As people age, the effects of gravity, exposure to the sun and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth, the jaw line grows slack and jowly, and folds and fat deposits appear around the neck.

A facelift, technically known as rhytidectomy, cannot stop this aging process. What it can do is “set back the clock,” improving the most visible signs of aging by removing excess fat, tightening underlying muscles and re-draping the skin of the face and neck.

Facelifts were first performed over 100 years ago and began as simple excisions of small amounts of skin near the ears and along the hairlines to tighten loose facial skin. Technology has advanced so much since then that the newest facelift techniques can lift, restore and rejuvenate the face with more long-lasting youthful and natural appearances and fewer telltale signs that surgery has been performed.

Mini Facelift Procedures
In analyzing the wants and needs of younger facelift patients, surgeons developed mini-facelift procedures geared toward producing a more natural look with shorter scars, less operative time, less recovery time and less risk for complications. The SMAS Plication and S-Lift proceedures are considered today's most commonly performed mini-facelift procedures.

SMAS Procedure
The Superficial Musculoponeurotic System (SMAS) Plication procedure fills the cheeks and produces a more natural look than a standard facelift. During the procedure, the skin is lifted to expose the SMAS, which is the underlying muscular/fibrous tissue.

Once the skin is raised, a serial plication (stitching procedure) laces up the face, starting low in the jowl and extending up the cheek, spaced from 12 to 15 millimeters apart. The SMAS is then elevated and pulled tightly in different directions than the skin. This allows the skin to gently be re-draped over the face without looking pulled back, producing a more natural post-operative appearance.

Because this technique avoids going into deeper planes of the face, complication rates are extremely low and bruising and swelling are minimal. Most patients return to work seven days after the proceedure.

S-Lift Procedure
The mini-facelift procedure was perfected with a technique called the S-Lift (Suspension Lift). The S-Lift differs from other mini-facelift procedures performed today as it is fundamentally a pure anti-gravitational lifting procedure that will suspend the sagging soft tissues of the face and neck in a vertical direction into the place where they previously belonged.

To do this, a small incision is made at the crease of the front of the ear. Next, the skin's middle layer of muscle and tissue is lifted up with dissolvable sutures. Because everything is lifted in a vertical direction, the horizontal “wind-swept” look is eliminated. A very small amount of skin is removed and used to cover the lifted layer. The inconspicuous short scar by the front of the ear is a big attribute to this surgery. There is no long scar behind the ear or lifting of the hairline. Recovery time is usually about seven days.

Deep Plane Lift
Older patients with severe facial sagging and laxity typically benefit from a Deep Plane Lift. This facelift offers the most dramatic improvement to the face because the underlying tissue layers and muscles are lifted and repositioned, producing improvements to the cheeks, nasolabial folds, jaw and chin. The detachment of skin and muscle from the bone makes this surgery much more intensive than other facelifts which only pull up facial skin and muscles.

A Deep Plane Lift typically begins with an incision at the temples above the hairline. The incision is extended downward, along the natural creases in the skin in front of the ear, below the ear lobe and behind the ear. Making the incision in the natural creases helps to hide scarring after surgery. The skin and muscles are then separated from deeper facial tissues.

In some cases, the skin is removed; in others, the skin and muscles are reshaped. After the tightening or removal of excess skin, the skin is re-draped, sutured or stapled in place. There is typically more swelling, risk of nerve damage and longer healing times associated with the Deep Plane Lift compared to less intense facelifts. The incision should heal after two weeks and recovery time is about four to six weeks.

The SMAS Plication, S-Lift and Deep Plane Lift should all be performed in a hospital or accredited surgical facility typically under general anesthesia. With the mini-facelifts, local anesthesia with sedation may be used depending on the patient's circumstances and the surgeon's preference.

Patient satisfaction with the results of these facelifts usually lasts for about ten years. Related procedures to rejuvenate other areas of the face are frequently performed in conjunction with facelifts including neck lifts, rhinoplasty (nose reshaping) and blepharoplasty (eye lifts).

Roger Bassin, M.D., is a board certified Ophthalmologist and Oculoplastic surgeon whose Melbourne practice is limited to eyelid and facial plastic surgery and reconstructive surgery. For more information, call (321) 723-9558 or visit online at www.bassinplasticsurgery.com.