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Plastic Surgery Center of Tampa

Surgical Technique of Facelift

A face lift is usually performed under genera or local anesthesia on an outpatient basis, meaning the patient goes home the say day. Rarely, if a patient has other procedures performed in addition to a face lift, an overnight stay may be required. Face lift in Tampa. The surgery usually takes three to four hours depending on the individual technique that Dr. Perez feels is most appropriate. Occasionally, if only a mini-lift or small revision is needed, this can be performed under local anesthesia in Dr. Perez’s new, state-of-the art office, the Plastic Surgery Center of Tampa.

"Jaime Perez is one of the best and few Board Certified Plastic Surgeons in Tampa." - GR

The various types of face lifts can generally be divided into superficial and deeper plane procedures depending on the exact level of dissection. The levels, or planes, of the face from the surface (i.e. superficial) to deep are skin, fat, muscle-fascia layer (i.e. SMAS), and bone. Superficial plane face lifts involve dissection under the skin but above the muscle-fascia layer. Deeper plane face lifts involve dissection deep to the muscle-fascia layer. Each type of face lift has pros and cons and not one type of face lift is suitable for all patients in all instances.

Subcutaneous (Skin Only) Face Lift

Male Facelift TampaA subcutaneous, or skin only, face lift is one in which dissection is limited to the fatty plane between the skin and underlying muscle-fascia layer. An inconspicuous incision is made along the sideburn, in front of the ear, under the ear lobe, ending in the hairline near the nape of the neck. With the technique, the skin and various amounts of fat, depending on technique, can be excised and redraped to reduce facial wrinkling, soften the appearance of nasolabial folds, decrease jowling, and better define the neck. Incisions are meticulously closed with a no-tension technique to ensure barely visible scarring. Ideal candidates for a skin only face lift have moderate amounts of lax skin, minimal to moderate amounts of facial fat, and little to no muscle-fascia malposition. Proponents of this technique note ease of dissection, decreased risk of nerve injury, and a shorter recovery time. Critics of this technique claim that deeper plane face lifts provide a more dramatic, powerful, longer lasting result.

Mini-Face Lift

A mini-face lift is actually not a face lift at all, but rather a limited, skin tightening procedure. With a mini-face lift, an elliptical incision is made in front of the ear and a small wedge of skin is excised to produce a limited tightening of the lower cheeks. This procedure is primarily performed as a secondary surgery after a complete face lift in patients who have a recurrence of nasolabial folds or sagging soon after their original operation. In rare cases, younger patients who have only a minimal amount of sagging of the lower cheeks may be candidates for this procedure as well. The benefits of this surgery are obvious and include limited dissection with minimal downtime; however, the results are also minimal and almost never effective as a primary facelifting procedure.

Subcutaneous (Skin Only) Face Lift with Muscle-Fascia (SMAS) Tightening

A skin only face lift with muscle-fascia (SMAS) tightening is similar to a traditional skin only face lift; however, the underlying muscle-fascia layer is tightened with sutures, excised, or a combination of both to aid in reshaping the facial soft tissues. The SMAS can be plicated (i.e. tightened with sutures), imbricated (i.e. cut, redraped, and tightened with sutures), or excised (i.e. partially removed with the remaining SMAS tightened with sutures). Incisions and closure techniques are similar to the traditional skin only face lift. Ideal candidates for this procedure have moderate amounts of skin laxity, minimal to moderate amounts of facial fat, and little muscle-fascia malposition. Supporters of this technique claim that suturing the muscle-fascia layer allows for better definition of the jaw and neck while having less risk of nerve damage or other complications associated with deeper plane face lifts. Skeptics note minimal results obtained by suturing the muscle-fascia layer without dissecting it free of underlying attachments. It is also reported that suturing the newly positioned muscle-fascia layer can be unreliable leading to early recurrence of an aged appearance and need for early revision.

Sub-SMAS Face Lift

A sub-SMAS, or sub-muscle-fascia face lift, involves dissection above and below the muscle-fascia layer of the face. The increased amount of dissection allows for movement of the skin and underlying muscle-fascia layer in different directions permitting greater tightening of muscle-fascia layer, less tension of the skin closure, and longer-lasting, natural results. An inconspicuous incision is made along the sideburn, in front of the ear, under the ear lobe, ending in the hairline near the nape of the neck. Various amount of skin are excised and redraped to reduce facial wrinkling, soften the appearance of nasolabial folds, decrease jowling, and better define the neck. The muscle fascia-layer is dissected free of the underlying tissues and tightened to further reduce nasolabial folds and jowling and better define the jaw line. Incisions are meticulously closed with a no-tension technique to ensure barely visible scarring. Ideal candidates for a sub-SMAS face lift have moderate amounts of lax skin, moderate amounts of facial fat, and moderate amounts of muscle-fascia malposition. Proponents of this technique claim that the sub-SMAS dissection provides more dramatic, longer lasting results than a standard skin-only face lift. Critics of this technique feel that the greater amount of dissection poses an increased risk of facial nerve injury, more postoperative edema, and a longer recovery time.

Deep Plane Face Lift

A deep plane face lift is similar to a sub-SMAS face lift with dissection beneath the muscle-fascia layer, however, only limited dissection is performed above the muscle-fascia layer. Proponents claim that the minimal dissection between the skin, fat, and muscle-fascia layer gives the skin an even smoother appearance and faster recovery time while still providing dramatic, longer lasting results than with a standard skin-only face lift.

Composite Face Lift

A composite face lift is essentially a deep plane face lift that includes dissection and tightening of the muscles beneath the lower eyes. Proponents claim that tightening of the muscles around the eye rejuvenates the upper face and reduces the appearance of bags under the eyes. It is felt that this added step results in a more harmonious, youthful appearance of the entire face rather than just the mid and lower face.

Subperiosteal Endoscopic Face Lift

A subperiosteal face lift involves dissection in the plane of tissue just above the facial bones, below the skin, fat, and muscle-fascia layer of the face. Depending on technique, varying amounts of dissection just beneath the fascia-muscle layer are also performed. Incisions are usually made just under the lower eyelid eyelashes or inside the mouth; a second incision is usually made in front of the ear and an endoscope is used to complete the subperiosteal dissection. Ideal patients are generally younger and require less skin excision than a traditional face lift patient, have bags under the lower eyes, and minimal to moderate nasolabial folds. Supporters of this technique feel that greater rejuvenation of the upper and mid face can be achieved with a subperiosteal face lift than with traditional skin only or sub-SMAS face lifts. Additionally, it is felt that the results of this face lift last longer and produce a more natural result. The added use of an endoscope makes for safe dissection through smaller scars. Critics of this technique note an increase in facial nerve injury and often inadequate correction of nasolabial folds and jowls.

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