Dear Dr Yang,thank you so much for making yourself available to answer our many questions. I just wish I lived in New York!
I had a consultation for a FL and when I asked the ps if I would need a mid face lift in addition to the face lift, he said a mid face lift was an “integral” part of his fl. He went onto describe the raising of the malar pads giving a more youtful look. He performs a ” plication standard face lift” That means he will lift the cheek without performing a periostal mid face lift or deep plane or extended SMAS. Is that possible? Also you have mentioned in the past that a browlift can be ageing. What is your opinion regarding lateral brow lift, with incision on the scalp Thank You very much!
He performs a ” plication standard face lift” That means he will lift the cheek without performing a periostal mid face lift or deep plane or extended SMAS.Is that possible? ”
Maybe, but the cheeklift may have more to do with the facelift incisions than with the technique of the facelift. I will also discuss whether or not a deep plane will have long lasting improvement of the nasolabial fold which should stay improved if the cheek/midface stays in the lifted position.
The cheek/mid-face (middle third of the face, upper third-> forehead/brow, and lower third->lower cheek/jawline) is somewhat lifted with a lower facelift, but less than with a subperiosteal midfacelift which is usually performed endoscopically (AKA- endoscopic midfacelift.)
A short scar facelift typically has a short incision from the top of the ear going horizontally across the sideburn/temple hair tuft. The advantage of limiting the incision here is it will maintain more of the sideburn. This avoids one of the tell-tale signs of a facelift which is to lose a significant portion of the temple hair. The traditional incision facelift has an incision which goes vertically into the temple hair instead of horizontally. The advantage of the vertical incision is that the cheek and temple can be lifted more than with the short scar incision. However, depending on the laxity (looseness) of the cheek area, more or less of the temple hair can be lost as the excess hair-bearing skin is removed from the scalp in the temple area. An alternative to this incision is to extend the short scar incision around the front of the temple hair, which allows the excess skin in the temple and cheek to be trimmed in front of the hairline. This allows for maintenance of the hairline while also removing more non-hair bearing skin from the temple/cheek area, but the trade-off is that the incision is potentially visible, since it is in front or along the front of the hairline.
My short scar facelift incision with a short incision under the sideburn hair tuft.
As you can see surgery has trade-offs and pro’s and con’s to each technique. If the ps you consulted with performs a “standard plication facelift” with the traditional incision which goes up into the temple, then I think there will be some lifting of the cheek/midface. However, even with the best of techniques, the improvement of the midface can be subtle, and also potentially short-lived. A well-known facelift surgeon, who coined the term deep-plane facelift and composite facelift, Dr. Sam Hamra, had performed a study on his own patients following the longevity of their facelift results. He felt there was an initial improvement of the nasolabial fold [smile line from the nose (naso-) to the corner of the mouth (-labial)], but the improvement was not present by the 1-2 year follow up. The conclusion that Dr. Hamra made at the time the article was published (2002) was that the only a direct excision (cutting out) the nasolabial fold was the only permanent correction for this problem. This was before injectable fillers became popular, and before the discussion of loss of facial volume was common place.
If Dr. Hamra (a world class facelift surgeon) was not able to maintain the improvement of the midface to keep the improvement of the nasolabial folds smooth, I don’t know who would be able to do it with less of a surgery (SMAS plication facelift.) Dr. Hamra’s surgeries are very aggressive to get the lift in the midface which he is able to achieve. Yet he concluded it doesn’t hold up long term.
See if your consulting surgeon can show you significant midface improvements on his or her facelift patients using the “standard plication facelift.” Of note, the after photos cannot be smiling. When a person smiles, they can lift and “mound” the cheek better than a surgeon can do with their surgery, so this does not count. The after photo needs to be at rest, just like the before photos. If they want to compare a post-op smiling photo, it should be compared to a smiling pre-op photo for a “fair comparison.”