For the last four decades, the full subcutaneous face lift has been the procedure of choice to treat the facial effects of aging. Superficial musculoaponeurotic system (SMAS) plication, platysma tightening, and deep-plane surgery have improved face lift results. However, to achieve optimal results, it is important for the surgeon to understand and appreciate all available techniques. All face lifts are not the same: all procedures are not necessarily indicated for all patients, and physical findings dictate the choice of specific procedure.
In the last 15 years, less invasive techniques have been proven appropriate for earlier signs of aging. Such techniques have assumed increased importance as a younger group of patients (eg, those in their fourth and fifth decade) seek to counter the effects of aging.
The limited-incision face lift technique (LIFT) offers an effective procedure for meeting the needs of many patients. A principal advantage of this procedure is the elimination of the postauricular, neck, and often temporal scalp incision and the scarring and sequelae that accompany each incision. The LIFT allows full correction of upper, mid, and lower facial aging without the pulled look that often results from traditional subcutaneous procedures (Figure 8–1). It also allows a more rapid recovery and return to activity as well as ease and safety of performance.
Preoperative and postoperative photographs of woman who has undergone limited incision face lift (LIFT). A: Preoperative frontal view. B: Postoperative frontal view. C: Preoperative lateral view. D: Postoperative lateral view. (Courtesy of Robert C. Silich, MD, FACS)
A thorough understanding of the normal facial anatomy and the changes associated with aging is paramount to successful aesthetic surgery. Facial skin undergoes atrophy with aging and the most significant effect is seen in the dermis. Fine facial rhytids are caused by the combination of actinic damage, gravitational forces, genetics, and the repeated use of facial muscles. Deep to the skin is a layer of subcutaneous fat, which is the dissection plane of the traditional rhytidectomy. In the face, this plane separates the SMAS-muscle layer from the overlying skin. It is convenient to think of the facial planes of the scalp-temporal region-face-neck as continuous units. Superiorly, the SMAS-muscle layer of the face continues above the zygomatic arch as the temporoparietal fascia and further on as the galea in the scalp. Inferiorly, the SMAS-muscle layer continues in the neck as the superficial cervical fascia investing the platysma. The SMAS, platysma, and muscles of facial expression may be thought of as a single anatomic unit. Deep to the SMAS-muscle layer in the face is the parotid-masseteric ...