What are the different types of facelift, and how do they differ?
This is a complex question, because there are so many different techniques that have been described for facelift, and the terminology is not always consistent in the literature. However, all properly performed facelifts employ some common basic principles. First, a variable length incision is made in the hairline in front of the ear, extending down along the natural creases around the front of the ear, and then possibly extending up along the backside of the ear and down along the hairline behind the ear for a variable length, depending on the needs of each individual patient. A separate small incision may be made in the natural crease under the chin to permit access to the midline of the neck, if needed. The skin of the face and neck is then elevated from the underlying soft tissues, called the SMAS in the face and the platysma muscle in the neck. This deeper layer of fascia and muscle is more resistant to stretch than the skin, and it is this deeper layer that is elevated and secured to re-contour the neck and jawline. Once the SMAS and platysma have been lifted and secured in a more youthful position, the excess redundant skin that comes back with the lift is trimmed along the incision lines and sutured back in place. Depending on the needs of the patient, liposuction of the jawline and neck, and tightening of the platysma muscle in the midline of the neck, may be performed through the incision under the chin for patients with significant fat accumulation or laxity in the neck. The thing that distinguishes different types of facelift procedures is the technique used for management of the SMAS and platysma. A SMAS plication involves folding the SMAS over onto itself as the tissues are lifted and suturing the layers together to support the lift. A SMAS imbrication procedure involves excising or removing a variable width strip of SMAS and platysma around the ear and approximating and securing the free edges together to support the lift. A deep plane facelift involves developing a separate plane of dissection underneath the SMAS layer to allow release of ligamentous attachments along the jawline and in the midface to allow additional mobilization of the SMAS during the lift. This is primarily to allow additional improvement in area of the nasolabial fold and midface. There are other variations related to suturing techniques and vectors of pull that distinguish facelift techniques. There are pros and cons to each facelift techniques, and the choice of facelift technique is dependent on the skill, experience, and preference of the operating surgeon. However, there has been no consistent evidence in the medical literature to demonstrate any advantage of one technique over another, in terms of outcome, complications, or longevity of results. Most experienced facelift surgeons have likely performed all of these techniques and utilize each to some degree based on the anatomy, concerns, and goals of each individual patient.