Facelift Techniques and the Differences Between Them

by Dr. Paul K. Holden, Scottsdale Plastic Surgeons

Nearly a century has passed since the first versions of the modern facelift. During that time, a lot has changed. Putting aside advancements in sterile technique, antibiotics, anesthesia and suture material, which have all made substantial improvements, the facelift technique has also improved a great deal.

It may come as a surprise, but even though the facelift has evolved and improved significantly, there are still a significant number of doctors performing older versions of the surgery, and patients are experiencing the limitations of those procedures.

For that reason, it’s important for patients to know which technique a surgeon uses to decide if the procedure will get the results desired. In some cases, the older techniques are “rebranded” with a new name, which can be misleading. The good news is that, after reading this article, you will know the difference, regardless of what name is given to an operation.

What is a facelift?

The facelift addresses the lower half of the face and should also address the neck. In older techniques, the neck was treated as a separate area of the face and surgeons would frequently address only one or the other. 

Many doctors will say that a facelift or “full” facelift involves lifting the brows, upper and lower eyelids, the face and the neck. This can cause confusion among patients seeking rejuvenation, and in academic circles, this is not considered correct. 

It is widely accepted that not all patients require all of those procedures, and it is incorrect to bundle all of those procedures together under one name. A facelift is correctly defined as a surgical operation to lift the face from below the cheekbones, including lifting and tightening of the neck.

The three major classes of facelift include a skin-only lift, a skin-muscle lift that involves minimal tightening of the muscle layer (called the SMAS), and a skin-muscle lift that involves significant lifting and tightening of the SMAS. The latter is widely considered the best current technique, or gold standard.

Skin-Only Technique

In a skin-only lift, there is some lifting and tightening of skin with no tightening of the SMAS. The usual duration of improvement is approximately 12-18 months, and there is often significant scar formation on the incisions and earlobe deformity due to tension on the skin. The neck in these patients is usually not addressed at all or sees minimal improvement. This technique is not commonly used by surgeons, however, there are nonsurgeon physicians that perform a version of this operation and it is often given a catchy name to make it sound new. 

Minimal SMAS Tightening Technique

One of the most common techniques used by surgeons today involves minimal tightening of the SMAS layer. This may be done simply by placing some sutures in the muscle layer (plication) or by cutting away a section of the muscle layer and closing it with suture (fasciectomy). By not actually moving the robust SMAS layer, the lift is again short-lived (approximately two to three years) and still often results in scarring and earlobe distortion. 

SMAS Lift Technique

In a proper SMAS facelift, the skin is lifted, and the SMAS layer along with the neck muscles are lifted and tightened as an entire unit. By moving the whole layer (which includes the neck muscle or platysma), the patient has a strong layer that is substantially doing all the “work” of the lift. 

By transferring all of the force required to lift the face and neck to the deeper muscular layer, the surgeon avoids tension or a “pulled” look on the skin. This technique minimizes scarring and distortion of the earlobes, and, most importantly, lasts the longest. If the procedure is properly done, and the patient continues to live healthy and take good care of their skin, the results last 10 to 15 years or longer. 

I perform the gold-standard SMAS facelift at my practice in Scottsdale and keep abreast of the latest technology. To learn more about the best and most current techniques in facial plastic surgery, call my office at 480-787-5815 for a free consultation. I am in Prescott every month and you can meet with me to discuss options to help you determine what is right for you.