Stephan Baker MD, FACS
There might be some confusion these days among prospective patients, caused by claims made on social media, that one type of facelift might be better, more effective, or longer lasting. Confusion leads to anxiety and more confusion, which is not helpful. So, let’s focus on what matters when it comes to your face.
Most facelift patients care about safety and want to end up with an aesthetic and natural-looking result. They wish to look younger and refreshed but still like themselves - not pulled, not weird, not different, and certainly all with minimal or no unnecessary risk. How a surgeon proposes to accomplish this goal isn’t really their concern, it is the surgeon’s job and challenge. In aesthetics and plastic surgery there isn’t always one way of doing things. Different approaches and innovations are fundamental to progress. With years of training in plastic surgery and actual facelift experience, capable surgeons will evolve different, personalized techniques and nuances which work best in their hands and optimize their patients’ safety and aesthetic outcomes. Imposing one particular ‘technique’ on every patient isn’t sensible. Patients are different, anatomically, medically, and emotionally, and surgical techniques should allow for these variations.
It is worth noting that your result is created by your plastic surgeon, not a particular technique. Excellent surgeons generally create excellent results, and consistently, with whatever technique they have evolved and which has proven itself safe and effective in their hands. One particular ‘technique’ applied inappropriately or poorly by a less experienced or less skillful surgeon will not guarantee a happy result. Thus claiming one particular ‘technique’ to be superior to another is really more about marketing and self-promotion than the patient. With that in mind, let’s briefly review variations in facelifting. Facelifts started decades ago as a skin-only procedure, sometimes resulting in a pulled or ‘surgical’ appearance. Despite its potential shortcomings, it remains a reasonable option for certain patients.
History of Facelift Techniques
Anatomic face studies in the 1970’s revealed the presence of a strong support layer below the skin. The difficult to pronounce name given by anatomists to this layer was abbreviated as ‘SMAS.’ Plastic surgeons began to add this layer to their previous skin-only facelifts and learned that, when skillfully performed, this new SMAS lift did improve aesthetic outcomes and generally provided longer-lasting results when compared to most skin lifts. Why? Because the tension to lift the face was transferred from the skin to the deeper and stronger SMAS layer. The skin was thus allowed to re-assume its natural function to cover the face, not to lift and hold it up, which really is the job of the deep support (SMAS) layer.
“I do every procedure three times. I do it all in my head in advance. I do the actual surgery. I review it all from start to finish to look for ways to improve. This way, each procedure I do is my best work.”
In the late 80’s and early 90’s, some surgeons ventured below the SMAS and, while keeping the skin and SMAS together, lifted it as a single (or composite) unit. Though initially called a ‘composite lift,’ the name was soon simplified to the ‘deep plane lift.’ But this deeper layer, below the SMAS, is the territory of glands, the muscles of facial expression and their nerves. Careful evaluation and experience with the ‘deep plane lift’ by plastic surgeons, along with live, simultaneous comparison operations at scientific meetings of our principal plastic surgery societies (ASPS, ASAPS) unfortunately (or fortunately?) did not demonstrate better or more effective or longer lasting results, despite its potentially increased risks to sensitive deeper structures, which could result in months of patient distress. Most plastic surgeons, therefore, abandoned this technique a few decades ago.
Despite the ‘deep is dangerous’ concern by experienced plastic surgeons, the ‘deep plane lift’ of the 1990’s remains a technique that some surgeons may prefer and select for their patients. In recent years, however, graduates from ear, nose, and throat (ENT or Otolaryngology) training programs, self-designated as ‘facial plastic surgeons,’ have engaged in marketing campaigns, especially on social media, to resurrect the ‘deep plane lift,’ and claiming it to be superior with regard to result and longevity. Any claims of superiority of the ‘deep plane lift’ are simply opinions, not facts!
Returning to what matters to you, the patient. There is more than one way to get a good or excellent and long-lasting facelift result. Your plastic surgeon should be experienced and flexible in their approach to your anatomic uniqueness and select the appropriate technique they are most experienced and comfortable with to give you the result you seek, and in the safest way possible!
There is agreement that a modern facelift today should, in most patients, provide ‘deep support’ with tightening of the strong connective tissue (SMAS) layer in the cheek, along the jawline, as well as the superficial muscles of the neck (platysma). Yet it is equally important to mobilize and remove lax, sagging skin, particularly in the jowl and neck areas. The combination of ‘deep support’ and skin tightening, when skillfully performed, will provide a smooth jawline (the key feature of youth and beauty!) and a pleasing, refreshed appearance, and with the least amount of risk to deeper structures. The skill required to do so well will vary greatly among surgeons, so research and evaluate your prospective surgeon with care before entrusting your face.
Dr. Baker is certified by the American Board of Plastic Surgery, with decades of experience in facelifting, and is a Member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.
The care you deserveThe results you want
Dr. Baker offers an inimitable treatment experience with a highly personalized, precision-based approach. With extreme dedication, Dr. Baker takes the time to ensure that every detail of your treatment is designed uniquely for you with optimal safety, effectiveness, and compassion. Take the first step toward your best possible outcome by scheduling your in-office or virtual consultation with Dr. Baker today.
3850 Bird Road Suite 702, Miami, FL 33146