A facelift, or rhytidectomy, lifts and tightens the skin and deeper tissues of the face to create a more youthful and refreshed appearance. Historically, facelift techniques have focused primarily on lifting and tightening the skin alone. However, this approach often resulted in an unnatural, wind-swept look, and the lift effect had poor longevity, as the skin stretched. Modern facelift techniques have evolved significantly. Today, most contemporary methods involve a more comprehensive approach, combining skin redraping with the tightening and lifting of the SMAS layer (Superficial Musculoaponeurotic System). The SMAS is a connective tissue layer located beneath the skin and above the facial muscles. Lifting and repositioning the SMAS can produce more long-lasting, natural results by lifting and repositioning deep tissues that contribute to facial aging.
Dr. Goldman utilizes advanced two-layer or deep-plane facelift techniques, which involve both the SMAS layer and the skin to achieve a harmonious and youthful appearance. The choice of technique is personalized based on the individual patient's facial characteristics. For instance, a patient with a fuller, rounder face may require a different approach compared to someone with a thinner face. Dr. Goldman’s expertise ensures that each procedure is tailored to the unique anatomy and aesthetic goals of every patient to provide a natural but dramatic rejuvenation.
The term deep plane facelift has gained buzz on social media. Some surgeons will refer to any facelift that lifts the SMAS layer as a deep plane technique, but this is not entirely accurate. The deep plane technique refers to a specific method in which the SMAS layer is lifted further forward than older techniques, closer to the tissues that require elevation and repositioning. Dr. Goldman feels that this provides a more powerful yet more natural looking lift.
In Dr. Goldman's opinion, the best way to think about and discuss facial rejuvenation is by analyzing the factors that contribute to the appearance of aging in each patient (like eyelid droop, jowls, sun damage, the “waddle”) and then discussing the possible surgical and nonsurgical options to treat these concerns. Ask your surgeon to clarify the specifics about the procedures he or she uses: what type of facelift they use; how does that differ from other techniques; and what other procedures should be used in conjunction with the facelift to achieve the best results.
Dr. Goldman uses the deep plane facelift. This refers to a specific technique in which a connective tissue layer called the SMAS (superficial musculoaponeurotic system) is lifted to pull the neck, jaw-line, and mid-face upward and backward into a more youthful position. For this technique, the SMAS is addressed further forward in the face then with traditional facelift techniques. Most patients do like to know some of the specifics about the techniques used, especially in a situation where multiple variations exist. Patient education is a key component to the consultation process that helps you make better decisions for your care.
Different variations of the facelift procedure are used by different surgeons, and several terms are commonly used when referring to these procedures. However, these terms are not used consistently, and some terminology is now outdated as techniques continue to evolve. This is why Dr. Goldman favors more medically accurate, specific terms, as discussed below:
Most contemporary facelift techniques lift and redrape the SMAS layer, but different surgeons do this in different ways and are more or less aggressive about repositioning the SMAS. Lifting and redraping the SMAS has more long-term benefit for the face than just rearranging the skin. The SMAS connects to the platysma muscle in the neck (the muscle that forms vertical bands), so tightening the SMAS lifts and tightens the neck. The SMAS can be lifted more aggressively and with different vectors than the skin. When combined properly, use of different skin and SMAS vectors can produce a dramatic but natural looking facelift, unlike traditional techniques, which often produce a surgical, fake look.
Nomenclature can be confusing because of the multiple variations of the SMAS lift that can be performed. Dr. Goldman prefers the deep plane facelift, a form of the SMAS lift that he feels gives the most effective rejuvenation.
The deep plane facelift is a specific type of SMAS lift in which the SMAS layer is lifted further forward on the cheek than with traditional SMAS techniques, allowing a more direct lift of the deep tissues and platysma muscle. This can permit more dramatic tightening of the jawline and neck while still maintaining a natural appearance in most patients. Some lifting of the midface is can also achieved.
The term ‘deep plane facelift’ has gained recognition online, and therefore many surgeons are referring to their facelift techniques as deep plane facelifts. In some cases, these techniques are more closely related to other SMAS lift techniques that have not traditionally been referred to as the deep plane facelift. Patients should always feel comfortable asking their surgeon why he or she prefers a given technique for their facelift.
As with facelifts in general , there are multiple variations of the mini-facelift, which can be confusing for patients. Generally, mini-facelift techniques use shorter incisions and involve less dissection and less aggressive lifting than other facelift techniques. Some involve very limited tightening of the SMAS. Prospective patients who are considering a mini-facelift do have to be cautious and educate themselves because the term "mini" (whether it refers to facelift, tummy tucks, or other procedures) is often used as a marketing technique to imply a less involved procedure with less downtime and cost. However, in multiple studies and surveys mini-facelifts had lower satisfaction rates than regular facelifts.
Mini-lifts may actually look more surgical, distorted, or fake than full face lifts because they tend to pull the skin in unnatural vectors with more tension than regular facelifts, which can also leave thicker scarring, even if the scars are shorter. In Dr. Goldman's experience, most patients with early aging are good candidates for nonsurgical procedures, and patients with moderate or advanced aging get a more dramatic yet more natural result from facelift techniques, like the deep plane facelift.
Dr. Goldman does feel that there is a subset of patients with mild facial aging who may benefit from mini-lifts. Dr. Goldman most commonly uses the MACS (minimal access cranial suspension) lift as his preferred mini-lift technique. This technique involves less dissection and utilizes an innovative suturing method to tighten the SMAS layer, making it an ideal option for patients with early facial aging who want a surgical option. For suitable patients, mini-lifts, like the MACS lift, offer a less invasive and cost-effective alternative to more extensive procedures. While the results may not be as dramatic as a full facelift, mini-facelifts can provide significant improvement.
Thread lifts have actually been around for over 20 years. Sutures used to be permanent, but all companies have now switched to dissolvable sutures, because the permanent sutures would sometimes push their way through the skin, get infected, form nodules, or cause other problems. The threads have tiny fish hook-like projections that allow them to grasp tissue.
Despite being around for over 2 decades, thread lifts have remained a niche procedure. Thread lifts generally only last for a few months and can cause significant bruising since the threads have to be tunneled underneath the skin. They do not lift the SMAS layer; they pull on the skin, which will pull back down around the threads over time. Threads are therefore generally used as a temporary measure to enhance other nonsurgical procedures.
Threads are also used like fillers, but fillers can generally be injected with less downtime than with the subcutaneous tunneling required of the threads. Threads also tend to be used more by medical spas when surgical options are not available.
We invite you to experience the highest level of care available, with one of the most experienced, skillful, artistic, and compassionate teams anywhere, trained and led by Dr. Goldman, one of the few triple board certified facial plastic surgeons in America.
