Los Angeles Face Lift
How is a face lift different than a mini-face
lift or midface lift?
In short, a Face lift, will address
cheek laxity, jowls, and neck laxity. It usually involves tightening
not only the skin, but also underlying fat and muscle.
Mini-Facelift:
A mini-facelift is reserved for someone with minimal
neck laxity, and usually someone younger or who has had a previous
facelift.
Midface lift:
A midface lift repositions the cheek skin and muscle
vertically towards the eyes. This is used for someone who has lost
fullness in the upper cheek area due to descent of the tissues.
The following
are some of the more popular face lift techniques:
Mini-lift - A "mini-lift" refers to a number
of different techniques with limited incisions, and usually are
best for patients with very early signs of aging, usually in their
30s and early 40s. In most cases, mini-lift equals minimum results.
Some techniques commonly referrred to as mini-lifts
are the Lifestyle Lift, the S-Lift, and the weekend face lift.
S-lift - The so-called "S-Lift" is a type of SMAS
facelift (see below) that gets it's name from an s-shaped incision
in the hairline at the temple and in front of the ear. Since the
incision does not extend behind the ear, the best candidates for
an S-lift do not have significant laxity of the neck skin, and this
type of facelift is best for people that are just starting to show
signs of aging (in their 30s or 40s) and want a little tightening
of the lower face without longer incisions.
An S-lift can be beneficial for mild jowling and very
minimal neck laxity. When you hear S-lift, think "S" for
small.
Subcutaneous / skin only - The subcutaneous
lift (meaning just beneath the skin) is a facelift that addresses
excess skin only and does not address aging changes in the deeper
structures, such as fat pads, connective tissue, and muscle.
It is used mostly for thin women with some excess
skin but good position of the underlying muscles, or for a patient
who has already had a deeper facelift, but is requesting a touch
up. It does not work well forheavier jowls, sagging muscle, or for
neck fullness.
The subcutaneous facelift may have less risk for facial
nerve injury, but the results do not last as long as deeper facelifts
because the underlying structures still continue to sag and pull
on the skin. While the subcutaneous or "skin-only" face
lift used to be the most common face lift technique until about
10 years ago, it is not commonly used anymore due to the potential
for a "windswept" or pulled look.
SMAS Face lift - The SMAS (sub or superficial
muscular and aponeurtoic system) is a sheet of muscle and connective
tissue on the cheek that contributes to facial expression. Over
time, the SMAS can become lax and sag, contributing to jowls and
deepening of the nasolabial folds.
The more common "SMAS face lift" repositions
skin and the underlying muscle of the cheek to more adequately correct
jowls and skin laxity. This will allow for a less "pulled"
look and longer lasting results than a skin-only facelift, but a
SMAS face lift does not significantly address the nasolabial area
(around the nose and mouth) or a sagging malar fat pad (upper cheek
fat pad).
Extended SMAS Face lift - An "extended
SMAS lift" goes even further toward the nose to help correct
lines around the nose and mouth. This is the same surgery as the
SMAS facelift (see above), but with an extended SMAS lift, the SMAS
is separated from the underlying structures more extensively toward
the nose and upper lip.
This can increase the amount of improvement that is
possible in the center of the face, especially the nasolabial area.
Increasing the amount of SMAS lifted also increases the risk for
complications of tissue death, however, especially in smokers.
Weekend Face lift - The term "weekend
face lift" has been used to refer to any limited-incision face
lift procedure with a quick recovery time. There is, however, a
particular technique, which is specifically called the "weekend
alternative to the facelift." Using this technique, a small
incision is made beneath the chin, excess fatty deposits are suctioned
from the neck, and then the inside of the skin is lasered with a
CO2 laser to cause the skin to contract.
The muscle in the neck can be tightened, if necessary,
through the same incision, and a chin implant placed at the same
time. The procedure is performed with local anesthesia only.
The weekend alternative to the face lift may be beneficial
for someone whose primary concern is fullness and sagging of the
neck.
Some doctors advise against the internal laser portion
of this procedure due to safety concerns: the laser can burn the
skin and cause scarring, fluid accumulation, and sloughing or death
of the skin.
