Facelift Procedures

Certainly, one facelift is NOT like the other. There are various surgical procedures called “facelift” but these operations may be performed differently with likely different end-results. Therefore, we recommend a thorough discussion with your plastic surgeon about which procedure will be performed, why and what the end result will be. Some cosmetic surgeons perform one facelift procedure and adjust this procedure to the particular needs of the patient. Other plastic surgeons take advantage of a variety of facelift procedures to maximize on fine-tuning the procedure for the patient.

Traditional Facelift

The facelift in the traditional sense really addresses the lower face and the neck, therefore also commonly called a face/neck lift. It involves an incision starting high within the temporal hairline coming down in front of the ear, curving around the earlobe, continuing behind the ear and ends far into the hair behind the ear. The skin is extensively dissected off the underlying muscle layer towards the nose, the mouth and the middle of the neck. Using sutures, the muscle layer (also called the “SMAS” = superficial musculo-aponeurotic system) is lifted up and towards the ears. It is this repositioning of the muscles that gives a facelift the desired longevity. Next, excess facial skin and hair baring scalp is removed and the incisions are closed with sutures. Some surgeons also use surgical staples. Commonly, the traditional facelift incorporates some liposuction of the neck and under the chin as well as a platysmaplasty.

Deep Plane Facelift

The deep-plane facelift is an advancement of the traditional SMAS facelift in the quest of improved midface rejuvenation and a more natural appearance. As the name implies, a deeper plane of surgical dissection is entered within the midface and lower face region before the muscles are lifted. The incision line is similar to the traditional facelift. During a deep plane facelift, the SMAS layer is separated off the underlying deeper structures (i.e. chewing muscles, facial nerve etc.). Advocates of this procedure point to a “natural” plane of dissection with decreased blood vessels and an improved rejuvenation of the droopy midface. Plastic surgeons using the traditional facelift technique are sometimes doubtful of a significant outcome advantage and point out higher technical intricacy and an increased risk for nerve injury with the deep plane facelift procedure.

SMAS Facelift

This is a term that is interchangeable with traditional facelift. It points out the fact that the SMAS is lifted and distinguishes this from the deep plane facelift.

Temporal Facelift

There is not a universally acknowledged definition for temporal facelift. Most specialists use this procedure to give the brows a lift without having to do an entire browlift. Usually, the sides of the brows can be lifted by adjusting the facelift procedure and its incision accordingly. The temporal facelift is therefore a beneficial procedure for patients, who also have droopy eyebrow sides which often creates additional eyelid hooding. Some facial cosmetic surgeons may only perform a partial upper facelift without incorporating the neck for patients that have a youthful neck but are looking for an upper and midface improvement.


A necklift can be considered a partial facelift where the aging neck is rejuvenated. Therefore, the incision is usually significantly shorter and is limited to the earlobe and in the back of the ear. Commonly, a platysmaplasty is performed and fat is removed from the neck region by means of neck liposuction. Although not as much as in complete face and neck lifts, the jowls often improve hereby providing the patient with a cleaner jawline. Aside from focusing one’s efforts on the neck as the particular region of concern, a patient can commonly return sooner to his or her professional and social activities; after a necklift, the initial post-operative signs can be easier camouflaged by using scarves and turtle necks in addition to make-up.


Platysmaplasty literally means “plastic surgery of the platysma”. The platysma is the muscle located beneath the skin within the neck region. As aging progresses, the front edges of this muscle produce unsightly neck “chords” due to its decreased elasticity. During a platysmaplasty, the skin is separated from the platysma muscle and these chords can be lifted and hereby eradicated. A platysmaplasty is commonly performed in conjunction with a facelift and a necklift.

Neck Liposuction

Liposuction of the neck is sometimes performed as a sole procedure. Here it is limited by the patient’s skin elasticity to accommodate the new neck shape. More commonly, it is almost routinely performed with facelift surgery. Although one of the small steps during a facelift, it is usually very important for an optimal outcome. A tiny opening is placed underneath the chin to allow access for a small liposuction cannula. Using a suction apparatus, fat is carefully removed from the neck to allow optimal definition of the chin and neck angle. The key is to remove this fat evenly for a smooth neck appearance and not to remove too much to create an unnatural appearance. Generally, only a little fat removal is necessary to create the desired result.

Many people have seen body liposuction on reality T.V. and are concerned with the rather rough nature of this procedure. Certainly, there is a significant difference in the extent of liposuction, and volumes being removed with neck liposuction being a rather gentle and limited procedure with small risks.

Midface Lift

The midface lift is a relatively new operation within the realms of facelift procedures. The goal of a midface procedure is to elevate soft tissues that have drooped from the cheek bone downwards thereby creating a hanging and heavy midface appearance and deepened nasolabial folds. Opinions about its value vary widely: some plastic surgeons use the midface lift almost routinely as part of their facelift procedures; if combined with a facelift, then a traditional “SMAS” lift is performed to also rejuvenate the jawline and neck regions. The deep plane facelift may improve the midface more dramatically then a traditional facelift and therefore, a midface lift is usually not necessary. The midface lift is commonly performed using endoscopes through incisions within the temporal hairline and sometimes within the mouth or from within the lower eyelids.

