Lower Facelift with Vertical Skin-pull Vectors?

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.

When performed properly, face and neck lifts should lift the tissues in a vector that is both vertical and horizontal. As we age, most of the facial soft tissues tend to drift inferiorly (toward the feet) and medially (toward the midline of the face). Both of these directions need to be addressed in order to achieve the best result. Keep in mind that what you or your surgeon may simulate by pulling on the cheeks or neck might not be an accurate representation of what surgery will do. Be sure to look at face or neck lift before and after photos to see if you like that surgeon's results, as these are the best representation of what you might be able to expect for yourself. In some cases, computer simulations might also be helpful, and this is something I routinely provide for my patients at no charge. 
Be sure to see a surgeon who specializes in facial aesthetic procedures.
All the best,

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!

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!

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.

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.

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. 

The horizontal pull on the lips that you saw during your consultation with your plastic surgeon should not happen as a result of a well performed facelift.  When facelifts are simulated by tugging on the lateral cheeks and jowls during consultation lip pulling occurs because the pull is primarily on the skin and not underlying tissues.  The reveres is true in surgery where usually much more tightening is done of the  underlying tissue and generally the mouth or lips themselves are not pulled at all.   Facelift surgery rarely extends to the area of the modiolus (lateral attachement of the mouth/ lips) and should not effect this area negatively. 

Generally speaking, the vector of pull for a Facelift in the mid face and jowl region should be vertical.  The width of the mouth should not be elongated or widened.  I recommend that you see an experienced Facelift Surgeon, see examples of his work, and possibly speak to some of his patients.  The "overdone" look is completely avoidable.

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.