I am currently investigating facelift and lower eyelid surgery. I have two doctors that I've narrowed down to perform different types of lifts. One uses a more traditional SMAS type lift (45 degree vector) and the other an ENT Dr. suggested a deep plane lift (60 degree vector). What is your opinion of which lift might be better for a 56-year-old woman with a very saggy neck? Both doctors said they would place a suture under my neck.
Type of Facelift Best for a 56-year-old Woman?
Doctor Answers (31)
Choosing between facelift types
The most important goal of a facelift procedure is what the facelift will do for you and your unique anatomy. The most effective way of accomplishing this is through a very experienced surgeon who listens to you, and creates a procedure that maximizes your result.
We do not typically perform either the traditional SMAS or the deep plane lifts as they reduce tissue when the SMAS is pulled and then resected. We prefer multivector operations where volume and skin are treated differently, each pulling and restructuring in their optimal direction for the patient's anatomy and aesthetic needs. Not every patient's tissues should be pulled at 45 degrees, or 60 degrees, to achieve the best result. Especially if the skin goes along with the deep layer (i.e. deep plane or composite), loss of the sideburn and a high lateral tension appearance can result.
Nor is any one technique right for every patient. A patient with flat cheekbones requires a completely different technique than one with excessively prominent cheekbones.
Volume replacement goes hand in hand with pulling, since both drooping and loss of volume have typically occurred.
Good earwork is the hallmark of a top plastic surgeon. Examine the pictures carefully and critically for how the ears appear after the procedure!
The neck should typically be addressed as well, not just through facelift incisions but through an incision below the chin. How this is performed varies widely, and patients should examine each plan for how logical it seems, as well as what results the patients in the before-after photos have obtained.
A well done facelift often combines ancillary proeceures such as cheeklifts, upper eyelid surgery, browlifts, lip lifts, laser resurfacing, DAO release, LiveFill (R) placement, etc. The 360 facelift concept of looking at the face as a whole and addressing all (or as close to all as technology permits) is preferable to having a standard way of doing every facelift, in my opinion.
As often as not, patients have had prior "work". Rather than exacerbate the problems of the past, the plan should directly target "older style work" to reduce or eliminate signs of surgery. Specific, targeted steps are necessary to accomplish any revision work in particular, and a harmonious result in general. It will not occur by chance.
Web reference: http://drbrent.com/Articles/mathesbook.html
The surgeon is the most important factor
The most important part of getting a good result from plastic surgery, is the surgeon you choose. Most people choose a board certified plastic surgeon.
Having done extensive studies of face lift techniques on identical twins, I can personally state that it is a much more complicated topic than you realize. Your age is not as important a factor as the quality of your skin and the amount of laxity.
Don't get too hung up on the type of lift. You're paying your surgeon to apply their expertise to you, in order for the surgeon to pick the best technique for you.
With over 20 years of experience, I can assure you that this is not a one size fits all operation.
If a surgeon "performs a certain face lift technique," frankly it sounds like a sales job to me. Every operation should be tailored to that particular patient's needs and many different operations can yield excellent results. In general, I advise the smallest operation to give the maximum improvement with the least risk.
Each operation is tailored to the difficulty of that particular situation (patient). Performing surgery is like playing the violin. Some surgeons make beautiful music, and others just play a bunch of squeaky notes, using the same musical score.
I think you are missing the point here. Choose the best surgeon, both by experience and technique. You should not be concerned about the nuances of technique. Many surgeons cannot agree on them so what hope is there for you? Look at their before and after results, ask to speak to their patients and ask how many they do each month. This will give you a great idea where to go without worrying about the specifics of technique. Consider getting the work done under oral sedation and local anesthesia and removing 95% of the surgical risk. There are surgeons like myself that get long lasting and great results with this approach and compromise nothing. I personally prefer SMAS lifts and stay away from deep plane work. I think deep plane facelifts leave a somewhat unnatural smirk to the face.
You might also like...
What type of facelift is best for a 56 year old woman? It depends...
