The best facelift surgery is one which appears natural and leaves nothing to coverup, whether by hair or makeup. You want to appear as if you've aged incredibly gracefully - not that you've been pulled into a mask. How is this accomplished? Usually through a combination of skill and technique. There are several kinds of facelifts on the market. The most common are subcutaneous (skin only), SMAS (superficial musculoaponeurotic system), and deep plane (extended sub-SMAS lift).         With aging, not only does the skin stretch and sag, the cheek fat and underlying tissues shift downward and to the midline. A deep plane facelift resuspends the muscles and other tissues underneath the skin. This restores a youthful understructure prior to redraping the overlying skin. Less tension is placed on the skin and the results are more enduring.         In the older style of SMAS facelifting, deeper structures are not mobilized and the surface skin is pulled taut.         The SMAS facelift can result in the hollywood wind tunnel look - unnaturally tight with distortion of the mouth (look at Faye Dunaway's upper lip in the film "Don Juan"). Rapid relaxation of the stretched skin is frequent. Think of the deep plane facelift as a form of fine tailoring. No matter how sophisticated the fabric or the cut, the suit will fit poorly unless the padding and lining are appropriately addressed.         Treatment of the ears and hairline are finer details that make a big difference in the overall quality of a facelift. One give-away is pixied earlobes after a facelift: the lobe is attached to the face instead of hanging free. Another tell-tale sign is alteration of the hair line. (This concern goes doubly for men, since makeup, long hair, and large earrings are not usually an option.) According to Dr. Szachowicz, "you never want your facelift to limit your options. The surgeon's attention to the details means you can wear your hair in any style, with or without earrings."         Ever notice in later years that Frank Sinatra looks like he's wearing a really bad toupee? Well, he is wearing a toupee, but what makes it worse is his facelift. That lift cost Frank the tuft of hair just in front of and above each ear (the start of the sideburn in both men and women). Any toupee will look unnatural on top of that.         Scarring is minimized by careful suture technique. "I often spend as much time on my skin closure as I do on the deeper structures, just to make sure that whatever scars are left are nearly imperceptible", says Dr. Szachowicz. Ideally, the facelift scar should run from the temple region (inside the hair bearing area), loop in and out of the contours of the ear, tuck under the earlobe and along the crease behind the ear, and back into the hairline again. Poor technique can result in unsightly scars in any of these areas.          


Article by
Minneapolis Facial Plastic Surgeon