The best type of facelift for facial aging is one that produces consistently good results. Usually a SMAS lift where the muscle is tightened as well as excess skin removed produces better results. Choose a surgeon who is very experienced and consistently does natural looking faces for the best results. Do not rely on imagery.
Part of the artistry of facelift surgery is creating surgical scars that are minimally visible or even invisible, while avoiding distortion of the normal anatomy around the ears. Incision placement and ultimate scar location in front of and above the ears is a critically important part of achieving an aesthetically ideal and natural-appearing result. The decision regarding placement of the temple-area scar above the ears should be based on the amount of upper / lateral cheek skin that is expected to be removed. If there is fairly minor skin laxity and minimal skin excess in this area, then the scar can be placed behind the temporal hairline (well behind the sideburns). If there is not much skin excess to advance in a superior/lateral direction, then the sideburns will not be rotated to any significant degree laterally (towards the ear) and will be preserved. If, however, an incision is made behind the temporal hairline and there is significant skin laxity and excess that must be removed, then the sideburns may have to be removed as part of the skin excess anterior to the ear. This produces a permanently disfiguring facelift result. An obvious and unmistakable sign of a bad facelift is the missing sideburn. In order to avoid a ‘sideburn-ectomy’ in a patient with significant facial skin laxity, the incision should be placed along the temporal hairline to avoid rotating the sideburns posteriorly and removing them along with the skin excess. The removal of skin excess is performed anterior to the sideburns (as well as in front of and behind the ears) so that the position and pattern of the sideburns remain unaltered. A number of ‘finesse’ techniques allow the creation of surgical scars along the borders of the sideburns that are essentially invisible in most patients. In the MACS lift, little to no skin elevation and redraping are done behind the ear – the surgeon attempts to remove all skin excess in front of the ear and at the sideburn. This frequently leaves significant skin contour irregularity around the sideburns and tends to produce more noticeable sideburn-area scars. Look closely at this area when reviewing a surgeon’s photos if they are recommending a MACS lift to you. Also carefully evaluate the neck and the area below the ears, as MACS lifts do not redrape excess lower face and neck skin behind the ear and therefore frequently leave contour irregularities here as well. The decision regarding incision placement requires careful preoperative evaluation and a great deal of experience with facelift surgery. In general, younger patients with less skin laxity are good candidates for incisions placed behind the temporal hairline, while older patients with greater skin laxity are often best served by incisions along the temporal hairline that preserve the sideburns. How ‘significant’ the facial skin laxity is, and to what degree the sideburns might be rotated posteriorly with an incision placed behind the temporal hairline, is an important judgment call each surgeon must make for every facelift surgery patient. It truly is part of the artistry of facelift procedures. Make sure that you seek treatment from a board-certified plastic surgeon with experience in this area and who can show you a large number of ‘before and after’ photographs which demonstrate natural-appearing and aesthetically desirable results, particularly in terms of sideburn preservation, minimally noticeable to invisible surgical scars, a lack of distortion of ear shape and position, and smooth skin contours in the anterior and lateral neck.