Feather lift also called Aptos lift or Suture Suspension
lift - Aptos (from the words anti-ptosis) is a patented name
for a barbed, blue prolene (nylon) suture developed in Russia in
1999. The Aptos Lift or Feather Lift, as it's referred to in the
United States, can lift sagging underlying tissues (usually the
cheek and jaw line) by threading 4 to 12 of these barbed, permanent
sutures with a very long needle through the skin into deeper soft
tissue structures. Results have been less than impressive.
The name, Feather Lift, comes from the appearance
of the suture.
Once the suture is in place, it is pulled, anchoring
the barbs into the soft tissue and lifting the soft tissue. The
end of the exposed suture is then snipped, leaving the majority
of the suture buried entirely beneath the skin.
Since no skin is removed and no incisions are made,
this technique is not advantageous for people with excess skin.
Side effects include bruising, swelling, and tenderness. The most
common complications of the feather lift are puckering where the
barb is pulling, visibility of the blue thread through the skin,
and recurrence of sagging.
Deep Plane Face lift - A "deep plane facelift"
is especially useful for changes in the upper cheeks and midface
because the surgeon repositions the tissues in those areas as well
as in the lower cheeks.
Because the dissection is deep, the flap is thicker
than in the SMAS or subcutanoues methods, some doctors believe that
a deep plane face lift may be safer for smokers because of the greater
blood supply attached to the flap; however, smokers have an increased
risk of complications, regardless of the technique. There is usually
more swelling with the deep plane lift than with more superficial
lifts.
Sub-periosteal lift - The "sub-periosteal
lift" is another type of deep plane face lift commonly performed
with the aid of an endoscope, a tiny camera attached to a probe
to allow visualization of the surgical area through very small incisions.
The idea of the subperiosteal lift is to reposition
skin, fat, and muscle all at once since the tissues tend to sag
together, not individually. To do this, the surgeon goes all the
way down to the bone, separating the bone from all of the tissues
covering it (the periosteum is the thin sheet of tissue covering
the bone, so by definition, a sub-periosteal lift goes beneath that
tissue and lifts everything over the bone).
For patients in their 30s or 40s who do not require
skin removal, the inicions can be very tiny and hidden in the hair.
For patients requiring skin removal, standard facelift incisions
will need to be made, and the surgery is thus not done with the
endoscope. Facial implants may also be easily placed at the same
time, since the implants are positioned directly on the bone which
has already been separated from overlying structures.
Many surgeons prefer this techniqe for patients 45
and under who desire facial implants. There is more swelling with
the subperiosteal lift than with more superficial lifts due to the
depth of the dissection.
Composite Face lift - The composite face lift
is essentially a deep plane lift (see above) with the addition of
an extra step to include the muscle around the lower eyelid.
This is advantageous to address changes in the upper
cheek and midface region, such as a crescent shaped sagging of the
fat pad.
To accomplish this, the orbicularis oculi muscle (around
the eye) is separated from its attachment to the cheek bone through
an incision in the lower eyelid. It can then be lifted and sutured
into place. At the same time, the arcus marginal muscle is released
(AMR) and repositioned to cover the orbital bone.
The remainder of the procedure is the same as the
deep plane lift. There is more swelling with the composite lift
than with more superficial lifts.
Awake
Face lift
- This refers to a technique developed by Dr Hoenig in 2002 and
performed with tumescent anesthesia, instead of general anesthesia
or local with IV sedation.
Benefits of the Awake Facelift are less bruising and
swelling, less chance of nausea and vomiting, quicker recovery,
less risk of anesthesia complications, ability to check nerve function
during surgery, possibly reduced fees because there's no need for
a separate anesthesia specialist, and overall greater safety.
With over a dozen different techniques
and types of face lifts, it's hard to know which one is right for
you. A thoughtful discussion and careful examination with Dr.
Hoenig will help determine which approach you should take.
Related Procedures:
Face lift surgery in Los Angeles is often combined with blepharoplasty,
browlift, necklift,
fat transfer, botox,
and chemical peels or laser
resurfacing.
dr. hoenig
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