Facelift Procedure From Dr. Moulton-Barrett

The youthful face is essentially heart shaped and suspended on a pretzel-thin neck. In contrast, the aging face becomes rectangular and the aging neck becomes bulky and folded. Why is this? It is in fact a combination of fat atrophy with a gradual laxity of the skin, fat, muscle and their ligaments, particularly in the temporal region, then in the mid cheek area and finally in the peri-orbital, peri-oral and jowl region.  The temporal hollowing and descended cheek with jowls creates this rectangular pattern. The aging neck is characterized by a bow-stringing of the underlying suspending platysma muscle and an accumulation of fat in the midline under the muscle and over the muscle. Heredity, personal habits, smoking history, the pull of gravity and sun exposure all contribute to the aging face. Dr. Rex Moulton-Barrett offers facelift surgery in Alameda and Brentwood to help women and men correct signs of facial aging for a naturally more youthful appearance.

To meet with Dr. Rex Moulton-Barrett and find out how a facelift can improve your appearance, request a consultation using our online form.

What is involved in a facelift?

A facelift, otherwise known as a rhytidectomy is used to restore a more youthful appearance of the face and neck.  Based on the above changes noted to the aging face, it follows that are 5 components to a successful rhytidectomy: removal of excess and lax facial skin, tightening of underlying muscular support, release of ligaments ( which create hollows in the presence of fallen soft tissues ), suspension the facial fatty tissues and removal of neck fat with tightening and re-suspension of the platysma musculature. The results may be subtle or dramatic, depending on your appearance prior to the surgery and your desired outcome.

The duration of a facelift is between three to six hours of anesthesia, depending on the extent of surgery: with or without brow lift, eyelid surgery or additional procedures.  Several types of facelift surgery procedures are available, including the standard facelift, deep plane, lower facelift, mid facelift, mini facelift, and thread lift.  These procedures are described below.

Standard Facelift

This is a term that is interchangeable with traditional facelift. It points out the fact that the SMAS is lifted and distinguishes this from the deep plane facelift. For patients interested in both cheek elevation and tightening of the neck and jowls, a standard facelift may be more appropriate.  In the standard facelift, an incision is made in front of the ear extending up into the hairline.  The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck.  After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck.  At this point, the deeper tissues can be tightened with sutures, with or without removing some of the excess deeper tissues.  The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon.  The excess skin is then removed, and the skin incisions are closed with sutures and staples.

Deep Plane Facelift

The deep-plane facelift is an advancement of the traditional SMAS facelift in the quest of improved mid-face rejuvenation and a more natural appearance. As the name implies, a deeper plane of surgical dissection is entered within the mid-face and lower face region before the muscles are lifted. The incision line is similar to the traditional facelift. During a deep plane facelift, the SMAS layer is separated off the underlying deeper structures (i.e. chewing muscles, facial nerve etc.). Advocates of this procedure point to a “natural” plane of dissection with decreased blood vessels and an improved rejuvenation of the droopy mid-face. Plastic surgeons using the traditional facelift technique are sometimes doubtful of a significant outcome advantage and point out higher technical intricacy and an increased risk for nerve injury with the deep plane facelift procedure.

Temporal Facelift

There is not a universally acknowledged definition for temporal facelift. Most specialists use this procedure to give the brows a lift without having to do an entire browlift. Usually, the sides of the brows can be lifted by adjusting the facelift procedure and its incision accordingly. The temporal facelift is therefore a beneficial procedure for patients, who also have droopy eyebrow sides which often creates additional eyelid hooding. Some facial cosmetic surgeons may only perform a partial upper facelift without incorporating the neck for patients that have a youthful neck but are looking for an upper and mid-face improvement.

Sub-Periosteal Lift

After the advanced technique of the deep plane facelift has become popular with some cosmetic surgeons, others searched for an even deeper layer of tissue dissection in the quest for optimal results. “Subperiosteal” means right on top of the facial bones and this is therefore as deep as it gets. This technique is a continuation of the midface lift. In general, only few surgeons apply the technique of the subperiosteal facelift. Reasons for this may include the technical difficulty of this facelift technique, its prolonged swelling after the procedure and the unanswered question whether the final result is superior.

Neck Lift

A necklift can be considered a partial facelift where the aging neck is rejuvenated. Therefore, the incision is usually significantly shorter and is limited to the earlobe and in the back of the ear. Commonly, a platysmaplasty is performed and fat is removed from the neck region by means of neck liposuction. Although not as much as in complete face and neck lifts, the jowls often improve hereby providing the patient with a cleaner jaw-line. Aside from focusing one’s efforts on the neck as the particular region of concern, a patient can commonly return sooner to his or her professional and social activities; after a neck lift, the initial post-operative signs can be easier camouflaged by using scarves and turtle necks in addition to make-up.

Platysmaplasty & Liposuction of the Neck

Thread Facelift

A thread facelift is a convenient, less invasive alternative to traditional facelifts, designed for people experiencing early signs of aging, such as minor facial sagging.  The best candidates for a thread facelift are in their 30s to 60s and have relatively good skin tone.  Most are beginning to experience sagging in their face or neck but do not have excessively loose skin or drooping facial areas that might require more rigorous facelift surgery.  This facelift procedure can be performed in just one or two hours, often without anesthesia.  During a thread facelift, the cosmetic surgeon inserts thin threads into the face through tiny incisions made in the targeted area.  These threads attach to the skin tissue and are then pulled back to lift and smooth the face.  Almost immediately, treated areas will be raised slightly, eliminating sagging and giving patients a rejuvenated appearance.  Because patients usually remain fully conscious during the procedure, they can approve the look of their thread lift while the surgeon works.  Once the threads are knotted, they become hidden within the skin itself, and any scarring that results will be virtually invisible. Various branded and self-made sutures are available (i.e. Contour, APTOS, Silhouette etc.). These sutures differ in how they hook into the facial tissues (barbed fish-hook like teeth, knots etc.). The longevity of these sutures is not known. Improvements may request re-tightening procedures after 4 to 9 months. Many plastic surgeons are not offering the thread lift to their patients anymore for this reason. 

Lifestyle Lift

The so-called “Lifestyle Lift” is a proprietary term used by a consortium of otolarygologists for a facelift.  Don’t be deceived that this procedure is any more effective or less risky than any other facelift procedure.  Facial plastic surgeons performing this procedure apply a modification of the traditional facelift to allow that the lifestyle lift can be performed in approximately one hour under local anesthesia. Commonly, neck liposuction is performed as well. The incision is usually significantly shorter than that of a full facelift and the recovery time is shorter. Plastic surgeons performing the Lifestyle Lift commonly perform a large number of these procedures and therefore become extremely proficient with it. Because it is a less extensive and less invasive procedure, the results are likely not quite as dramatic as with full facelift. Therefore, the Lifestyle Lift may be best suited for younger people in their 40s and 50s who are not interested in the larger facelift procedures (i.e., traditional facelift, deep plane facelift). For more information, please visit the official Lifestyle Lift® website.

Recovery, Precautions and Risks