Why do most doctors not do the composite lift? I mean deep plane, with fat repositioning under the eyes and lateral lift.

Question

I've seen pictures of people 20 years out and they still look great. You don't get a lateral sweep years later either. And why don't doctors make an effort to post pictures 8-10 years post facelift? Thank you to all you doctors who take time to answer questions.

Evan Ransom, MD, FACS · Answer

Thank you for the great question. Dissection below the SMAS increases the technical challenge of the procedure and the duration of the surgery, so many providers (and patients) are hesitant to take it on. In my practice, I use a deep-plane (a.k.a. composite) facelift technique in a great majority of cases. The advantages, in my opinion, are clear: 1) no lateral sweep or wind-blown appearance; 2) lifting the facial fat pads with the flap for cheek correction; 3) significantly lower hematoma rate. There continues to be some debate among specialists, but I feel that these points are true in the technique that I use. I do agree with some of the other answers here, however, that choosing the right provider is at least as important as the right technique. Best of luck in your search!

John Mesa, MD · Answer

There are many types of facelift techniques (skin only, SMAS, deep plane, composite, etc). The type of facelift that a surgeon performs usually is the one he or she learned during training. The most common type of facelift done these days is the SMASectomy or SMASplication facelift. Not to many surgeons perform a composite facelift because they didn't train on it and also because is a difficult one to do.In my practice I perform the malar fat pad facelift, which is a type of composite facelift that includes a cutaneous component, an SMAS component and the most important component: the elevation of the malar fat pad which gives a NATURAL look result to the facelift with a long lasting result.

Ercan Karacaoglu, MD, FEBOPRAS · Answer

Hello and thank you for this great question.  I am pretyy sure that you know other face lifting procedures like limited incision face lifting, skin only etc... Dissection under the SMAS ( a layer of thick deep face tissues just under the skin ) increases the technical challenge of the procedure. And it increases the duration of the surgery as well. In our hands it takes 5 hours.  The others take 3 hours. In my practice, I use a smas lifting technique with deep-plan facelift technique in a great majority of cases. I believe there are great advantages of this approach. Firstly the fake looking  effect of face lifting like wind-blown appearance does not seen with this deep plane tectechnique. This is important for some sort of aging face. Secondly, you have the advantage of lifting the fat pads over the cheek and chin bones with smas lifting techniques.  There is debate on this issue  among plastic surgeons, but my perspective is that these points are true and important in the techniques that I use. On the other hand  I am not against with some of the other answers here. Best

Kenneth D. Steinsapir, MD · Answer

Unforuntately what makes compelling anatomy for surgoens does not always translate into a natural serene facelift result.  These are very mechanical procedures that often result in very unnatural results.  They are often associated with an extreme appearance. Also due to the anatomic necessary for these radical procedures, they are associated with a significant rate of motor nerve injury (about 5%) even in the best of hands.  There is also very persistent swelling associated with these procedures.  In my expereince, there can also be unexpected fat atrophy with these procedures that contributes to a skeletonized appearance in some patient. The counter trend is small incision facelifts featuring more natural results.  Be careful what you look for and you might find it.

Miguel Delgado, MD · Answer

More important than the technique used is the experience of the surgeon. Each patient is different and the approach needs to be tailored to the patient. View before and after pictures of patients to get an idea of the surgeon's expertise. Many surgeon do have pictures 10 years later, although they can be harder to obtain when the patient doesn't return or moves out of the area. Good luck!

John L. Burns Jr., MD · Answer

I would recommend choosing the right doctor rather than a particular type of facelift.  In consultation make sure to review photos of their work and make sure you are comfortable with what they can deliver.  You will get a sense of their work in review their before and after photos.  The most aggressive technique in the wrong hands won't give you a better result.  Many of the world's most accomplished surgeons practice a very safe and highly reproducible result with minimal risk.

Trevor M. Born, MD · Answer

Dear VickielpThank you for your question and photos! The type of surgery a surgeon chooses should be tailored to the changes a patient needs .  The composite lift is a good procedure but has more risk. Having been in practice for 20 years- seeing the results at meetings - the best results I see are from surgeons who have the ability to shape the face - no matter the technique and have beautiful long lasting results. With photos - the difficult part is having a patient consent to having their photo posted on the WEB.  I really appreciate it when patients are willing to share their results!

Arnold Almonte, DO · Answer

Thank you for your thoughtful question. The composite lift, popularized by Dr Sam Hamra in Texas, is a unique technique because it simultaneously addresses multiple features on an aging face, such as the brow and lower eyelids, in addition to the cheeks, jowls and neck. The reality is that not everyone needs everything done all at once. In many cases, I believe surgeons (and patients) take a step by step approach, as many factors play into the decision of undergoing surgery. Regarding long term photos, follow up is a variable thing in plastic surgery, particularly cosmetic surgery. Patients move, change doctors, or don't return for any number of reasons. Furthermore, medical conditions change over time. But I do agree with your point. If it is possible and available, I think posting long term before and after photos would be a helpful thing.

Steven Wallach, MD · Answer

A good question. There are many different techniques out there each can be used for various anatomical differences, and each may create some differences in results.  When surgeons were polled at one of our national meetings, I have seen less then 1-2% raise their hands stating that they use it as the "go to" technique.  There are pros and cons of each technique, but it is not that popular. for various reasons.  Good, safe results can be obtained with many techniques.

William Portuese, MD · Answer

The deep plane lift has a higher complication rate. In our practice, we perform a high-SMAS composite face and neck lift . That does not create the lateral sweep . The goal is to remove fatty deposits above and below the platysma muscle in the neck, tighten loose facial and neck muscles including a platysma plasty, lift the jowls, and tighten loose facial and neck skin. It's important to perform this procedure to rejuvenate the face,  and to give patients a natural look. For many facelift before-and-after examples from our practice, please see the link and the video below

Why do most doctors not do the composite lift? I mean deep plane, with fat repositioning under the eyes and lateral lift.

Answers (15)

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