important issue for patients to understand is the more extensive the aging of their skin, the more extensive the surgery must be to correct those problems.
There is no one procedure which will work on every patient. It should be decided, in concert with the surgeon, what corrections are being sought and what procedure has the best chance of delivering that result for any individual patient.
This is a summary of what each procedure offers:
Traditional Facelift: The incision runs from above the ear, around the ear to the hairline. The skin is widely undermined allowing full access to elevate and tighten the deep tissues of the neck and face and to remove any unwanted fat deposits.
Once the deep tissues are sculpted to the proper shape, the skin is draped over, the excess trimmed off and the skin closed. This procedure allows maximal skin removal.
MACS Facelift: The incision runs from above the ear, to the bottom of the ear but does not go behind the ear.
Less undermining of the skin is done and several sutures are woven through the deep tissues of the face as purse string sutures to elevate the tissues. Once the deep tissues are repositioned the skin is redraped and excess skin trimmed off.
This procedure does not address the fat deposits in the neck or loose muscles along the front of the neck. The sutures woven in the deep tissue may be visible or break requiring replacement.
Short scar Facelift: Many procedures are included in this category and marketed as “minimally invasive”.
These use a short incision, minimal undermining and predictably give a minimal/modest improvement. Excess skin is harder to remove and sculpting the deeper tissues is more difficult. The most important take home message is: don’t get fixated on a certain procedure or name.
Consult with your surgeon so a procedure can be agreed upon which will deliver the results you want in the safest way. (Jeffrey M. Darrow, MD, Boston Plastic Surgeon)
Variations in Facelift Techniques
The most important consideration (from a patient perspective) should be the Surgeon doing the procedure, not details of the technique he/she uses. However, to answer your question, a MACS lift utilizes a smaller incision and a series of purse strung type sutures through the SMAS, without elevating the SMAS.
In the community, I have personally seen great results from this procedure, and very poor results. It is certainly not agreed upon to be a better technique than a SMAS elevation and imbrication procedure. Likewise, there is really no data to suggest that a MACS lift offers less downtime.
The one piece of advice I will offer: heavier necks, more extensive aging changes, and revision
Facelift patients require more extensive procedures than the average patient. In Facelift, less is definitely not more; there is definitely no new “magic” procedure that can be performed in 60 minutes, with now downtime, that offers long lasting results.
Let your surgeon decide how to apply his/her technique to the concerns that you have. (Stephen Prendiville, MD, Fort Myers Facial Plastic Surgeon)
Easy facelift, great natural results, local anesthesia
Like most active face lift surgeons my approach has changed over the years. I originally started out doing extensive flap facelifts with SMAS work and platsyma work. This was somewhat long and involved significant recovery for the patient.
I now do a facelift with shorter flaps, SMAS plication only and no platsyma work. The results are 90% as good as what I used to do… The procedure is done under local anesthesia with perhaps a Valium added by mouth.
Recovery is simple, complications are rare, the cost is less…..and the results are fantastic and all my patients are satisfied and happy with the results. As an added bonus the results are actually more natural looking..(Richard Galitz, MD, FACS, Miami Facial Plastic Surgeon)
Traditional face lift, MACS or short scar lift
Names, names and more names. I see how patients can get confused what about us doctors. You must apply the correct adaptations to each face individually. The name of the type of facelift only serves to confuse us all.
The latest – “Vampire Facelift” What will be next?
Every patient requires something a bit different. Therefore there are many different types of facelift operations to achieve the desired goals. (Steven Wallach, MD, New York Plastic Surgeon)
The MACS-Lift, short scar Face Lift has advantages over traditional Face Lifts.
The MACS-Lift is a Face Lift that leaves a small scar in front of the ear and in the temple hairline, and may result in a natural-looking appearance that is never “wind-swept”.
It’s a wonderful operation to rejuvenate the midface, jowls, and neck with minimal inconvenience. The principle behind the MACS-Lift is that the superficial and deep facial layers are repositioned in a purely vertical fashion with no backward pull that can often look “operated” in appearance.
Problems like scarring behind the ears, funny looking ear-lobes, or changes in your hairline-position are avoided with MACS-Lifting, and there is typically only around 2 weeks of downtime. I’ve embraced this operation since it’s reliable, versatile, and leads to high patient satisfaction while minimizing downtime and eliminating most of the stigmata associated with traditional “Long scar” surgery.
Only those patients with severe cases of sun-damaged, wrinkled facial skin are not candidates. Patient selection, and education is very important. I think that the surgeons from Belgium who originally described this operation with meticulous detail should be commended for their huge contribution in the arena of face lifting.
The operation makes a lot of sense, and has worked well for my patients and me. (Eric M. Joseph, MD, West Orange Facial Plastic Surgeon)
There is FACELIFT and then a thousand different names for a minifacelift. A traditional facelift is the gold standard. All others are shortcuts which might work in a select group of patients but cannot deliver the same results as the traditional facelift which includes either SMAS excision, tightening or a deep plane elevation. (Tanveer Janjua, MD, Bedminster Facial Plastic Surgeon)
A lot of differences between these facelift techniques
Part of the problem is that similar “words” are used for each of these techniques but the net result can be different depending on what doctor you speak with and their expertise. Then, there is the assessment of what option is best for you, your expectations and budget.
Teaching doctors about the above procedures requires hours so don’t expect to have a full understanding unless you are going to spend a great deal of time doing your research. Then there is the option of a laser vertical Facelift – not burning the skin but actually using a laser to do the cutting.
In most offices, a traditional Facelift is a SMAS Facelift. The MACS is a procedure that may not be best suited for someone who has a lot of redundant skin. A short scar Facelift can mean different things to different doctors.
Having facial surgery is not like buying a “standard” product. Think of this more like buying art work. You are commissioning an artist, the doctor to do the work. The doctor should be able to explain the above surgical options.
There are many articles written about all of the above procedures to help you understand the anatomy and concepts of each procedure. (Michael Kulick, MD, DDS, San Francisco Plastic Surgeon)