Overview of Facelift and Necklift Surgery
As we age there are certain patterns of change that are commonly see in our faces. These changes occur mainly as a result of the decreasing elasticity of skin, the sagging of tissues, and the loss of facial volume in the form of fat. These changes start to become evident in our 30’s and progress slowly over time. Genetics have a major influence on this process along with one’s habits. For instance heavy sun exposure and smoking have a strong detrimental effect and hasten the process significantly. The changes involve all the features of one’s face to some degree. With the lower face we see atrophy and sagging of the cheeks that leads to a deepening of the fold between the nose and mouth (nasolabial fold). Further we see the loss of a distinct jawline and the formation of jowls that leads to a deepening of the fold between the mouth and jaw (labiomandibular fold). With the neck there is sagging of the tissues accompanied by the formation of neck bands (platysmal bands).
A facelift or rhytidectomy aims at reversing many of these aging patterns creating a youthful yet natural look. The goal is to not change who you are, but simply take you back to a more youthful version of yourself. It is important to mention that a facelift will only treat sagging of the tissues and other treatments may be necessary like fat injections to treat the loss of facial volume or skin resurfacing to treat skin changes secondary to sun damage. Modern day facelift surgery focuses on the deeper layers of tissue below the skin. This layer called the SMAS is manipulated in order to elevate and reposition sagging facial fat improving the cheeks and jowls. The same concept is applied to the neck to produce a more defined angle between the neck and jaw. Some fat may be removed from the neck but excessive removal will not lead to a youthful soft contour. In the face, fat is commonly added via fat injections in order to replace lost facial volume (the fat comes from your own body and is obtained via techniques similar to liposuction).
A facelift usually requires an incision that starts at the sideburn, travels just in front of the ear, around the earlobe, behind the ear, and then partially into the hair behind the ear. An additional short scar is usually required below the chin to get the best possible results in the neck. In younger patients the incision behind the ear can be eliminated (Short scar facelift or “S” lift), however many will argue that this can produce an inferior result and has limited benefit anyways as this portion of the scar is well concealed.