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The Advanced Facelift

By Beth Landman
Posted On Mar 03, 2017
The Advanced Facelift

The facelift is no longer a “dirty little secret.” Thanks to scientific advances and fuller more natural results, a lift is giving life to more women than ever.

BY Beth Landman PHOTOGRAPH by Shutterstock

One mild spring evening earlier this year, i met a friend for dinner in Midtown Manhattan. I hadn’t seen her in a couple of months; in between bites of salad and sips of Chardonnay I kept staring at her. She looked different—somehow transformed, like the way Geena Davis was after meeting Brad Pitt in Thelma and Louise. Her smile seemed more radiant, and I knew something was up.

She was married, so I felt awkward about questioning her. Could it have been a lover? Maybe she had lost a little weight, altered her hairstyle or color, or just taken a well-deserved vacation. Eventually curiosity overpowered discretion and I blurted it out: “What’s going on? You look amazing. Did something change?”
“Why do you think I look this way?” she asked, through a Cheshire grin.

“I have no idea,” I replied frankly.

“Dr. Silich,” she whispered, referencing an Upper East Side plastic surgeon. “I did it for my fiftieth birthday.”
I blinked hard. Even though I had many friends who routinely went for Botox and fillers, I hadn’t known anyone who had gotten an actual facelift. I thought I would immediately identify a facelift, but—as logic would dictate—that would be the sign of a job badly done. My friend’s results were dramatic, yet subtle. There were none of the telltale signs of esthetic tinkering—no over-inflation, pulled skin, or distorted appearance around her eyes or brow. She simply looked soft and fresh.

Many lunchtime procedures—as well as new skin tighteners, lasers, and injectables—have entered into and fallen out of favor. The lift, however—which first came into vogue in the 1960s—is actually on the rise. According to the American Society for Aesthetic Plastic Surgery, 119,006 facelift procedures were performed in 2012, up 20 percent from 1997. Additionally, 15 percent of the patients are between 35 and 50.

Though the basic concept of a facelift—cutting, then restoring skin and muscles to their youthful, pre-sagging position—has stayed the same for over half a century, advances in techniques continue to emerge. And opinions still vary about which approaches produce the most natural and longest lasting results. Ten different doctors will likely give ten different answers.

The face has a deep layer of muscles, above which sits fibrous soft tissue known as the superficial muscular aponeurotic system (SMAS). Some surgeons lift and tighten the skin; others go to the deepest layer, performing what is called the Deep Plane Lift. Most stay in the middle, tightening the SMAS with or without an incision. “It’s not the operation, it’s the surgeon,” insists Dr. Daniel Baker, one of New York’s top plastic surgeons.Dr. Baker participated in a twins study in which a Deep Plane Lift was done on one sister and a SMAS procedure on the other.

“Ten years later, they both looked great,” he insists. Beverly Hills plastic surgeon Dr. Marc Mani practices the Deep Plane method, an operation he performs with an ultrasonic scalpel. “We’ve gained more knowledge of facial anatomy, so we can lift the deeper layer, which— though it takes longer and is more complicated—produces the most natural result. The deep plane is the layer that aging occurs on, and you can tell quite clearly that’s where gravity acts,” Mani says.

As this deep layer has the least amount of blood, less swelling occurs, according to Mani, who asserts that ultrasonic scalpels reduce bleeding during surgery, which speeds healing time. “Within two weeks, my patients are restaurant-ready,” Mani says. “I’ve done this on many actresses who are back on camera within a month.”

ENT-trained cosmetic surgeon Dr. Mark Berman, also of Beverly Hills, who is the former president of the American Academy of Cosmetic Surgery, disagrees. “When you pull muscle back and elevate it up, you are distorting the face’s anatomy and it will never look like it used to,” Berman insists. “If someone has loose skin, I will undermine it for two or three inches, and just pull the skin and not muscle. It gives a much more natural result.”

Minimally invasive options such as the Thread Lift (which sutures the skin without cutting) or the Lifestyle Lift (which excises a small patch of skin and stitches it up) have become a cottage industry; some procedures are even available in strip malls.

However, minimal operations often leave patients complaining of a lack of symmetry, unnatural banding, and short-lived rejuvenation. Incision size is also up for debate. “The sideburn and the distance from the hairline to the eyebrow should stay intact,” asserts Dr. Stanley Frileck, a Los Angeles plastic surgeon who does the SMAS lift with a full incision. “You can abridge the scar, but what you tradeoff is that it will lay in pleats, like the top of a curtain.”

Dr. Silich, on the other hand, favors a SMAS lift with the short scar technique. “You can’t over pull with a short incision, and if you lay it in a way that is hidden, it has no pleats,” he says. The Minimal Access Cranial Suspension, or MACS Lift, also uses a short scar incision, but loops the SMAS with internal stitching and suspends it in a vertical direction.

“I don’t like the deep plane because I don’t want to look at facial nerves when I am doing this operation,” says Manhattan plastic surgeon Dr. Sharon Giese. “The MACS is safer, lifts tissue up, and anchors it right by the cheekbone, which adds volume to the cheek area.”

Arguably the biggest advance in facial rejuvenation— and one thing cosmetic doctors seem to agree on—is the notion that restoring volume is as important as tightening. Surgeons often perform lifts in addition to fat transfers. 

Stem cell-rich fat has an added benefit of giving skin a more youthful quality. Dr. Baker offers a trifecta of a lift, fat injections, and a peel or Fraxel (fractional ablative laser treatment) to treat discoloration and fine lines. Dr. Silich strengthens the jawline by using microsuction around the neck and jowl area, then reinjecting fat. Dr. Giese adds internal ultrasound along with microsuction of the neck and reinjection of fat, called the Natural Lift.

Florida-based aesthetic surgeon Dr. Sharon McQuillan, founder of the Ageless Aesthetic Institute, ensures survival of the transferred stem cells using a fortifying method known as cell augmented lipo transfer, or CAL. “So often, the problem a patient has is that he or she has lost underlying structures including bone, subcutaneous fat, and dermal thickness,” explains Dr. McQuillan. “After age 30, we lose about five cc’s of volume each year.

Fat transfer has addressed deflation of the face, but was not reliable before. Research showed it was not lasting because fat cells die.” Dr. McQuillan points out that stem cells survive, and augmenting the number of stem cells ensures longer lasting volume. “The skin improves because the transfer also stimulates fibroblasts to produce collagen, hyaluronic acid, and elastin,” she says. “This improves circulation, so you get better metabolic turnover.” Of course, techniques and surgery variations are always dictated by a patient’s needs.

But, with the addition of volume and sophistication of methods, lifts seem to be lasting longer—which is great news for the entire industry. “We used to say ‘seven to ten years,’” says Dr. Baker. “Now, what everyone is doing is less invasive.

By adding fat and filler I think they last up to 14 years.” Dr. Baker points out that certain patients who come in for a secondary facelift leave looking more youthful than ever. “I think they look better and younger at 65 than they did when they first came to me,” he says.