woman holding her face on green background

Breaking down the Facelift

Having performed thousands of facelifts, I have seen fads and miracles come and go. Some are a laughable waste of time, some outright dangerous. Plastic surgeons, myself included, have worked hard over the years to improve the procedure and serve our patients better. The scientific paper published on my first 1,000 Limited Incision Facelift Technique (L.I.F.T.) procedures largely changed the way facelifts were performed, produced more natural results with hidden scars, and generally became the gold standard procedure. But there are many variations of the procedure. Every individual has individual issues, there is no way one operation fits all, and the surgeon must be capable and comfortable with them all. Unfortunately, many surgeons have blanketed the landscape with confusing information on social media. All well-trained BOARD-CERTIFIED plastic surgeons have the same tools. Experience, skill, common sense, and taste make the difference. Let’s try to make things a little more transparent. Patients are confused between the Limited Incision Facelift or Short Scar Facelift, The Full Face and Neck Lift, and the Deep Plane Facelift. Each address increasingly more significant aging and wider areas of the face and neck.


The Limited Incision Facelift Technique (LIFT) or Short Scar Facelift, uses an incision from the sideburn to the earlobe and effectively deals with the nasolabial folds, cheeks, jowls, loose skin under the chin, and upper neck laxity. If there is more significant laxity of the skin of the neck, the incision is extended behind the ear and up into the hairline. This additional incision makes it possible to re-drape the skin of the neck and becomes virtually invisible even with the hair worn up.


The full, true, Deep Plane Facelift is reserved for individuals with excessive laxity of the skin and muscles of the face, and I do not believe it appropriate to combat the normally aging face.


There is no such thing as a “one size fits all” facelift. Surgical techniques should address specific problems, and the same procedure is not applicable to every problem and every person. A forty-nine-year-old woman does not have the same aging issues as a sixty-seven-year-old, so why should she be offered the same operation? Men want to tidy up their necks and have their skin fit. Women are concerned with wrinkles, folds, and blemishes. Why would I offer them the same single option? It doesn’t make sense. Different people in different stages of life have different requirements, this is where the Limited Incision Facelift can be an option.


The Deep Plane Facelift elevates the skin and the muscles of the face in the lift. Unfortunately, the muscles of facial expression receive their nerve supply on their underside, so the procedure risks damaging nerves and paralyzing areas of the face, which is a complication no one wants. To avoid this risk, I have modified the deep plane to include only the platysma muscle which is used to tighten the jawline and neck. This includes tightening the SMAS, which is the upper end of the muscle and helps redefine the cheekbones. Almost no one needs more extensive surgery than this.


This modern mini-lift has been adopted, renamed, and publicized by many surgeons. On June 4, 2009, the New York Times published a long article about the marketing of specialized facelifts, making reference to the seminal importance of my original S-LIFT and the procedures it had spawned. But be warned: A new name doesn’t make a new procedure. After the journal, Aesthetic Surgery, published the scientific paper on the first 1,000 Limited Incision Facelifts I had performed, I smiled at advertisements for surgeons claiming credit for the new operation. I am happy to have had something to do with devising and popularizing an excellent procedure, but the real beneficiaries are my patients, who understood that the new procedure would help them achieve and maintain a natural, youthful appearance.

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