The term “facelift” means many different things. It’s like saying “car.” There are many types, varying in style, method, cost and results. You could have a Rolls Royce or a 20-year-old rusted Jeep. So, it’s important for patients to discuss fully with their plastic surgeon the exact surgery they will be undergoing so as to avoid misunderstandings later on.
A great deal of the confusion surrounding the term “facelift” comes from misinformation from the internet as well as cosmetic surgeons who are not board-certified plastic surgeons calling the operation by a wrong name.
The standard facelift, or rhytidectomy, as described in the plastic surgery textbook, involves three separate and distinct procedures. The procedures can be performed individually or in combinations of two, in which case they are called mini facelifts. The three areas addressed in the face surgery are the cheek lift, jowl lift and neck lift. These three are differentiated by the need to place incisions in different areas of the face to achieve the desired elevation on that particular area. For the cheek lift, the incisions are in the hair or at the hair line above the ears; for the jowl lift, the incisions are inside the ears; and for the neck lift, the incisions are behind the ears.
Once the incisions are made, there’s a whole other level of complexity! We are obviously lifting the face, but what exactly constitutes the face? A facelift almost always involves removal of some skin: a skin lift. Under the skin there are layers of fat, muscle and fascia (known as the SMAS), and I always lift these layers as well by putting in sutures that pull the fallen tissue back up to their normal position. Sometimes, some of these tissues are also removed. That is the way I do it. Others may do a deep tissue lift, where the whole of the face is removed from the patient’s facial bones and lifted to a higher position. Some just remove a little bit of skin and call that a facelift; mind you, they will still charge the same amount!
Lifting of the brow (forehead), blepharoplasty (eyelid surgery) and other procedures are distinct surgeries that can be performed at the same time as a facelift, but they are not part of one. By the same token, procedures that purport to lift the face with sutures and small incisions only in front of the ears are not a full facelift. I’ll talk about these lesser plastic surgery procedures another day.