Whether it is to regain the radiance of one’s youth, correct facial paralysis or improve the appearance of the face after permanent injections, the facelift can tighten the skin and sometimes even the muscles of the face. But what are the different techniques? How is the operation going? Focus on the different techniques.

Invented by French surgeon Suzanne Noël in the 1920s, the cervico-facial lift promises to restore tone and youth to the face and neck. 

The different facelift techniques

“There are several facelift techniques:

• subcutaneous ;
• subcutaneous with re-tensioning of the SMAS (superficial musculo-aponeurotic system, which is located under the skin and connected to the muscles of the neck and face);
• lifting  composite.

The modern facelift can no longer be understood without the addition of ancillary techniques such as laser, lipofilling (addition of fat to reshape volumes) or even peeling ”explains Dr. Michael Atlan, plastic and aesthetic surgeon at APHP.

Other lighter and less invasive techniques such as tensor threads can help restore a certain youthfulness to the face, but they are less durable than facelifts themselves.

The subcutaneous lifting 

The surgeon peels off the skin of the SMAS, after an incision near the ear. The skin is then stretched vertically or obliquely. Sometimes this tension causes a displacement of the edge of the lips. “This technique is used less than before. The results are less lasting because the skin can sag ”adds the Doctor.

Subcutaneous lifting with SMAS

The skin and then the SMAS are detached independently, to then be tightened according to different vectors. “This is the most used technique and it allows for a more harmonious result by moving the muscles to their original position. It is more durable than a simple subcutaneous lift ”specifies the surgeon.

Le lifting composite

Here, the skin is only peeled off a few centimeters, which allows the SMAS and the skin to peel off together. The skin and the SMAS are mobilized and stretched at the same time and according to the same vectors. For Michael Atlan, “the result is harmonious and when working the skin and the SMAS simultaneously, the hematomas and necrosis are less since they are linked to the detachment of the skin, minimal in this case”.

The operation takes place under general anesthesia and lasts more than two hours. The patient is incised all around the ear in a U shape. The skin and the SMAS are peeled off or not depending on the technique used. The platysma, a muscle that connects the SMAS to the collarbones and often relaxed with age, is tightened to define the angle of the jaw.

Depending on the severity of the neck sagging, a short incision in the middle of the neck is sometimes necessary to add tension to the platysma. Often the surgeon adds fat (lipofilling) to improve the volume and appearance of the skin. Other interventions can be associated, such as those of the eyelids in particular. “The sutures are made with very fine threads to limit scarring.

The installation of a drain is frequent and remains in place 24 to 48 hours to evacuate the blood. In all cases, after a month, the lesions due to the operation have faded and the patient can return to normal daily life ”.

Rare complications

“In 1% of cases, the facelift can lead to temporary facial paralysis. It disappears on its own after a few months. When touching the muscles of the face, in cases of subcutaneous lifting with SMAS or composite, it can result in nerve damage under SMAS. But these are quite rare cases ”reassures Michael Atlan.

The most frequent complications

The most frequent complications remain hematomas, hemorrhages, skin necrosis (often linked to tobacco) or sensitivity disorders. They are generally benign and disappear within a few days for the former and within a few months for the latter. “The pain is abnormal after a facelift,” adds the doctor. “It is possible to feel discomfort when swallowing or a certain tension, but the pains are most often linked to bruises”.

“There are no real contraindications for facelifts,” explains Michael Atlan. “However, the risks of complications are greater in smokers who incur skin necrosis”. In obese patients, the results on the neck are sometimes disappointing. Likewise, patients who have had many facial operations should not expect results as satisfactory as they did with the first operation.

The price of a facelift varies widely and depends on the complexity of the procedure and the surgeon. It generally ranges between 4 euros and 500 euros. These interventions are not covered by social security.

“Before a facelift, you must:

• stop smoking at least one month before the operation.
• avoid injections in the preceding months so that the surgeon can observe and treat the face naturally.
• avoid using permanent injections for the same reason.
• Last advice: always tell your doctor about the various cosmetic operations and injections you have had during your life ”concludes Michael Atlan.