Before delving into the specifics of facelifts, it’s essential to define the medical terms commonly used in this context
A lift means to elevate or raise. In medical terms, especially in cosmetic surgery, a facelift refers to correcting the signs of aging and rejuvenating the face by lifting the facial tissues. However, the term ‘lift’ doesn’t necessarily imply rejuvenation. It simply means lifting, which can be performed on a young individual (like a brow and temple lift to reshape the eyebrows or a central lip lift). Although these procedures lift and reshape the face, they aren’t necessarily done for rejuvenation purposes.
Various methods (surgical and non-surgical) can be used to correct sagging tissues in any area of the face. Contrary to popular belief, facelifts are not exclusively surgical procedures. Non-surgical methods like Botox, laser, etc., can also perform lifts. The primary difference between various facelift methods lies in the extent of the lift and its duration.
Generally, the signs of aging on the face occur through three main mechanisms:
1. Skin changes
2. Changes in tissue volume
3. Tissue sagging( Due to gravity, the tissues of the face can sag over time, leading to a drooping or downward appearance)
Wrinkles are the result of repeated folding of the skin (due to the movement of the underlying muscles), such as those on the forehead and around the eyes. Folds, on the other hand, are caused by more significant changes (such as tissue sagging) in the deeper layers of the face, like nasolabial folds. To correct wrinkles, superficial treatments (like laser resurfacing, Botox, and subcutaneous lifts) are often used, while deeper changes, like a deep face lift (with or without superficial treatments), are more effective for folds.
Note: In individuals with numerous wrinkles and generally very thin faces, subcutaneous lifts may be an unavoidable part of facial rejuvenation in some areas (such as around the eyes, forehead, and mouth).
Given the various mechanisms that lead to facial aging, there are different methods to address these signs. Therefore, it should not be surprising that a dermatologist claims to perform facial rejuvenation with laser treatments, while a general practitioner claims to do so with dermal fillers and Botox, and a plastic surgeon claims to achieve rejuvenation through a facelift.
These methods target the skin (or the superficial subcutaneous tissue) to reduce the signs of aging (e.g., laser, RF, Plexr).
These methods address the signs of aging by restoring lost volume (e.g., dermal fillers, fat grafting, implants). It’s important to note that a facelift isn’t always necessary for facial rejuvenation. Sometimes, the signs of aging are simply due to a loss of volume and facial thinness, which can be addressed by restoring the lost volume. For example, injecting fat into the face of a 35-year-old with a thin face can make them appear younger.
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As time goes by and we age, we will all inevitably experience signs of facial aging. With increasing age, our skin becomes loose and saggy, facial volume decreases, and the consistency of the deep tissues of the face changes in a way that deep creases form in the lower face and loose, sagging skin appears on the face and neck. Signs of facial aging include:
1. Sagging of the midface
2. Deepening of nasolabial folds (lines between the mouth and nose)
3. Deepening of the under-eye crease (below the lower eyelid)
4. Decreased facial volume due to loss of facial fat or sagging facial fat
5. Loose skin and increased wrinkles in the lower jaw and lower part of the face
5. Loose skin and fat accumulation under the chin, which can even create the appearance of a large double chin in a person with a normal weight
Although these are normal parts of the aging process, they can cause discomfort for the affected individual. In people with very severe changes, the best solution is rhytidectomy.
Rhytidectomy refers to the correction of signs of tissue sagging in the mid and lower face. In a facial beauty analysis, the face is divided into three parts: upper, middle, and lower, as shown in the image below, which are approximately equal to each other. Lifting and rejuvenating the upper part of the face involves a forehead and brow lift, and for a more detailed study, you can refer to this section.
Rhytidectomy, or a facelift, can be divided into two main categories: surgical (invasive) and non-surgical. Each method has its own advantages and disadvantages, but surgical procedures generally offer more long-lasting results, while non-surgical methods are typically less expensive.
As mentioned, non-surgical facelifts involve lifting facial features without the need for surgery. These methods include thread lifts, HIFU therapy, dermal fillers, Botox, fat injections, and more. For more information on each method, you can click on the specific link.
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Aside from subcutaneous lifts, there are various methods for lifting the SMAS (deep facial tissue). Broadly speaking, these methods can be divided into two main categories:
1. SMAS Rhytidectomy: These methods involve releasing the anchoring ligaments between the tissues and then lifting the SMAS (also known as SMAS Rhytidectomy).
2. Deep Plane Rhytidectomy: These methods involve lifting the SMAS (deep tissue) without releasing the anchoring ligaments (also known as Deep Plane Rhytidectomy).
