Deep Plane Midface Lift vs Suture Suspension?

What would you recommend?

1) suture suspension midface lift

2) the deep plane mid face lift?

Is the deep plane mid face lift really better? I have to make a decision soon between the two procedures and don't know which one to chose.

I am a 53, female. I have strong nasal folds and my lip corners now go downwards. I didn't have that when I was younger. My lower face looks fine as I had a good mini lower face lift last year. Please inform me about your experiences and I thank in advance.

Doctor Answers 20

Deep plane or sutures

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I really do not like either of these techniques.The deep plane dissection is much more time consuming and I believe that over the years comparisons of patients do not show a significant difference in long term results. Operating deep in the face puts other deep structures such as the branches of the facial nerve at risk. I believe that the standard  subcutaneous facelift with SMAS plication produces excellent results that will stand the test of time and I sleep better at night.  Extending the facial dissection under the nasolabial creases helps but I have had patients with such deep creases that I just cut them out and traded the crease for a scar line.Suture suspensions never seem to last as they break, cut throught the tissues over a short time, i.e. the cheese wire knife phenomenon,  or can bee seen and/or felt. There are other procedures to turn the corners of the mouth up. Nasolabial creases are natural facial creases that plastic surgeons have struggled with since the beginning of time.   

Which Facelift technique is Best?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is no one facelift technique that is necessarily the best in every circumstance.  Each technique as its advantages and disadvantages. Each technique has its proponents and detractors.

Each face is unique and a good surgeon will choose the technique or variation to give the best result.

It is more than reasonable to ask your surgeon what technique he/she will use for your procedure and why he/she thinks that best for you.

Beware: it is safe to bet that you'll get different answers from different surgeons! There probably is no one right or best answer!

Results of any operation depend almost exclusively on the surgeon

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I wouldn't hitch my wagon to any one hot or popular technique.  A good surgeon will strive for the best result for a given patient through the best approach.  A poorly executed "best way of doing it" operation will be disappointing.  Go to a good surgeon and he will explain what his going to do, why he is doing it that way, and how you will look when he is through.  Oops, your doctor could be a "she". 

Deep planes have traditionally been found to last the longest among facelifts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The suture suspension lift most likely refers to a midface lift, and there are many ways to do this. You can do it in a minimally invasive way through incisions in the scalp by the temple area. All is needed are very tiny incision near your nasolabial folds to allow the sutures to pull up the middle part of the face. Data on how long this lasts is not sufficient. Most surgeons believe that effect is not as long lasting as other procedures.

A midface lift that is done traditionally can be done through incisions in the lower eyelid. This requires the middle part of the face to be released from the bone and then suspended to more superior structures. This can help the nasolabial folds and elevate the midface cheek fat. The results from this, in my opinion, are modest. The reason for this is that the midface issue is really mostly a problem of volume.

Fat injections placed in the midface is a good option but not entirely perfect. Implants can give the sufficient volume that is needed to replace what is lost in the midface area. But you have to feel comfortable with implants in your face.

The deep plane smas lift is very difficult to do and if you go to someone that doesn't have a lot of experience with this it could be dangerous. When done correctly, you can get a lot of release and pull on the nasolabial fold area and this can lift the midface in a more lateral and superior direction then just superior. Most surgeons believe that the deep plane facelift will last longer than any suture only facelift 2-5 vs 8-10 year or more respectively for the suture lifts vs the deep plane. These numbers are a pure estimation though but are somewhat supported by scientific review.

Philip Young, MD
Bellevue Facial Plastic Surgeon

It's all about the timing...

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is my theory that the right procedure at the right time will give the best possible outcome with the optimal lasting power. For example. If you are young and have just experienced a drastic weight loss then a treatment to tighten up the jaw line may be reasonable; however, that same technique will not be substantial enough for elder skin that is much less supportive.

A SMAS "style" facelift should last between 8-10 years successfully! A neck lift or mini facelift is not supported in the same fashion and therefore the results begin to deteriorate about 3 years out. So in my opinion, it is best to address the problem of time and gravity with the appropriate technique. Because not all 50 year old skin is the same or ages the same, it is absolutely necessary to make adjustments. Every facelift I perform is, in some way, customized to the individual receiving it. The proper facelift will age gracefully, with you; a rapid change or deterioration of the procedure may indicate that you didn't get the optimal procedure for your timing.

Best wishes to you.

You have a good doctor!

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your doctor has taken good care of you based on my reading of your letter to Dr. Gross. Please understand that NO surgical procedure will eradicate the nasolabial folds and that improving your jawline and neck was a safe and effective rejuvenation for you. The problem with midface lifting is that the results are subtle and hard to see in photographs and the procedures are fraught with complications the more aggressively the midface is approached. There isn't an answer to whether suture suspension or deep plane techniques are better because it depends on the patient, their tissues, and the experience of the surgeon.

In general, it is best to stay as simple as possible in the midface region. The last thing you want is a lower lid malposition problem that is very hard to fix!

They may be both appropriate

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Unfortunatley it is difficult to give a general answer for all patients for this question.

The surgical plan is developed uniquely for each patient and depends on their unique anatomy, skin, volume, underlying bony support, as well as each patients goals and time for recovery.

That said i am not a fan of procedures that rely only on "threads" or sutures to do all the "work" of rejuvenation. There are typically just too many things going on to get a good result with only suture suspension. Many times when an "open' procedure sutures are used internally as part of the procedure.

John E. Gross, MD
Los Angeles Plastic Surgeon

Deep plane facelifts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There is no evidence that a deep plane lift or mid face lift really create a better result.  The deep plane lift, however, can place the facial nerve at risk of injury without a worthwhile benefit.  Also some surgeons charge additionally for the mid face lift whereas I think it does very little.

Deep plane vs suture suspension

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Surgeon techniques differ, as do results, bedside manner, and experience That said, look for someone who is board certified in plastic surgery; meet with a PS and find someone with whom you are comfortable. Please don't get lost in the specifics of a procedure. Many of my colleagues cannot agree on a specific way to address issues. Your interest should be the final result. How you get there is the partnership between you and your plastic surgeon.

Midface Lift Works Much Better

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

As the originator of the SOOF lift blepharoplasty I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic. As far as improving the nasolabial fold a SOOF lift by itself will help minimally. Most of my patients that have midface laxity have laxity elsewhere and have a deep plane minituck or facelift. I would recommend you avoid endotine lifts in the midface and/or "thread lifts" as in my experience neither is very helpful in the long run. To lift the midface solely a malar pad lift is done in my office with good results. It can be done under local. Occasionally a cheek implant is also helpful depending on the patient and pertinent anatomy. Seek a facial specialist and get two to three opinions, look at the doctor’s photos and you'll do alright in most cases.

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

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.