Is there one type of face lift which is better than the rest?

Question:
Is there one type of face lift which is better than the rest?

Answer:
To answer your question about composite face lift, one has to first understand the difference between the various types of face lifts.

• Mini face lift. The least invasive of the lifts. It involves a shorter incision. In addition, most of the lift comes from removing excess skin rather than lifting the deeper SMAS layer. Results are less dramatic. These are ideal for younger patients who need minimal results. Results can look unnatural and pulled if too much tension is placed on the skin especially in older patients where a deeper lift would have been a better approach as the skin can’t hold up the sagging SMAS and deeper facial structures.
• SMAS face lift. This involves tightening the deeper facial structures. It is less invasive than a deep plane face lift as the SMAS is not separated (or to a minimal extent) from the underlying facial muscles. Sutures are used to tuck the SMAS at a higher level. This is approach is safer than the deeper lift but at a price- there is less lifting of the mid face and toning of the jaw line. This type of lift is easier to perform than a deep plane lift.
• Deep plane lift. The SMAS layer is separated from the underlying facial muscles and sutured at a higher position on the face. This gives more of a lift along the mid face and jaw line than a standard SMAS lift. There is a slightly higher risk of facial nerve injury. This procedure should be performed by plastic surgeons who have a lot of experience with this technique. There is an ongoing debate as to superiority of results vs your SMAS lift. In my opinion, results are superior along the jaw line and cheeks which have more of a lift. Neither the SMAS or Deep plane lift have a substantial effect on the nasolabial folds (parenthesis lines) and fillers are used to smooth those out in both cases.
• Subperiostial face lift. This is not a popular technique as it results in prolonged swelling. In this technique the entire mid face is lifted off the cheek bone in an endoscopic (small temple incision) approach. It works well to lift the cheeks but falls short in treating the neck and jaw line. It can be combined with a SMAS lift if the surgeons wants to use the subperiostial lift to lift the cheeks rather than the deep plane approach (for the cheek lift)

There are two types of deep plane face lifts.

1. Multiplanar Deep Plane Lift: the skin and SMAS are lifted independently from the underlying muscle.
2. Composite Deep Plane Lift: the skin and SMAS are lifted as one layer. This is less than ideal in that a) it will often result in raising of the temple hairline and b) the ideal direction of lift for the SMAS layer is different from that of the skin. If they are lifted as one layer, the two vectors can’t be established. It is for this reason that the Multiplanar Deep Plane lift is more popular than the composite deep plane lift.

One final note. It is not so much the type of lift that determines the end result but the skill of the surgeon and the use of other concomitant rejuvenating procedures to balance out the rejuvenation process. In addition, I wouldn’t would use viewing pre and post op photos from prospective surgeons more as a tool to see if you find their results esthetically pleasing and not overdone. The type of face lift used is less important in viewing these photos. I would agree, that it would be helpful to see the photos 3 to 5 years out from the procedure but this is usually not possible as many patients don’t come back after their final post op visit for additional photos. The modern day face lift utilizes volume restoration as the cornerstone to a more natural lift. Less lifting is needed once lost volume is replaced with either fat, Sculptra or other products. Youthful skin adds a lot to a face lift result. My preferred skin resurfacing approach is with Fraxel laser. Remember, a face lift doesn’t rejuvenate the skin.