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What does facelift mean anyway?

Posted July 12, 2016 in Surgical procedures, Facelift

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A frequent question in our office is, “What is the difference between a facelift and a necklift?”  The problem is that a facelift is a misnomer.  When we say facelift, this means that we will lift the muscles of the cheeks, jawline and neck.  We then delicately redrape the skin so that the appearance is natural and not pulled.  So, it should really be “lower face and neck lift”, but that just doesn’t have the same ring to it.

 

What about lifting “just the face”?

Yes, the muscles in the cheeks can be lifted to address the center of the face and the jowls to a certain extent without doing anything to the neck.  This is called an “upper facelift”, short-scar facelift, mini-lift, or MACs lift, among other names.  The incision goes in the sideburn, hidden in the ear cartilages and just around the back of the earlobe.  In the right patient, this can be very nice.  However, this does not adequately address the jawline and obviously does nothing for the neck and a smooth, defined jawline and lifted neck are big factors in having a youthful appearance.  As they say, “the neck can give you away”.

The next question is nearly always, “What about the forehead? Isn’t that part of a facelift?” A browlift lifts the forehead and brows to open the eyes.  This can be performed at the same time as the facelift, but does not have to be.  Not everyone’s brows descend with time.  The best person for this procedure is a woman with brows that are at the rim of the orbital bone and men that their brows are below the rim of the orbital bone and their eyes look heavy.  Also, this person should look at photos of them from 10-15 years prior to see if the brows have descended.  The incisions are all hidden in the scalp and with the right techniques gives a rested, natural appearance.

 

Back to the neck. 

There are so many techniques and combinations, almost every surgeon has their own way of doing a facelift and their own preferences. In our practice, we have found that we get the best results by performing liposuction, because even very skinny people have some fat under the chin with the face/neck lift.  There is a thin, flat muscle on either side of the neck called the Platysma.  These are attached to one another in most youthful necks.  With time, they separate and cause bands in the front of the neck.

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Photo courtesy of Russ Kridel, MD The Aging Face

We reapproximate the front edge of the platysmal muscles to recreate that anatomy and to give a hammock effect that creates a beautiful, smooth neck when lifted from the sides.  When you think about the surface area of the neck vs the cheeks this is the larger part of the procedure.  So, the neck takes the majority of the time.  So when people ask if you can have only a neck lift, technically you can and many surgeons do this on a regular basis.  My thought is that you have already done the larger part of the procedure and lifting the cheeks will give you the defined jawline that makes such a difference and the youthfulness of the face and neck will match.  You don’t get the jawline definition with lifting the neck alone and this adds several years to how long this procedure will last.    The biggest difference is that the incision is extended as described above for the upper facelift, but these are all hidden by hair and ear cartilages.  For me, the benefit that you gain in overall appearance and longevity of the procedure outweighs the concerns of not wanting to do too much.

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Before                                 After

 

 

Posted in: Surgical procedures