Face Lift Variations in the Media - Dr. Young Award Winning Facial Plastic Surgeon, Seattle, Bellevue, Washington specializes and discusses Facelifts, What They Accomplish, and a Brief Explanation of the Different Face Lifts that are Being Marketed in the Media:

Face Lift (or facelift, quick lift, smas lift, short scar lift, facial rejuvenation, thread lift, s lift, weekend lift, lunch time lift, one hour lift) is generally a procedure that lifts part of the face. It works to improve the jowl area (see figure 1), marionette lines (see figure 2), neck bands (see figure 3), neck laxity, double chin, and nasolabial folds (see figure 4). You can see the pictures showing where these anatomic structures are located. After a Facelift, many of these things are improved as seen in the before and afters (see figure 5 & 6). As we will explain, a Facelift can strictly mean the pulling of the facial muscles above the jaw line with most of the effects seen above this level (in the jowls, around the mouth and in the cheek area). Through a Face Lift that is above the jaw line only, you can still see effects in the neck. The effects in the neck are limited and if you want a tighter neck, sometimes you will need to address the neck directly with the Neck lift procedure. You can read about our Neck Lift Procedure and all the options here. After the figures 1-6, we have more of an explanation of facelifts and the many variations that are out there in the press, media, and internet.

Figure 1                                        Figure 2

Figure 3

Figure 5 and 6 Before and After a Mini Face Lift

Here is a more in depth explanation on face lifts. There are many names for a Facelift and you might have heard some of these names in the media / press. Essentially all Face lifts, including these advertised lifts that are labeled as minimally invasive, all entail pulling on a layer of tissue called the SMAS (or Superficial Muscular Aponeurotic System). The SMAS is the layer of tissue that includes the facial muscles and platysma as seen in figure 7.  Notice how the platysma muscle blends in with the facial muscles. This layer of tissue is the layer that all facelifts "lift" or "pull" on to create the beneficial aspects of a facelift.  It does so because the SMAS is connected to other facial muscles and the pulling of the SMAS is transposed to the facial muscles that are located around the areas that need to be improved, such as the jowls, marionette lines, nasolabial folds, etc. 

How do facelifts differ? They differ in terms of how much undermining the surgeon does in front of the ear, how deep the dissection goes, how long the incision is carried out and what other adjunctive procedures are included to improve the facelift results.  Most minimally invasive facelifts entail less undermining, they usually use sutures to pull up the SMAS, and they limit their dissection and the extent of their incisions.  Minimally invasive facelifts that are advertised out there usually entail about 3-5cm (2-3 inches) of skin undermining in front of and behind the ear (see figure 8 blue line).  Usually they also entail sutures to pull up the SMAS, after skin undermining, without elevating deep to the SMAS. Most minimally invasive facelifts leave the SMAS intact and use sutures to fold the SMAS up and hence shorten the SMAS which, in turn, have a lifting effect on the intended facial structures.  The sutures typically grab the SMAS near the furthest part of the dissection and then are fixed and pulled to immobile tissue superiorly around the ear.  This is where the lifting occurs. The incision typically runs above the sideburn and then between the ear and the face.  The incision can go in front or behind the tragus (the flap of tissue right in front of the ear canal) and then it is carried in front of the earlobe. More advanced facelifts, extend the incision behind the ear (normally running in the crease) which then goes along or within the hairline (see figure 8, green dashed line). More advanced facelifts also extend their skin undermining (figure 8 Yellow line). This is in contrast to minimally invasive facelifts, detailed in blue in figure 8. 

This extension with the green dashed arrow is more likely a part of the neck lift. With this part of the incision, to fully treat the neck, you will likely need to have an incision under the chin as well. You can read more about the neck lift here.

As alluded to earlier, more advanced face lifts are more aggressive in their treatment of the SMAS through elevation of the SMAS and further dissection underneath the SMAS. Specifically, the SMAS is incised and lifted with instruments. Even more complicated facelifts carry their SUB SMAS dissection (dissection under the SMAS) over the facial muscles and specifically the zygomaticus major and minor which are the smile muscles (see figure 7).  The reason for taking the dissection over the smiling muscles is to have more of an effect on the nasolabial folds.  This approach is very complicated and usually mastered by the most experienced facelift surgeons.  Here is a picture of this dissection over the zygomaticus major and minor (see figure 9 smile muscles are labeled and what you are visualizing is the zygomaticus major) which I performed during an October 2009 facelift.  Again, as mentioned this is a much more advanced technique with more potential for complications if not done by someone with considerable experience. These smiling muscles have important facial nerve filaments below and rarely above these muscles which can be damaged. You will need to find someone who is thoroughly comfortable with this anatomy. Someone who specializes in the face and neck plastic surgery is ideal! Traditional facelifts are also more aggressive in their treatment of the neck muscles under the chin which I will discuss in a different page, under my discussion of neck lifts. Many consider the treatment of the neck a separate procedure as it entails considerable more time to effectively and fully treat.

Figure 7

Figure 8

Figure 9

You can read more about the different variations of facelifts, mini face lifts, and some of the important things to know about these options in making a decision. These are some questions that you can ask your potential surgeon to find out what will be done for you. Here is a link to read more about face lift variations.

If you are interested at anytime about scheduling an appointment you can email, call 425-990-3223 and even text message us at anytime. Click here if you would like to find out more about our consultation process. We can set up a phone consultation for you and show you how to take the 5 basic photos that you will need.

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