Would I benefit from an en-bloc facelift?

Question

With initial signs of facial ageing I am considering a facelift with the main focus on improvement of jowls and marionette lines. I came across a facelift technique - en-block, which the provider explains implies the the skin and the underlying SMAS layer remaining attached to each other - the skin then automatically goes with the deeper firm layer - and they are lifted as a whole. I understand that for the optimal results the skin needs to be stitches with zero tension.

Mitchell Hagen, MD · Answer

Hello and thank you for this question! I believe what you are referring to is a deep plane facelift. This technique allows the skin to stay attached to the the layer directly beneath it, called the SMAS or platysma muscle. This technique allows dissection under SMAS/platysma to correct midface descent, jowls, and neck laxity. By doing this, the layer of tension is not on the skin and the skin can be closed without tension to prevent noticeable scars. This technique also allows more vertical elevation of the areas that have descended. This provides a more natural result and prevents a "pulled" appearance that every patient is afraid of. This terminology is complicated and difficult to sift through for patients researching online with contradictory information and confusing marketing. I always suggest consulting in person or virtually with several surgeons until you find one you feel confident can provide the results you are hoping to achieve. Good luck out there!

John Michael Thomassen, MD · Answer

This sound like a deep plane facelift and I do recommend it for issues with lines around the mouth and jowl area as it pulls the tissue closer to the area of concern.  I agree that less tension on the skin results in improved scars.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting this question .When it comes to facelifts, there are multiple ways of performing such procedures, some examples include (MACS, ponytail, skin only, SMAS plication, Dual plane/high SMAS, and en-bloc (which some people label as deep-plane (but it's not the only procedure that involves the deep plane).The choice of surgery will depend on your situation and what your surgeon is comfortable with for example if there are any concerns about blood supply to the skin , a surgeon might choose the enbloc method as it preserves more blood supply to the skin, or if the surgeon feels that he needs to pull the skin and the SMAS in different vectors he might opt for a dual plane. There are many other reasons to choose one way over the other and tailoring the procedure to your need. Ultimately whichever method your surgeon picks maintaining no tension on the skin is something that should be respected across the board and I am sure your surgeon will be happy to discuss their reasoning with you further.Good luck in your upcoming surgery!

Jeffrey M. Darrow, MD · Answer

It is generally agreed upon that the deeper SMAS layer should be elevated and moved in a superior posterior direction, parallel to zygomatic major muscle and perpendicular to the nasolabial fold in order to contour the neck plus straighten and smooth the jawline and optimize the facial shape.  The skin should be moved in a more posterior direction, parallel to the jawline.  This bi-directional movement of the two different layers, gives the optimal result.   Best wishes.

Michael Zacharia, MBBS, FRACS, FAAFPS · Answer

En-bloc, aka deep plane face lift, is an advanced technique which involves releasing key facial ligaments then lifting the SMAS with the overlying skin firmly attached on it. It effectively addresses the midface and lower face without creating excessive tension on the skin therefore achieving a longer-lasting natural result.

Lexie Wang, MD · Answer

This is the same thing as a deep plane facelift. I remain impressed by the number of cute names people come up with for the same procedure. Anyway, it's hard to know if you would benefit from it without photos but if you are considering a lift procedure, this is currently the major workhorse type of surgery most surgeons do.

Ajaya Kashyap, MD · Answer

Thank you for your query.  It is difficult to say without photographs but an en-bloc facelift works well for people who show initial signs of skin aging, as you have stated.,  It can be done under local anesthesia.  The recovery is also short and this may be a good option for you. Please find an experienced board certified Plastic surgeon who can examine you and help you with all your concerns.

Jacob Tower, MD · Answer

Hello, hope you are well. This is an interesting question! Primarily because the 'en bloc' terminology is not widely used among facelift surgeons (at least here in the United States). Virtually all modern facelift procedures utilize the SMAS more or less in the way that you describe. There are many variations, but unless it is a 'skin only' lift, the SMAS is generally being used to support the lift. My advice is generally to focus less on the surgical technique and more on the results that your prospective surgeon can demonstrate.

Best,
Dr. Tower

Best,
Dr. Tower

Sean Fisher, MD · Answer

I encourage patients to find a surgeon that they feel comfortable with who can demonstrate results are in line with what you are looking for. There are a number of facelifting techniques, many of which can give exceptional results when performed by an experienced surgeon. There is not a single technique that will provide superior results over another. The vast majority of face lift surgeons will tighten the underlying SMAS layer in some manner to help re-elevate descended tissues. This is the key to a good facelift, as it allows for movement of deeper tissues without relying on pulling the skin layer too tight.

Would I benefit from an en-bloc facelift?

Answers (9)