Facelifts - Beyond Techniques
A prospective facelift patient researching options these days is likely to encounter some confusion, given today's abundance of enticing advertising on Instagram and other social media platforms. Claims are made about the superiority of one "technique" versus another, including a re-marketed technique originally conceived (and relegated) decades ago, the "deep plane" of the 80's and 90's.
It is true that a facelift can be performed in more than one way - as a skin lift, a SMAS lift (with its own permutations of a "high," "low," or "extended" version), a "deep plane," or yet deeper, as a "subperiosteal" lift (at the level of the facial bones). And that's not all. This is not just confusing for patients but also for surgeons.
So, what to do? First, don't believe everything you hear or watch on Instagram. Remain critical. Your result will be produced by your plastic surgeon, not a named "technique." That result will be the outcome of your surgeon's artistic abilities (which vary considerably) and their actual experience, utilizing a combination of techniques that, over time, have proven safe and effective in their hands. Different surgeons may well use different techniques. Good, excellent surgeons usually produce solid results and do so consistently.
What's actually important in a facelift? First, it needs to be safe - medically and aesthetically. You want to emerge healthy and looking normal since you can't hide your face (at least without a mask). Safety starts with medically screening patients for appropriate health and performing the procedure in a safe environment (accredited surgical facility, such as an Ambulatory Surgery Center) under the care of a board-certified anesthesiologist with a judicious combo of local and sleep anesthesia. Obviously, having a safe surgeon is as critical as having a safe pilot for a flight. Additionally, attentive after-surgery care matters.
Aesthetically, the techniques selected depend on a patient's anatomy and nuances. That's up to the plastic surgeon, and there is no substitute for the surgeon's experience and craftsmanship. What's important to accomplish during surgery is to re-tighten the support layer below the skin and adequately mobilize and redrape the overlying skin after removing its excess. This needs to be done with a delicate touch (to minimize bruising and swelling) while staying away from sensitive, deeper-situated facial nerves, which, if injured, can induce obvious deformities. A "deep is dangerous" awareness is a useful thought to keep in mind throughout the procedure.
Key areas to address are the neck and jowls and often the upper eyelids. Many patients do not need a brow or lip lift. Some volume addition, as well as Botox, can be helpful. A general "less is more" attitude is wise if you wish to remain looking like yourself.
In summary, facelifts are safe and highly effective procedures, providing unparalleled rejuvenation when expertly performed. Surgically, they are time-intensive and demanding to perform, requiring prolonged and nonstop attention to numerous details. A good facelift looks normal and natural, like yourself, while leaving the observer wondering why you look good. The not-so-good ones are pretty easy to spot, and you may have seen some.
As always, research and reflect carefully before proceeding. The "American Board of Plastic Surgery" has been certifying plastic surgeons since 1937, and looking to see if your surgeon is board-certified is a good starting point. Ask pointed questions, review the results of previous work, and ask around. Solid reputations take time to build.
