Face Lift Jargon – What’s what?

So, Mother Nature has finally won and when you look in the mirror, you can see what you have been dreading and avoiding for years – you’re ageing!!!  It’s inevitable: as we age, our facial and neck muscles loosen and the skin becomes slacker and loses its elasticity, creating folds, lines and wrinkles.  Years of sun exposure, the stresses of everyday life, gravity and smoking all begin to show on the face.

However, before you get too despondent, there are a number of different types of facial cosmetic surgery procedures that can be carried out, which can refresh the face to create and provide a more alert, youthful appearance.  The best candidate for facelift surgery is a person whose skin still has some elasticity and who has a strong, well defined underlying bone structure. This tends to be people who are in their 40s through to their 70s, although older people are occasionally suitable candidates.  Patients are assessed on an individual basis but must be in good general health, and must have realistic expectations of the outcome of the surgery.

A facelift is a procedure carried out to enhance and rejuvenate the appearance of the face with the aim of creating a fresher, smoother, more rested, youthful appearance of the face, and to enhance self-esteem and self-confidence.  There is a significant amount of confusion and misunderstanding related to this procedure amongst the general population and this is not helped by the wide range of different terminologies and names for this surgery that can be found on the internet.   These names will differ internationally, nationally or even regionally as here in Liverpool they are often referred to differently than in other parts of the North-West.

First of all, the name of the procedure – face lift – lends itself to be misunderstood on so many different levels.  The procedure is primarily related to tightening the jawline and to some extent the upper part of the neck.  It has little or no effect on the middle third of the face and the area around the mouth.  Also, the areas around the eyes and forehead are not affected – if rejuvenation in these areas is what you’re looking for, they would require other procedures.  Perhaps a facelift could be better referred to as a lower face and neck lift (in most cases) rather than a face lift which implies that it rejuvenates the entire face.  To add to this confusion, there are various different names associated with the procedure and these can generally be either related to the technical names (which are derived from the anatomy, for instance the SMAS lift (Superficial Musculo-aponeurotic System lift), the Sub-periosteal lift and also the High SMAS, amongst many others), or the techniques used to carry out the procedure.  The name of the MACS Lift (Minimal Access Cranial Suspension) is based on the technique used to carry out this type of procedure.

There are a great variety of names used to describe this procedure, usually designed to sell it, or to brand a particular variation as belonging to a specific surgeon or a clinic.  This does not help at all – it only confuses the issue. In Merseyside people often make enquiries using terms such as facelift, mini facelift or sometimes Short Scar lift but in other areas, even within the North West you may find patients asking for a MACS Lift or SMAS Lift.

Recent new names which are now cropping up on the internet include: the American Facelift, the French Facelift, the One Stitch Facelift and the Quick Lift, amongst countless more which are too numerous to list here.

So let’s cut through the jargon… essentially, as I’ve already said, a facelift is a procedure to try and give the lower face and neck a fresher look.  The different names for a face lift can perhaps be simplified according to the degree of complexity involved in the procedure. Perhaps calling them a Minor Facelift, a Moderate Facelift and a Full Face and Neck Lift may help.

A Minor Face Lift generally involves shorter scars and a minimal amount of skin undermining (separating the skin and the tissues underneath it) in front of the ear. This achieves a subtle lift of the jawline and in some cases, a subtle change in the upper neck as well.  This procedure is commonly carried out under a local anaesthetic and carries slightly lower risks than the other more complex procedures.  The effects of this procedure will usually last a few years (most often around 2 years). However, patients should remember that the ageing process of the face will continue and the longevity of the results depend to some extent on the quality of the tissues and the technique used to lift and hold the tissue into its new position.

MACS Face Lift

MACS (Moderate) Face Lift

The next level of complexity of surgery can be considered a Moderate Face Lift.  The most common type is known as the MACS Lift or Short Scar ‘S’ lift.  The technical details of this procedure may vary, but the common feature is that with this procedure, the scar is shorter than that of the full face and neck lift. In addition the surgery can be done both under local anaesthetic with or without sedation, or under general anaesthetic. The scar is usually from the temple down to the earlobe, or it may follow the hairline of the sideburns to the front of the ear, then either be placed in the crease in front of the ear, or follow the curvatures of the ear itself and usually ends just around the earlobe. While this can sound confusing, the diagrams may help to clarify.

The more invasive procedure is the Full Face and Neck Lift, which again, depending on the technique used, can be described as a SMAS Lift, a Sub-Periosteal Lift (where the dissection takes place at the level of the bone), a variation of a SMAS called a High SMAS Lift or a variation of the MACS Lift. All of these procedures can fall within this category. This surgery involves extensive dissection of the tissues, and lifting, or undermining of the skin around the face as well as the neck.  This produces the most dramatic results out of any face and neck lift surgery.  The longevity is variously described as between five and ten years, however, again it is important to remember that there are multiple factors which determine how long the effect of a facelift will last. The first area to show recurrent skin laxity and folds is the area under the chin, which can start to loosen (with skin folds reappearing) within a year of the procedure taking place.

When we talk about a Mini Facelift or its various other names (like the French Lift or One Stitch Face Lift) it sounds like a simple procedure.  There is now a tendency for those who normally do not carry out full Face Lift procedures to start dabbling in this type of surgery.  It is important to remember that those who are carrying out any surgery on the face should be fully trained Consultant Plastic or Facial Surgeons, who understand both the anatomy and also the risks and complications involved.

Complications with this surgery include such things as haematoma, scarring and loss of skin.  One of the most serious risks is an injury to the facial nerve which can potentially lead to permanent paralysis of the muscles of the face.  Only fully trained surgeons with a thorough understanding of the structures of the face can have the knowledge to avoid this type of a complication; even then, a fully trained surgeon cannot guarantee that injury to the facial nerve won’t happen.  It is an increasingly worrying trend that doctors who are not specifically trained have started carrying out the Mini Facelift and selling it as a simple procedure with little risk of permanent damage.

It is important to remember that the effect of any cosmetic procedure, and this includes the Facelift, does not last forever. Before embarking on this procedure patients must remember: a surgeon can “turn back the clock but can’t stop it ticking”.  The risks associated with this procedure are numerous and some complications can have a devastating long term effect.  A fully trained Consultant Plastic/Facial Surgeon can use their skills to produce a pleasing result whilst having the best chance of minimising the risks to their patients.

It is important not to rush into this type of surgery – take your time, do your research!

Without seeing you face to face it would be very difficult to determine which procedure would be most suitable for you. All of our Consultant Plastic Surgeons are NHS trained, on the specialist register of the GMC and are members of BAAPS and/or BAPRAS.  You should take the opportunity to look at some of the photographs on our gallery (more are available to view during your consultation here in the clinic).

If you wish to book a free, no obligation consultation with one of our Consultant Plastic Surgeons here at Sthetix, please call 0151 669 1114, or, if you prefer you can email us at [email protected] .