Facelift, Mini Face Lift, Quicklift - which one is the best
Article by Boris Volshteyn, MD, MS
East Brunswick Plastic Surgeon
I'm not sure about you, however, I am always confused about different names, different terminologies and different revolutionary techniques.
For the purpose of disclosure, I do not perform Lifestyle lift procedure specifically, however, I do perform Quicklifts along with the traditional SMAS flap facelifts and endoscopic procedures. I do have a full spectrum plastic surgery reconstructive and cosmetic practice as well as radiation wound treatment center and hyperbaric oxygen therapy center.
It happened, that the majority of my cosmetic surgery interest lies within the area of facial rejuvenation. Regardless of what specific name of procedure is, Lifestyle lift, Quick lift, Bandaid lift, S- lift, MACS lift or any other, at the end of the day this is a facelift. It is important that both patient and the surgeon treated it as such. All the techniques involve scarring, they all involve elevation of the skin and some of them involve elevation of them underlying SMAS layer (aka deep muscle). Regardless of how simple or easy they may appear or sound, the complications are still possible. That is why in our office, for example, any patient undergoing facelift, mini facelift, or any other variation of facial rejuvenation procedures, is provided with the same information and signs the same extensive informed consent that includes all the complications related to traditional facelift surgery.
Instead of specifying each individual technique, and there are over 200 of them published, lets organize all facial rejuvenation techniques into groups. For the purposes of this discussion, I am going to ignore thread lift techniques, which I do not personally perform, or believe in their longevity or validity.
Group 1. Skin only lifts. Skin only lifts, just like the name implies, lift the skin only. Even though it is not the most common procedure performed today, skin only facelift procedure can be quite helpful. It can be performed in younger patients with excessive amount of skin and small amount of deep muscle laxity. I also use it for patients with very severe acne and I ice pick scarring, when the scarring extends to underlying tissues. It is also helpful in touchup procedures after previous more aggressive facelift surgery. I agree with most of the authors that skin only facelifts are not the first choice for patients who need more than just skin elevation.
Group 2. Skin lifts with SMAS plication. This is one of the most popular techniques. This mass is a deep muscle layer located underneath the skin. Plication in common language means pleating. During the surgery the surgeon will withhold the deep muscle layer over itself and secure it with sutures. To people familiar with slowing this is very similar to pleating. As a result, both deep muscle layer and skin are tightened. This technique allows improvement of the neck, it does provide durability and depending on direction of the pleat, can result in various degrees of improvement.
Group 3. Skin lifts with SMASectomy. This technique is similar to the previous one but instead of folding over and creating a roll, the excessive deep muscle is removed and then the edges are sewn in together. It is also very effective in lifting deep tissues and the skin. Depending on the exact direction of suturing and deep muscle removal the effective lifting of the lower third of the face is very possible. This is also one of the most common techniques utilized today.
Group 4. Skin lifts with suture suspension. Most commonly known variations of this lift is MACS lift, QuickLift, S Lift and others. During the surgery the skin was lifted. Deep muscle is lifted with suture material and attached to the bone were to the deep muscle layer above. Depending on direction of the suture, number of the sutures, type of suture placements, different techniques have been created. Lately it became one of the most popular techniques of both mini lifts and more traditional facelift procedures. My confusion about this technique is some surgeons utilize it for patients requesting traditional facelift surgery, the others use it for mini facelift procedures. I believe, this is one of the most effective ways of lifting up deep muscle. I have been skeptical about it for years but now I am convinced that this is one of the most effective techniques out their. The advantage of this technique is that deep muscle is not traditionally cut or elevated and theoretically has a significantly lower risk of nerve injury. I have spoken to multiple surgeons who use this technique alone and in conjunction with all other techniques to strengthen the deep muscle elevation.
Group 5. Skin lift with SMAS mass flap. This is what most surgeons consider traditional facelift procedure. During the surgery, skin is lifted and deep muscle, also known as SMAS, is lifted separately from the skin and then lifted. It is traditionally considered that when the deep muscle, SMAS, is separated from underlying parotid gland, it can provide much more effective elevation of deeper structures and more durable result then the other techniques. Until I tried group 4 techniques, I was under the same impression. Currently, when I use this technique, I like to create an additional support with suture material just like it is described in group #4. Because group #4 and group #5 lift the same deep muscle layer, I cannot explain why one last longer or shorter than the other. At the end of the day, the longevity of the facelift is dependent on strength of this muscle layer and not necessarily on the method in which the lifting of this layer had been accomplished.
Group 6. Composite lifts. Composite lifts usually separate skin, deep muscle layer and deeper tissues from the bone and then lift each individual layer separately. In experienced hands, the surgery can be very effective, however, the swelling stays for a long time, there are very few surgeons performing this technique today. I do not perform this procedure.
Groups 7. Endoscopic Techniques. Most of the time, endoscopic techniques are used with or without skin lift procedure. By themselves, these are designed to lift deeper tissues through small incisions usually located in the hairline.
Majority of commercially available techniques today fall into one of those groups, or somewhere in between.
To confuse the issue, there is also short scar technique. The short scar technique does not necessarily refer to any specific method, but rather describes a way to shorten surgical scar either in front, or behind the ear in patients who do not have very large amount of extra skin. The techniques of deep muscle elevation used with a short scar technique can very from surgeon the surgeon.
In essence, these are the main techniques used for facial rejuvenation. To improve the result, these techniques can be combined with additional procedures, like liposuction, neck muscle tightening, fat grafting, cheek or chin implants, browlift, blepharoplasty and others.
Some surgeons routinely include some of the techniques in their definition of traditional facelift, others do all of them ala-carte.
A million dollar questions is which technique is better. The answer is that there is no universally perfect technique for everyone, otherwise every surgeon would use it.
Most surgeons customize available to them techniques in such a way to produce the best result for the patient. Each technique has its subtle advantages, and disadvantages.
That is why it is very important to communicate all your specific concerns to your surgeon. He is also important to make sure that the aesthetic vision that you have is similar to the aesthetic vision of your surgeon.
Boris Volshteyn M.D., M.S.