Undoubtedly, the methods that release the anchoring ligaments and then lift the SMAS produce more significant and long-lasting results.
In recent decades, endoscopes have been used in various surgeries, including facelifts. Using an endoscope, the soft tissues of the face are separated from the bone, and inevitably, the anchoring ligaments attached to the bone are separated. However, the attachment of these ligaments to the periosteum, which is a very strong and non-elastic tissue, remains intact. Additionally, the ligaments that connect the more superficial layers to the periosteum remain unchanged, and the connection between the different layers of soft tissues remains intact. The endoscopic method can only be used in the upper third and middle third of the face (midface) and cannot be used to release the lower third of the face. Therefore, the endoscopic method currently has no application in the lower third of the face. Since the middle and lower thirds of the face are closely related, not releasing the lower part of the face can relatively hinder the lifting of the middle part of the face. Therefore, although endoscopic lifting in the forehead and brow (i.e., the upper third of the face) yields relatively good results, it shows less effective results in the midface and, except in specific individuals (young individuals with minimal facial tissue sagging), it is often not satisfactory for most people or has a short duration. Therefore, both surgeons and patients are less inclined towards endoscopic lifting of the midface.
Note: The midface refers to the part of the face between the lower eyelid and the oral commissure or corner of the mouth.
The advantage of Endotine is that it helps the surgeon to slightly increase the speed of fixing tissues, which undoubtedly provides convenience for a skilled surgeon. However, in terms of the final outcome, there is no difference compared to the result obtained from suturing. Of course, Endotine is very helpful for surgeons who have less experience in endoscopic lifting, as they no longer have to worry about improper stitches.
Note: Endoscopic lifting of the cheek and midface can lead to an increase in facial width and prolonged swelling of the cheeks, making this method unsuitable for individuals with broad faces as it can disrupt the proportions of the facial features. However, it can be beneficial for young individuals with long and thin faces.
1. Versatility in Lifting Depth: The surgeon can choose at which layer to perform the lift. Unlike endoscopic lifting, where the surgeon is limited to specific layers, open surgery allows for more flexibility in choosing the depth of the lift.
2. Ability to Remove Excess Skin: Open surgery allows for the removal of excess skin, which is either limited or not possible with endoscopic lifting. Therefore, individuals with older skin and significant sagging benefit more from open surgery.
3. Multi-Layered Lifting: In open surgery, the facelift can be performed on two or more layers. Each layer of the face can be lifted separately and even in different directions. For example, in the lower part of the face and upper neck, better results are obtained when the SMAS is lifted upwards and backwards, while the skin is lifted backwards.
For a facelift, we can lift the entire face in one stage or perform the lift in multiple stages (meaning that different parts can be lifted at different times). Lifting certain parts of the face without addressing the surrounding tissues is not always ideal (for example, lifting the lower third of the face without addressing the midface is not very suitable and may only be done in a few individuals). However, some parts of the face can be lifted completely independently of the surrounding areas
● Forehead and Temples:
Especially in younger individuals experiencing sagging foreheads and brows.
● Direct Brow Lift:
This procedure can be performed alone for individuals with drooping brows without other signs of aging. However, it can also be combined with other surgeries like eyelid surgery or forehead lift.
● Midface Lift:
This can be done endoscopically or with traditional open surgery, either alone or in combination with temple and forehead lifts.”
Essentially, this text is discussing specific areas of the face that can be targeted for a facelift procedure without necessarily addressing the entire face.
Most isolated lift procedures are performed on younger individuals or older individuals with localized sagging. Conversely, individuals with severe sagging across their entire face are not ideal candidates for localized lifts unless there is a significant medical reason. For example, severe eyelid and brow droop can restrict vision, making correction necessary for both aesthetic and functional reasons.
Performing localized rejuvenation on individuals with severe signs of aging can result in an imbalanced appearance, with some areas looking younger than others. This can be more visually unappealing than a consistently aged appearance.
Therefore, older individuals often benefit from a full facelift and neck lift (rhytidectomy) for optimal results. Younger individuals with localized sagging, however, can opt for isolated lifts. For instance, a young person with a small chin and a double chin but a firm neck might benefit from a chin implant and neck liposuction.
Note: It’s important to remember that facelifts do not address the areas around the eyes and mouth. Eyelid and lip surgeries are separate procedures. Many people mistakenly believe that a facelift will completely eliminate wrinkles around the eyes and mouth, but this is not the case.
To correct these areas, additional procedures like eyelid surgery, fillers, and Botox are necessary
In our classic approach, facelift incisions are made in front of the hairline (or within the hair), extending from the temple area, down in front of the earlobe, and then behind the earlobe into the crease between the ear and the head. If a neck lift is also being performed, the incision continues into the hairline at the nape of the neck.
If the incision is placed in front of the hairline, removing excess skin will result in the hairline being pulled back. However, for individuals with a small distance between their hairline and the outer corner of the eye (normally between 3 and 5 centimeters), the incision can be placed within the hairline if they are willing to accept this hair recession. We would never recommend placing the incision within the hairline for individuals with a distance greater than 5 centimeters.
Incision placement for men and women differs slightly. In men, the incision is made in front of the tragus to prevent hair growth over the tragus after the lift. In women, the incision is made at the edge of the tragus to better conceal it.
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Initially, an incision is made in the skin, and the skin is separated from the underlying connective tissues and facial muscles. Subsequently, the deep support structures of the face are loosened so that these tissues can slide and be pulled upwards to a higher position. Using special sutures, this released framework is securely fixed in the new position to pull the sagging tissues. Finally, the skin is pulled taut over the repositioned tissues, and excess skin is removed.
It’s important to note that the goal of a facelift is not merely to tighten the skin. Skin acts as a covering, and if the deeper tissues of the face are not pulled upwards and secured, they will not have the strength to support the heavier, sagging tissues below.
Note: As a recommendation, complementary surgeries, such as eyelid surgery and brow lift, can be performed during the facelift to enhance the overall results. However, these procedures are performed at the discretion of the surgeon.
Rhytidectomy can be categorized into several different methods. However, commonly, these methods include:
This method involves small incisions in the midface (such as the cheeks) and upper face (forehead) and can lift these areas. However, it cannot lift the lower part of the face. The entire face cannot be lifted with this method.
The open facelift is the standard surgical procedure for facial rejuvenation, and the results of other methods are usually compared to this method. The incision is the first step in this procedure. Depending on the surgeon’s preference, the surgical incision may vary slightly from what is described below. The open facelift is most often performed with an incision below the hairline.
As seen in the images above, the surgical incision can vary slightly between men and women. This incision is designed to be hidden from view after surgery, resulting in a natural-looking outcome.
If the lift is performed only at the subcutaneous level, the skin is lifted towards the front of the face and then returned to its original position, with the excess removed. This is a very old technique and is now performed only by surgeons with limited experience. The results in terms of correcting sagging are very short-lived, but it can reduce wrinkles and is more effective in treating wrinkles caused by aging (e.g., forehead lines). Since the tension is placed on the skin, there is a higher risk of scarring, earlobe deformity, and an unnatural appearance of the lifted face.
Note: Although deep lifting is recommended for most people and provides better results, in certain cases (especially in individuals with thin skin and a thin face, particularly in the forehead and temple areas), a subcutaneous lift may be used.
In the image above, a disfiguring scar can be seen at the surgical incision site. The patient had undergone a subcutaneous lift performed by another surgeon one year prior.
Due to the rapid return of symptoms, patient satisfaction with this method over the long term is significantly lower than with other rhytidectomy procedures. Many of the post-surgical dissatisfactions with this method are due to the complications of the resulting scars (as seen in the image above).
The high rate of complications and the ineffectiveness of this method have forced surgeons to seek more durable rhytidectomy methods. In this pursuit, they realized that instead of applying tension to the facial skin, tension should be applied to the deeper, stronger tissues. This approach not only provides better results but also reduces the risk of post-surgical scarring.
Note: Other names that some surgeons use for subcutaneous lift surgery include mini-lift, mannequin lift, brief lift, etc.
In SMAS plication, after elevating the skin, the SMAS (superficial musculoaponeurotic system) is pleated on itself using sutures without being detached from the underlying tissues or releasing the anchoring ligaments. This creates tension in the SMAS.
Classic Deep Plane (Low SMAS Deep Plane): In this technique, the upper portions of the SMAS are not released, but the lower portion (below the zygoma) is released and fixed to the higher tissues using sutures.
In the MACS lift, the SMAS is placed under tension using sutures, similar to the straps of a bag, without being released.
In this technique, both the upper and lower portions of the SMAS are released and fixed to the higher tissues.
In the extended high SMAS deep plane technique, in addition to releasing the SMAS in the lower and upper portions, the SMAS is also released in the anterior (frontal) portions and then fixed to higher tissues. A combined two-layer technique exists where the skin is released to a greater extent than in the deep plane procedure, and then the deep plane procedure (with any of its variations) is performed.
Note: The skin incision is similar in all of the above methods, and the type of surgical procedure cannot be determined from the incision alone.
1. Thin faces: (If they have significant sagging, they will have better results than fuller faces)
2. Faces with more sagging
3. Faces with stronger ligaments
4. Faces with a well-developed skeletal structure: (People with small jaws will have less significant results)
5. Individuals with good natural beauty
6. Individuals who wear makeup and care about their appearance
7. Individuals with healthier teeth
8. Individuals whose facial appearance is younger than their age
9. Individuals who do not have overly active facial muscles and experience less tissue movement: (Introverted individuals appear younger)
10. Individuals with a good body and are considered well-styled
11. Individuals who have not obtained good or complete results from non-invasive methods and are mentally prepared for surgery and its potential complications.
1. Individuals with full, shapeless faces.
2. Individuals with weak ligaments: (The boundaries of the ligaments are not well-defined)
3. Edentulous individuals: (Those without teeth)
4. Individuals who do not care about their appearance and are undergoing facelift surgery due to external pressures.
5. Individuals with poorly developed facial skeletal structures.
6. Individuals under 40 years old.
7. Individuals with minor facial sagging who can benefit from non-surgical methods.
8. Individuals with hyperactive facial muscles: (Subcutaneous lift is better for them in the forehead area)
Although rhytidectomy (facelift surgery) is a very safe procedure, like any other surgery, it can have complications. Each of these complications can be prevented or treated using specific solutions.
These complications include post-operative bruising, pain, numbness of the facial skin, facial swelling, and more. To learn more about the complications of this surgery and methods of prevention and treatment, you can read the article on complications of facelift surgery.
Given the nature of the surgery and the post-operative conditions, it is necessary to be aware of the exact post-operative care methods so that you can return to your normal life as quickly as possible and avoid specific complications related to the surgery. For this reason, immediate post-operative support will be provided to you through the sending of care files and telephone calls.
It’s clear that any surgery involving incisions will leave some sort of scar, and it’s important to remember that the skin at the surgical site will never be exactly the same as it was before surgery. However, there’s a difference between a scar and a visible scar. Plastic surgery incisions are designed to be less noticeable. For instance, they can be placed in the crease behind the ear or within the hairline. To further minimize the appearance of scars, techniques like wound repair (using exfoliating creams, lasers, RF, dermabrasion, etc.) can be used.
Although in most cases, the incision site heals well and becomes hidden, no surgeon can guarantee this to their patient. They can only inform the patient of the possibility of a surgical scar and provide methods to prevent and treat it.
These individuals are more prone to having persistent scars compared to others. Although there are methods to treat these scars, they must be aware of the risk of surgical scarring and accept it before undergoing a facelift.
Because the skin that is under tension will gradually stretch and return to its original state over time, and the sutures that hold the superficial tissues together tear the tissues (cheese wiring) and the signs return. To prevent this, the best thing is to transfer the tissue tension from the skin and subcutaneous tissue to the SMAS. Due to its strong collagenous tissues, the SMAS can bear the tension and weight of the facial tissues and move them upwards.
SMAS helps prevent certain complications such as earlobe deformity, surgical scar, and changes in the hairline.
We must first define what we mean by “permanent” results. If by “permanent” we mean that after surgery, the face will remain young forever and will no longer age, then this is not correct. However, if we mean that in identical twins, the one who has had a facelift will always appear younger than the other, then this is correct. In this way, the results of a facelift will keep the individual younger than their peers who have similar genetic conditions. In other words, a facelift turns back the clock but does not stop it.
This is because 1. This technique is very time-consuming; 2. It requires a great deal of experience; and 3. The surgeon must have a complete mastery of the anatomy of that area. Therefore, most surgeons choose easier alternative methods that are available. And of course, these easier methods meet the needs of younger people (under 40) for a long time.
A deep plane facelift typically has fewer complications than a superficial lift for two main reasons: 1. It’s performed by a more experienced surgeon and 2. It doesn’t put as much tension on the skin. However, it’s important to note that the complications that can occur are more serious (like damage to the facial nerve).
One of the potential complications of a facelift is a change in the shape or form of the ear. Fortunately, the likelihood of this complication is much lower in lifts where the deep tissues of the face are under tension, compared to when the skin and subcutaneous tissues are lifted. There are methods to correct this ear deformity that are very effective in restoring the ear to its original shape.
The incision location is typically as shown in the image below, but it may vary in some individuals.
Yes. Wound healing varies from person to person. Some individuals heal very well, while others may have poor wound healing (such as keloids). In these cases, it is important to pay attention to the individual’s previous surgeries or skin cuts.
Yes, in all cases of facelift, there will be numbness in the incision area for a long time. Over the course of several weeks to months, sensation will gradually return to these areas.
Suture removal takes between 1 to 3 weeks. However, most sutures are absorbable and will fall out on their own without the need for removal.
