Abstract
Facelift techniques can be classified according to the depth and extent of the dissection
applied. Imbrication and plication of the superficial musculoaponeurotic system (SMAS)
referred to as “SMAS lifts” or “classical facelifts” are the most commonly used techniques.
Plication techniques involve in-folding of the SMAS and suture suspension without
any SMAS incision whereas imbrication techniques involve a SMAS incision with a portion
of the SMAS either removed or transposed with or without limited sub-SMAS dissection.
Aging changes in the lower face and neck can be successfully treated with SMAS lift
techniques. However, there is no lifting effect at midface level or improvement in
the nasolabial folds since the retaining (zygomatic cutaneous and masseteric cutaneous)
ligaments that prevent the transmission of traction to the malar portion of the facelift
dissection are not released. Extended facelift techniques involve surgical release
of these ligaments, and produce combined, balanced, and harmonious rejuvenation of
the midface, cheek, and lower face without requiring a separate midface lift procedure.
There are different techniques having similar extended midface dissections with some
variations: The extended SMAS technique involves a long skin flap and a distinct SMAS
flap dissected and pulled separately. The high SMAS technique has a similar dissection
but involves a higher SMAS flap along the superior border of the zygomatic arch. The
deep plane facelift involves undermining of skin-SMAS flap as a single unit following
a more limited subcutaneous dissection. In the composite plane facelift, in addition
to deep plane facelift dissection, the lower part of the orbicularis oculi muscle
is also dissected and included in the flap. As they have a single unit, deep and composite
flap facelifts allow excellent blood supply to the overlying skin. In this article,
various facelift techniques are discussed in detail in line with the relevant surgical
anatomy.
Keywords
facelift - rhytidectomy - SMAS lift - deep plane facelift - composite plane facelift
