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Facelift Operations (Rhytidectomy)

An operation to rejuvenate the face.

Nowadays there are many different types of facelift. This can be confusing to the layperson :

To make sense of the different names think of the modern facelift as having developed from three main procedures :

1.    Skin only Facelift

Before 1970 there was only one type of facelift operation and that was the Skin Only Facelift. Essentially a facelift incision was made around the ear and the skin was undermined over the side of the face. The mobilized skin was pulled upwards and backwards and the overlapping excess skin was removed. The incision was then stitched. This operation was quite effective except the effects did not last very long because the skin stretched  under the influence of gravity on the aging skin.This operation is seldom used these days. 

2.    SMAS Facelift

In the 1970s an anatomical layer under the skin was discovered, it is called the SMAS layer. It is made of fibrous-fatty tissue perforated with ligaments which connect the skin to the underling muscles and bone.Lifting the SMAS will also lift and support the skin preventing it from stretching. When surgeons talk about a facelift they include the neck because the SMAS extends up through the neck into the face so lifting and shortening the SMAS lifts both the neck and the face.

3.    Subperiosteal Facelift

Since aging and gravity affect all the soft tissues of the face it would seem logical to lift all the soft tissue layers including skin, SMAS, facial muscles, fat  and periosteum (which is the deepest layer and is adherent to the facial bones), This technique can give a dramatic result  but the surgery is severe and leads to  prolonged downtime. Consequently it has never really been popular with either patients or surgeons.

In recent years there has been a resurgence in the subperiosteal approach for treating the midface. The Midfacelift elevates the area of the face under the eyelids down to the corner of the mouth and helps to rejuvenate the lower eyelid, the cheek prominence and the nasolabial fold.

Before and after images following a SMAS facelift with liposuction and upper and lower blepharoplasty: