Facelift
A facelift is a surgery that can help your face look younger and smoother. Facelift surgery is often done simultaneously with other procedures such as a neck lift to address sagging of the neck or double chin, facial fat grafting to restore volume, and laser skin resurfacing to address skin changes. As we age, several changes occur in the face and neck: the facial bones shrink, the fat of our face shrinks, connective tissue stretches and loosens, and our skin begins to get fine lines, wrinkles, and pigmentation changes. Best results come when all of these components of facial aging are addressed.
What Is the SMAS?
The SMAS (Superficial Muscular Aponeurotic System) is an important layer of tissue in the face and neck composed of the muscles of facial expression and their supportive tissues. As people age, the SMAS stretches and sags, resulting heavy cheeks, deep nasolabial folds, and jowles. Effective facelifts work on this layer because mobilizing and lifting the SMAS—rather than only tightening the skin—creates results that look more natural and that last longer. You can think of the SMAS as the “support layer” that keeps the face in the right shape.
What is a Deep Plane Facelift?
A deep plane facelift works on the deepest layers of the face, underneath the SMAS. The deep plane facelift is Dr. Poppler’s preferred facelift technique. In this surgery, Dr. Poppler lifts the skin, fat pads, and muscles together as one unit. Going beneath the SMAS allows Dr. Poppler to release the retaining ligaments that prevent movement of the SMAS, making this a much more powerful technique than alternate facelifts that do not go into this plane. The deep plane also preserves connections of the skin with the deeper tissues, which decreases facial distortion and the chance of some common facial complications. This method can give very natural, long-lasting results. It is especially good for people with sagging cheeks, deep folds, or a heavy neck.
There are many ways to perform a deep plane facelift and choosing an experienced, board-certified plastic surgeon is important. Using the deep plane gives Dr. Poppler the option to place the stretched out, redundant tissues of your face in places that are hollow or need more volume (like a permanent, natural filler). Dr. Poppler chooses the point where he places your scars, where he enters the deep plane, and where he places the redundant tissues that he has moved based on your unique needs. For this reason, he will ask you to bring in photos of yourself at younger ages so that you and he can compare those side by side with your current photos and make a plan together to restore your unique youthful appearance and not make you look “done.”
Are There Other Types of Facelifts?
Yes, there are many ways to do a facelift. Many techniques have been described to minimize scars or to avoid going beneath the SMAS. Non- deep plane facelifts generally try to tighten the SMAS from above. These techniques can be effective, especially in patients with less prominent signs of facial aging. However, these techniques have important limitations including not being able to release the deep ligaments that limit movement of the SMAS and not being able to control where you place the redundant tissues that are moved.
Incisions and Scars
The incisions are hidden around the ears. One goes in front of the ear, one curves around the bottom, and another may go behind the ear into the hairline. Sometimes a small cut is made under the chin. After healing, these scars usually blend in very well.
Possible Complications
Swelling and bruising are common at first. Temporary numbness can happen as nerves heal. Rare risks include infection, bleeding under the skin, or temporary problems with facial movement. Following your surgeon’s instructions—such as avoiding smoking, sleeping with the head elevated, and attending follow-up visits—helps prevent problems.
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