In my nearly 30 years as a board-certified plastic surgeon, the evolution of facelift techniques has been remarkable. Research and innovation have led to modern, sophisticated surgical methods that produce facelift results that are better than ever. At my Chicago practice, I use these techniques, coupled with my own experience, to reduce signs of aging in a customized, natural-looking way.
After performing almost 2,000 facelifts, I have determined that a few methods can make a big difference in the quality of the results. Let’s take a closer look at 3 key techniques I frequently use:
1. A Deep-Plane Approach
One of the most common concerns people have about facelift surgery is that they will have an unnatural, “windblown” look. This can occur when surgeons use a more common, and I believe less effective technique that focuses on the facial skin rather than the muscle and tissue structures below, where the signs of aging start. Every surgeon recognizes that the deep fat layers contribute to aging, but most techniques do not completely release the deeper layers and rely on sutures to “drag” the deeper layers. Unfortunately this can result in unequal tension, or a skin pull that is too tight, and those characteristics are the hallmark of a “surgical” appearance.
By fully releasing and elevating deeper tissues at selected points, I’m able to avoid stretching or pulling the skin unnecessarily. This is called a deep-plane lift, and it involves manipulating tissue and muscle below the SMAS layer (the superficial muscular aponeurotic system). Elevating and repositioning these deeper tissues along with the skin reduces tension on the surface and creates more natural-looking results.
This method also produces results that last much longer. Even if a surgeon gets a natural look from a facelift that relies on sutures to “drag” the deeper layers, those tissues have not had their underlying anatomy changed, and the results tend to relapse earlier. By starting from a deeper level, I build a strong foundation for results that usually last a decade or longer.
I also remove excess skin and carefully redrape the remaining skin in a way that enhances the patient’s natural contours of the lower and middle portions of the face and, in some procedures, the neck.
2. Careful Incisions
As a surgeon who has devoted much of his career to the field of wound healing, I know that scar prevention techniques are critical to getting excellent results. I believe a cosmetic procedure is not a success unless the incisions are discreetly hidden. Carefully plotting incisions is almost as important as the technical skill involved during the procedure.
I also tailor incisions to the needs of each patient; shorter incisions can produce the desired results in many cases. Scarring can compromise the results of any cosmetic surgery, which is why I consider my expertise in wound healing essential to getting predictable, successful outcomes.
In past blog posts, I wrote in depth about what causes scarring, scar management techniques, and scar treatment. I invite you to review those posts for more on this topic.
3. Adding Fat
Becoming more popular nationwide these days is a technique called fat transfer, or fat grafting. I have worked for many years to develop excellent results with fat transfer. The process involves removing fat from an area where it is unwanted (such as the abdomen or hips) and moving it somewhere more useful. In a facelift, this is the midface area or cheeks.
It is widely accepted in the plastic surgery world that loss of fat and volume in the face is one of the most obvious signs of aging. This has led to the high popularity of injectable fillers. Fat is a natural filler that can add volume to cheeks and other areas of the face where a hollowed-out or sunken appearance can detract from a facelift’s overall results. Fat lasts longer than synthetic fillers and produces a more natural look and feel because it is softer and smoother. It is important to not add too much. There are many people who have had so much fat or filler added that there face shape changes. It is important to restore, but not change.
I often add fat to a facelift to give the cheeks a youthful plumpness, and I sometimes have patients return for a series of fat injections after the initial surgery for a lasting overall result.
What It Means for You
Not only do these techniques all create more natural-looking and long-lasting results, but they also provide an improved recovery experience for patients. I perform facelifts using a local anesthetic with sedation, which is not only a safer approach but also avoids the extended recovery that follows surgeries in which general anesthesia is used. Additionally, these techniques minimize trauma to tissue, limiting the amount of bruising and increasing postoperative comfort.
If you are considering a facelift, I recommend finding a board-certified plastic surgeon who uses these techniques to ensure you get the best results possible.