Do lower / concept face lifts last?

Hi there. Great observation! the neck region is often undertreated in lower facelifts and mini facelifts leading to early recurrent sagging. Concept facelift is just a gimmicky name for a local anaesthetic procedure. To get the most out of a lower facelift (i.e. greatest improvement in jawline/ neck contour), the neck needs to be opened by a small incision under the chin (3cm or so) - this allows removal of excess deep tissue and tightening of muscles - both of which contribute to a longer lasting result. Good luck!

Thank you for your question.

The most likely situation where there is an impression of recurrent laxity under the chin following a short scar facelift is related to the volume under the chin and sometimes to the platysma muscle bands. These aspects are not treated by the facelift intervention and require a neck lift intervention, commonly a deep plane neck lift intervention.

Although when lifting the cheek skin with your hands it appears that there is good correction of the contours of the neck, surgery does not have the effect of lifting the volume under the chin and it does not have the power to control the platysma bands either.

This is common when the neck has not been addressed as part of the initial surgery. One has to remember the neck is in continuity with the jawline. Usually if the neck is operated on at the same time with a platysmaplasty this will improve the result and prevent the issue of recurrent laxity as you say. Of course there are situations when the neck does not need to be corrected at the same time. This is why an accurate assessment is needed before the surgery and the correct plan made for the procedure

There was really no change in the way we do face and neck lifts based on SMAS concept in the past 20 years or longer.  A number of new procedures coming out with different names however, do not include SMAS concept which is a gold standard and provides best durability. Lower face/neck lift  involves tightening and rearranging anterior neck muscles, cleaning and reshaping fat deposits in the neck, along jawline (jowls) and lower and mid face lifting. This creates the longest lasting but it doesn't grantee lifelong result (average lift in our practice lasts 8-12 years). Neck is, unfortunately, the first where signs of aging reappear after surgery. Using remedies like radio frequency, ultrasound, thermal energy in addition to surgery may improve durability. A consultation with a board certified plastic surgeon with long experience and good reputation in facial rejuvenation and discussion about your goals and expectations is recommended. Good luck.

Key to a good neck lift is addressing the SMAS or platysma muscle. The muscle needs to be elevated and fixated with permanent stitches. Also positioning the neck properly during surgery allows for best possible results. Unfortunately some people swell after surgery and require additional procedures later. 90% of my cases do not require additional touch ups within two years. See a board certified ASAPS plastic surgeon ion consultation. Good luck....

In my practice a lower facelift includes treatment for the jowls, marionette lines and neck sagging/fat and platysma bands.To correctly treat the neck issues, the surgeon needs to address the;Platysma bands by repairing the muscles in the midline and pulling the outer edges outward.Neck fat above and below the platysma muscle needs to be treated and removed. Liposuction will removed some but not all of the extra superficial fat and none of the deep fat. Direct fat removal is the only way to adequately treat this issue.Excess neck skin is removed by pulling the skin outwardly.Many limited procedures do not directly address the deep fat and central platysma band repairs. In these cases, the neck will sag in 4-6 months

 Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  The reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance). Non smiling photos of your face from the front and side would help in the evaluation.  
 If you have "jowls”, in the lower face, these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  If the cheeks are flat or concave in the front, cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.  Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.
 This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, requires placement of drains, possible hair loss and months of recovery.  Results and how long they last are directly proportional and dependent of how the facelift is performed.
Hope this helps.