Facelifting, and facial cosmetic surgery in general, are true arts. The key to a beautiful, rested, and natural results is not a specific techique, vector, or piece of equipment. Instead, a surgeon with a true sense of the actual aging changes to be addressed, and a good vision of the shape that must be created, will choose from a variety of techniques.
I always enter facelift surgery with a specific plan of action to achieve the shape I am seeking. Due to unforseeable surprises in muscle quality, facial fat, tissue strength, and tissue elasticity, I find I often change the specific type of lift technique I use "on the inside".
So, rather than picking a surgeon on vectors and technique, choose on his demonstrated ability to draw from a wide variety of techniques to match the tissue qualities of each patient to predictably deliver consistent, predictable, pretty results.
Type of facelift recommended
Obviously we don't have a picture to render a more accurate opinion. In general, I am more comfortable with a SMAS lift combined with a platysmal muscle plicaton in the neck. The deep plane lift is not one that I perform. It may be advisable to look at a lot of before and after pictures prior to choosing you surgeon. Also a personal chemistry with your surgeon can be very helpful.
All the best,
Tal Raine MD FACS
The best type is the type that works. You have to evaluate the before and after photos of the surgeons and see what looks best to you. I would not concern yourself with the type as it is not the type but the surgeon that will get you the results. There are surgeons out there that will argue SMAS elevation vs. SMAS plication vs Deep Plane that they all will achieve the same results in different hands.
It all depends on what your surgeon feels comfortable with and what kind of results they obtain.
Web reference: http://www.feplasticsurgery.com
The name of the facelift isn't as important as the results that doctor gets
The exact name of the facelift isn't as important as the actual photos of many of that doctor's patients showing what kind of results they get. Each doctor is different and so are their results.
Personally, I use a SMAS lift with a directly vertical vector on the SMAS because I believe the cheek tissues descended vertically down, not at 45 or 60 degrees.
Since we are both in WA, please check the facelift and cheek and neck lift photos on my web site and see if you think there are differences from the other doctors you have already seen.
Web reference: http://www.randcosmeticsurgery.com
The best facelift is one that addresses individual needs
The trends in facelift today are away from deep plane procedures, and from extensive surgery on the SMAS as well. The idea had been longevity of results warrant the procedure, but current understanding is that the risk of deeper plane procedures and longer recovery may not be worth the potential of a longer lasting result.
Patients today have come to expect safe procedures with short scars if possible, substantial improvement, and a rapid recovery from a pleasant experience. The key again is individual care, many vectors as needed, support of the SMAS as gently as possible, restore volume where needed, and safe a rapid recovery.
Best of luck,
Peter E Johnson MD
Web reference: http://www.peterejohnsonmd.com/facelift
Face lift options
It sounds like you are being very thorough and seeing several doctors, which is good because the choice of surgeon is more important than the choice of technique. In general, the deep plane version should produce good long-lasting results, though whether the results are better than less invasive approaches has not been proven. The risks of nerve injury may be greater with the deep plane, and there may be more swelling that takes longer to resolve. The vector is something that should be individualized. Most important in my opinion is to decide which procedure will give the best 3-dimensional result for a natural appreance.
Facelift Options for You
The treatment of facial aging should be individualized based on the patient’s aesthetic goals, anatomic findings and social situation. No two patients are exactly alike and because of this appropriate treatment depends on the patients specific anatomic needs. In your case it’s virtually impossible to make a recommendation without pictures or a physical examination.
When choosing a facelift technique, the analysis of the patient’s anatomy and how it’s effected by the aging process is critical. Careful analysis will determine the type of procedure that will optimize your result.
Each of the procedures that you mention has a place in the management of facial aging. There utilization is dependent upon the surgeons analysis of the patients anatomy and how it’s been effected by the aging process.
Although, the type of procedure chosen is important, the selection of a plastic surgeon is even more important. It’s important that you consult a board certified plastic surgeon with experience performing facial rejuvenation surgery. Make sure you review pre and post-operative pictures and have an opportunity to get comfortable. This surgeon should be able to formulate a treatment plan that’s specific for your anatomic findings and meets your aesthetic goals.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.