A facelift is a surgical procedure in which the facial muscles and tissues are tightened to produce a more youthful appearance. It is intended to rejuvenate and tighten the muscles of the facial region, including your cheeks and neck. This should result in a more youthful appearance as well as minimize sagging skin and wrinkles. The face has two parts: lower and upper. The lower face includes eyebrows such as your cheeks, jawline, and neck. The upper face includes forehead, temples, and scalp. After a facelift, the lower face is lifted and tightened, but it is not as taut as the skin of your upper face. The most common procedures used in a facelift include a cutaneous component, soft tissue component, and browlift surgery.
Facelift Anatomy
The skin overlying the entire face and neck muscles is quite thin. It consists of the superficial surface layer called the epidermis and a deeper dermis layer. The dermis contains your skin’s elastic fibers, collagen, and some fat. The superficial muscles of your face are called platysma muscle and it inserts along both sides of your jawline going all the way back to your ears. It also supports your face. Your skin’s other muscles are the sphincter muscles that close and open the corners of your mouth. These are found in the same place on both sides of your face and run back to the ears. The top layer of deep dermis is called an extracellular matrix or ECM. The ECM contains collagen, elastin, bone, fat cells, and muscle fibers. It holds your tissues together to give your skin its shape, elasticity, and properties. The dermis also contains blood capillaries and nerves that help provide nutrition for the skin and send signals about temperature and pain to the brain.
The structures of the lower face are located on both sides of the face. They are called the platysma muscle and they insert at the upper part of your neckline to create a line that goes back to your ears. They run from ear to ear. Your facial nerve is located in this area as well. Your muscle fibers are so thin that they can be seen under the skin. The muscles of your upper face are called the zygomatic muscle. They are attached to the corners of your mouth, and run from ear to ear. They are connected to a small group of nerves that go back to your brain.
Facelift Techniques
1. Subcutaneous Facelift
A subcutaneous facelift is one that uses the existing subcutaneous tissue as the screen between the skin and muscle. It is most commonly used in wrinkle reduction and sagging skin removal.
First, a very thin incision is made across a natural scar line called the levatorplasty line. The facial muscle attached to other nerves is exposed by pulling down the upper lip with your fingers. This allows the surgeon to see and feel the extent of muscle removal. The facial skin is then separated from the subcutaneous tissue along a horizontal incision line.
The skin is lifted off the deep dermis as one entity. The scarline is not compromised in any way, and therefore, will not change overtime. All of the fat cells are left intact, so that they can provide natural volume to your face. No fat grafts are necessary, because there is already plenty of fat present in your subcutaneous tissue.
Second, the subcutaneous tissue is separated from each side of your face with a blunt knife.
The fat cells are protected, and no muscle is removed. In order to make the scar line less visible, a very small amount of muscle is removed from the sides of the face. The muscle is then repositioned to the middle of your neck using fine sutures. A portion of this muscle not only tightens your neckline, but also lifts up your cheeks and jawline.
2. Minimal Access Cranial Suspension (MACS) Lift
MACS is a technique that uses a surgical cradle to suspend the head in mid-air while the neck is stretched. This results in a small but noticeable increase in the size of your jawline and cheekbones.
In MACS, two incisions are made on opposite sides of the face to access the muscle from above and below. A very small amount of muscle is removed from each side on either side of your neck. The muscles are then repositioned using fine sutures.
After the muscle is removed, some of it is repositioned to each side of your face. It acts as a puller and lifts up these areas, such as the skin of your cheeks and forehead. A portion of this muscle also stretches across your neckline to lift your chin to give the effect of a “sneak peak” before the surgery takes place.
Another benefit of MACS is that it replaces one small muscle with two larger ones. This is because the facial nerve is right next to your neckline. The nerve will have less tension after surgery, which will reduce the appearance of fine lines.
When you look in a mirror at yourself while wearing glasses, you’ll notice your eyebrows are higher in your view. This is due to the line from your hairline to the outer edge of your eyebrow being lower than normal. Fluid or “salt” can also be injected under this line during MACS for improved definition and height.
The MACS technique allows for a much smaller scar line, but still gives the same amount of muscle tension required to rejuvenate your face. The surgeon can make the incisions from any direction, and they can be placed in areas that will be hidden by hair.
3. Deep Plane Facelift (DPFL)
A deep plane facelift removes the platysma muscle and a portion of the underlying deep dermis. This pulls up your skin and some of your fat, which results in a more noticeable change from a facelift.
Deep plane facelifts are used to:
After a DPFL, there are two scars left on your face. They run from ear to ear at the upper part of your neckline, and slightly overlap at the lower part.
The scars from DPFL do not pull your skin, but instead sit underneath it. In order to reduce their visibility, they are made narrow and as flat as possible. Your surgeon will usually perform a secondary lift up with the scar in its final position before cutting it so that he can see how the scars will look after healing.
Deep plane facelifts result in a firmer and longer lasting result due to the amount of tissue removed.
Recovery
Recovery from facelift surgery is painless. You will be able to go home the same day. Ice and a mild painkiller will help reduce swelling and discomfort. If your doctor has injected fat into your face, it may appear swollen for up to three days after the procedure. The results after facelift surgery are generally visible in two to four weeks.
You will be able to go back to work after a short period. The results of face-lift surgery are permanent. You can have a facelift again in the same area, but more fat will need to be removed from your midface and neck. A serious complication that can occur during facelift surgery is rupture of the superficial facial veins caused by hypertension and high blood pressure (a medical emergency).
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