Lower Facelift with Vertical Skin-pull Vectors?

Is it at all possible to get a lower facelift without using a horizontal vector? Are there any lower facelifts that use non-horizontal/vertical vector for skin repositioning? I'm a bit terrified of having my lips elongated horizonatlly (as one plastic surgeon was kind enough to simulate for me)--please tell me there are other ways of going about this!

Doctor Answers 22

Lower Facelift with Vertical Skin-pull Vectors

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The move to vertical facelifting I believe has been one of the most significant technique advances to give patients a more natural, less visually "pulled" result. The use of vertical vectors is commonplace today, and various techniques on the facial and neck muscles  really focus on this issue. In my experience, one addition that has helped me gain the best results in the vertical pull direction has been the use of the new generation of  Quill  (Angiotech) suture to secure my SMAS after the deep plane pull. This new class of sutures provides a unique capacity to really distribute the tension in the vertical line over many small points of fixation. This distributed tension philosophy I believe is one of the most significant advances in facelifts over the past few years.

Phoenix Facial Plastic Surgeon

What's a facelift with a vertical vector?

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Some physicians use a vertical vertical vector when elevating the SMAS (muscle layer). By doing this, the correction of the jowls and neck laxity is maximized. I think the vertical vector can improve the face and neck in a much more powerful way than the horizontal vector. However, it does not mean that the horizontal vector will distort your face and lips. Any technique, if overdone, can create un-natural results. Consult with a surgeon that has experience with the facelift procedure.

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 123 reviews

It is possible to do this

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Dear Youngrace,

What you are describing is exactly what I try to achieve in what I call a "cheek and neck lift" procedure. In my procedure, the deep tissues are repositioned directly vertically and the skin is gently removed along natural vectors but with no tension that would distort the mouth. A direct vertical pull on the skin will create other distortions even if it doesn't distort the mouth.

Vertical Vector Mini Facelifts result in a natural appearance

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Simply put, the answer is yes - there are facelifts and mini-facelifts that focus on a vertical vector to give you a natural appearance. The  ones that come to my mind most readily are the MACS (minimal access cranial suspension) and LiteLift procedures.

I think your reasoning is right on. To turn the clock backwards to an result that mimics the way you once looked, i.e. a real and natural appearance by necessity has to be in an anti-gravity vector. That is, in an upward, vertical, manner. After all gravity and loss of elasticity of skin (elastosis) is downward so it makes sense to redrape opposite of this direction. In contrast horizontal or oblique pulls if overdone can cause an unnatural or "swept away" or "wind tunnel" that most are all too aware of. 

Natural look with plastic surgery

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The numbers of available facelift procedures are daunting. The technical translation from a verbal description of "what procedure a doctor does" to the final result is literally all over the board. Two doctors using the exact same theoretical technique will have very different results.

More important than the type of procedure used are the reputation of the facelift specialist and the results.

By now you have apparently had many consultations. No doubt you have narrowed your search to board certified plastic surgeons with considerable experience with facelift surgery. You have probably narrowed it down further to doctors with exceptional credentials and a personable manner.

At this point, there is a simpler way to choose a surgeon. By simply looking at all the before and after pictures, you can look for the natural appearance of the postoperative patients that you desire. You can see for yourself if the ears appear natural, or if they are pulled or are covered up by large earrings. You can check the hairline and see if it has been greatly altered (i.e. sideburn gone), or is intact. You can see the mouth and judge if it is pulled or relaxed.

If you try to educate yourself on every facelift technique, and then decide which doctor can actually implement in practice what you have discussed in theory, you can see that your task will be nearly impossible.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Vector of pull with Lower Facelift

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The typical vector of pull I use is superior/oblique. I have not seen the mouth pulled in an unusual way, though there is very nice improvement of the lines around the mouth. Incision is around the ears and well hidden!
Best of luck!

Michele A. Shermak, MD
Baltimore Plastic Surgeon
4.8 out of 5 stars 57 reviews

Vertical Vector Facelift

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Thank you for the fantastic question. Yes, this is not only possible but is the best way to achieve natural-appearing results. A vertical-vector facelift involves some changes in the incision placement and deep suturing, to orient the lift in the direction of gravity (vertical!). In my practice, I use a deep-plane facelift technique to vertically lift the lower face, neck, and midface together -- in fact, I've written a paper or two about it!. This allows me to get a great lift while avoiding the pulled or stretched look associated with a more horizontal "lift." Best of luck moving forward!

Lower facelift using a vertical vector

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In our practice we use a mostly vertical vector on the skin in front of the ear, and a partial vertical/ partial horizontal vector for the skin behind the ear. This allows for maximum re-draping of the skin after the muscles and SMAS have been tightened. A purely vertical lift or a purely horizontal lift will not leave you with a natural result.  For many examples, please see the link below to our facelift  photo Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Vertical Vector for Lower Facelift

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Yes, a necklift can be achieved with vertical lifting.  In fact, this approach is the basis for one of the more recent trends in facelifting surgery, the short-scar facelift.  The neck  and lower face muscles, fat, and skin are lifted much more vertically, thus avoiding a long incision behind the ears.  Often, some limited liposuction or muscle tightening might be added just below the chin through a small incision there.  However, be aware that if someone has a lot of loose neck skin, loose in a horizontal direction, then a more traditional lower facelift with tightening of neck skin behind the ears would be indicated to get the best result.  Generally speaking, the short scar techniques with more vertical lifting are more appropriate for younger patients with less skin looseness.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Face Lift Vectors and the Different Planes

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When you are discussing facial rejuvenation, you have to consider the different levels of the face, which can simply be divided into:

  • Skin
  • Everything below the skin (fat, fascia, muscles)

     With early facial aging, some patients do not have significant skin excess, and just repositioning of the deeper tissues will give them a rejuvenated look.  For these patients, the “minimal incision” procedures are appropriate.  For those with slightly more laxity, a skin resurfacing / tightening procedure may be appropriate to address the surface issues.  In patients with significant skin excess, skin needs to be removed, and the more traditional face lift incisions around the ear are necessary.
     As far as what happens below the surface, that part will be customized to the individual patient.  If the eyelid / cheek junction is very noticeable / hollow and a deep nasolabial fold is present, a mid-face procedure (or advanced lower blepharoplasty) is indicated.  If the problem is sub-malar hollowing, jowls, and marionette lines, some type of SMAS procedure is indicated.  If the neck muscles are divided or the neck obtuse, a platysmaplasty is indicated.  You need to visit a surgeon comfortable with all aspects of facial rejuvenation and discuss your individual goals as far as what you want to achieve. 
Best regards,

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.