Why are there so many different types of face lifts?
First I’m going to explain the basic face lift. After you understand this, I will explain some of the variations. The goal of a facelift is to tighten the midface- the area from the cheekbones down to the jawline. The neck is not addressed unless a separate neck lift is done, but these two procedures are frequently combined.
- An incision is made just in front of the ear (known as a pretragal incision). This incision may extend up into the hairline, and may also extend around behind the ear.
- The skin is elevated, raising up a skin flap to reveal the layer of connective tissue and muscle underneath. This tissue is known as the superficial musculoaponeurotic system, or SMAS. How far anteriorly (toward the front) the skin is raised can vary. In an awake setting such as LifeStyle lift, the skin elevation may be very minimal. For a full face lift, the skin may be elevated over the entire cheek, nearly to the smile lines (nasolabial folds).
- The SMAS layer is tightened. This step is what does the actual lifiting portion of a face lift. There is significant variation in this portion of the procedure as well. On the less invasive end of the spectrum, sutures may be used to tighten this layer without lifting it up or removing any tissue. On the more invasive end of the spectrum, the SMAS may be raised up and some of it removed.
- The skin is redraped over the underlying tissue, and the excess skin is removed before closing the incisions.
These are the essential steps of any facelift: elevate skin, tighten SMAS, redrape skin and remove the extra prior to closing incisions. If a neck lift is done at the same time, as is common, the steps are very similar: the skin over the neck is elevated, the muscular layer is tightened, and the skin is re-draped before removing the excess. So where do all the different names come from? There are several possible variations:
- How long the incision is. The short-scar facelift limits the incision to in front of the ear.
- How much the skin is elevated. The MACS lift stands for minimal access cranial suspension lift. In this type of lift the incision is up higher in the hairline, and minimal skin undermining is performed.
- If the SMAS layer is elevated, or just tightened. In a mini-lift, for example, the skin is elevated just enough to tighten the SMAS, but no SMAS tissue is removed.
So all those different types of face lift that you’ve heard about are just variations on a theme, and there are very, very few studies comparing them head-to-head. But it’s really not critical for you to understand all the minute variations in face lifts. Just be aware that the different names out there are essentially marketing gimmicks trying to carve out a niche. All that really matters is that your surgeon obtains good results with his or her chosen technique. The one type of lift I would like to mention specifically, however, is a “thread lift”. This is not a true face lift at all. Instead of elevating the skin and tightening the muscle layer below it, the “thread lift” attempts to perform a lift by running a suture through a very small incision. Because the skin and underlying SMAS are not separated from one another, thread lifts tend to not be very effective or last very long.
I hope this post cleared up some confusion about the different types of face lift out there. I would love to hear any questions you might have.