Various technical aspects are common topics of discussion during scientific facial cosmetic surgery conferences demonstrating, that the last word of the best approach to the midface has not been spoken. As a side note, some facial plastic surgeons believe that a similar improvement can be obtained by using fat grafting (“lipostructure”) or cheek implants. Also, before embarking onto a midface lift, you should know about the possible prolonged swelling (3 to 5 weeks) after this procedure. One plastic surgeon therefore named the midface lift also the “pumpkin operation” because of the rather impressive facial swelling. On the upside, a midface lift may provide a potentially more complete final result.

Subperiosteal Facelift

After the advanced technique of the deep plane facelift has become popular with some cosmetic surgeons, others searched for an even deeper layer of tissue dissection in the quest for optimal results. “Subperiosteal” means right on top of the facial bones and this is therefore as deep as it gets. This technique is a continuation of the midface lift. In general, only few surgeons apply the technique of the subperiosteal facelift. Reasons for this may include the technical difficulty of this facelift technique, its prolonged swelling after the procedure and the unanswered question whether the final result is superior.

Lifestyle Lift®

The Lifestyle Lift® is a branded procedure offered in various Lifestyle Lift centers throughout America. Facial plastic surgeons performing this procedure apply a modification of the traditional facelift to allow that the lifestyle lift can be performed in approximately one hour under local anesthesia. Commonly, neck liposuction is performed as well. The incision is usually significantly shorter than that of a full facelift and the recovery time is shorter. Plastic surgeons performing the Lifestyle Lift commonly perform a large number of these procedures and therefore become extremely proficient with it. Because it is a less extensive and less invasive procedure, the results are likely not quite as dramatic as with full facelift. Therefore, the Lifestyle Lift may be best suited for younger people in their 40s and 50s who are not interested in the larger facelift procedures (i.e., traditional facelift, deep plane facelift). For more information, please visit the official Lifestyle Lift® website (www.lifestylelift.com).

Short-Scar Facelift

The name “short-scar facelift” does not give much information about the procedure itself. It solely implies that the incision lines and therefore the resulting scar may be shorter than in other procedures. Although it is of course nice to keep the incision line as short as possible, most people who had a facelift done in the past would agree that this line is rarely a cosmetic concern but that preservation of hair is a much greater concern. Therefore, it is more important to learn what the plastic surgeon is doing after he/she did the shorter incision line: are techniques of a traditional “SMAS” facelift, deep plane facelift or “S-lift” employed.


A S-Lift is a modified Mini facelift where the lifting sutures are placed in a specific S-shaped pattern. The S-lift procedure was introduced in the United States by Dr. Ziya Saylan from Germany. It is not clear if there are advantages to this particular way of suture placement.

Mini Facelift

There is certainly not only one mini facelift technique. In general, a small incision is placed to gain access to particular areas of concern. Although certainly attractive to people looking for a quick and easy fix, commonly the results have been moderate at best and often only short lived. But as with any cosmetic procedure, the final result depends primarily on the patient’s particular condition and the surgeon’s expertise. There certainly are also positive reports from people who underwent a mini facelift. Best candidates for mini facelifts are usually the young with minimal sagging who just require a small touch up.

Fat Transfer (Lipostructure)

In recent years, there has been an emergence of discussion about volume replacement as a rejuvenation technique. Because there were no great man-made volume fillers available, a person’s own fat harvested from other areas (i.e., belly, thighs etc.), can be injected into the face for volume enhancement. The popularity of fat transfer may be changing as new volume fillers become available (namely Sculptra™ and liquid silicone). Most patients require lifting of sagging tissues within the jowl and neck region. The addition of volume augmentation can further improve the final result in the right patient. This fat transfer can be performed at the same time or later. If you have a thin face, ask your cosmetic surgeon about his thoughts about fat transfer for facial enhancement in your particular situation.

Thread Lift

The goal behind the “thread lift” is to lift without elevating and removing skin. Sutures are fed beneath the skin and pull up droopy facial structures. Various branded and self-made sutures are available (i.e. Contour, APTOS, Silhouette etc.). These sutures mainly differ in how they hook into the facial tissues (barbed fish-hook like teeth, knots etc.). These techniques are very new and they longevity is not known. Although initial improvements are noticed, they may be only temporary (approximately 4 months). Companies promote touch-up or re-tightening procedures after 3 to 4 months. This is why many plastic surgeons who initially incorporated this technique into their practice, are not offering the thread lift to their patients anymore.
For more information, please visit the official websites for Contour Threads™ (www.contourthreads.com)

Feather Lift™

Feather Lift™ is another brand name for a thread lift. This technique has been introduced to the United States by Russian surgeon Dr. Salamanidze. Again, although decreased downtime is appealing, longevity is unproven.

For more information, please visit the official Feather Lift™
Website (www.featherlift.com).

Non-Surgical Facelift (Thermage™)

Thermage™ is a technique where radiofrequency waves applied to the skin lead to heat injury to deeper structures of the skin. This may lead to tightening of collagen and can increase the skin collagen contents. Digital measurements showed improvements after treatments. Unfortunately, these changes are often so subtle that patients with real gravity related concerns seek other procedures after their Thermage™ treatments. In addition, the longevity of these treatments is not known.
For more information, please visit the official Thermage™ website (www.thermage.com)

Natural Facelift

Claims for a “Natural facelift” are multifold; though none of these has been studied scientifically. And another word of caution: If it sounds too good to be true, then it may just be that! Some promise that certain facial exercises can reverse signs of aging. In addition, skin treatments (creams, lotions and masks) are promoted as the solution to the aging face…

Call Worcester Face Lift Specialist Dr. Fechner