Facelift techniques have steadily improved over the last century going from skin only procedures to developing ways to address the deeper structures, all in an attempt to provide a longer lasting result. Some techniques have been found to work while others have been tried and abandoned. The basic principle is to re-position those structures that have sagged as we age and remove excess skin without putting it under tension which results in a “stretched” look.
Evolution of Facelift Techniques
Originally only skin was removed from in front of the ear. This helped but as we all know skin under tension (think pregnancy or weight gain in general) stretches. As the results were not long-lasting surgeons began to tighten the skin more and more by pulling and removing more skin. Eventually the skin could not be tightened more and the result was an overtight, windswept, pulled face. Not a good look.
The SMAS Facelift Technique
Attention was then turned to tightening the deeper structures to elevate them. The superficial musculoaponeurotic system, SMAS, is a layer of tissue that connects facial and neck musculature to the skin and aids in expression. Initially this layer was tightened with sutures in a limited way. Over time surgeons began dissecting under the SMAS but only over the parotid gland in front of the ear because the nerves to the facial muscles are deep to the gland and this offered absolute safety. The small flaps that were developed were tightened to elevate the midline face but with only limited success.
Next came more skin undermining and placement of sutures in the SMAS all along the face and in to the neck to tighten the SMAS. This folding, or plication, of the SMAS does tighten the underlying structures but has limitations in that it does not elevate the midface due to ligaments that are not released and leaves the deep layer of fat (buccal fat) unaffected. Results from this procedure can be excellent and it is a safe technique in that rarely are deeper nerves affected.
The Deep Place Facelift Technique
At about the same time some surgeons began exploring dissecting below the SMAS all the way in to the mid-face and cheek to allow the connected tissue above to be elevated. They were going “deeper” in to the face and thus the term Deep Plane Facelift was used to describe the procedure. This can give a pulled look if done too much and also has the risk of injury to the facial nerve branches if not performed with care. The advantage is that the buccal fat can be more easily addressed, the mid-face is elevated after ligament release and less skin undermining is necessary. It also holds the potential to provide a longer lasting result. An “extended” deep plane has also been developed that involves underming the superficial muscles in the neck to better tighten them.
Facelift Techniques Performed by Dr. A. Dean Jabs, M.D
I perform both the SMAS plication and the extended Deep Plane facelifts. Different people benefit from different procedures. Having been a plastic surgeon for 35 years I can tell my patients what would benefit them the most based on their desires and anatomy.
Both of these procedures are safely and routinely performed under sedation anesthesia in my office.
I hope this helps in your understanding.
Article by Dr. Arthur Jabs, board-certified plastic surgeon in the Washington, D.C. metro area, specializing in deep plane facelift and natural facial rejuvenation.
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