Cosmetic Surgery - Face

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As a craniofacial surgeon I have strong interest in the variations in facial structure and anatomy. Facelift techniques are individualized according a persons anatomy and concerns as demonstrated below (also see the neck lift page for further examples)

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		SMAS plication facelift and malar pad imbrication Upper and lower eyelid blepharoplasties Rhinoplasty
		SMAS resection facelift and platysma plication Transpalpebral corrugator resection (removal of vertical frown muscles through the upper eyelid)
		SMASectomy facelift and Genioplasty (chin Advancement) Rhinoplasty and blepharoplasties
		MACS Facelift and neck lift (minimal access cranial suspension) and SMAS plication Submental liposuction and vertical platysma suspension
		Vertical vector SMAS resection facelift with malar pad imbrication Limited incision browlift Rhinoplasty and Blepharoplasties Dermal filler lips
		MACS facelift (minimal access cranial suspension) Submental liposuction and platysma plication Upper and Lower Blepharoplasties
		SMAS resection facelift with malar pad imbrication Oblique platysma suspension Open browlift (pretrichial incision) and corrugator resection

For a long-lasting effect, the SMAS layer of the face should be dissected out and resuspended. When performed by an untrained surgeon there is a great danger to the facial nerve which animates the face. Each facelift will be different depending on patients own variations in facial ageing. I often combine a facelift with;

-tightening of the neck skin
-removal of fat under the chin
-elevation of the brow with weakening of the central frown muscles
-removal of excess eyelid skin
-resurfacing of the skin around the mouth
-fat grafting to augment specific areas

A facelift may also be combined with chin advancement (genioplasty) and rhinoplasty
Variations of the facelift include;

Minilift /S lift
A “minilift” and “S lift’ excise skin only. It does not dissect out and tighten the underlying SMAS layer of the face or its suspensory ligaments. Although it gives a good effect initially, this usually only lasts a few months. This may be appropriate in elderly people with fragile subcutaneous tissues and thin facial bone structure and is safer for surgeons not trained in SMAS facelifts

Volumetric facelift
A volumetric facelift is another term to describe repositioning the slumped facial tissues into a youthful and anatomically appropriate position. This looks more natural than simply pulling everything back tightly.

Subperiosteal facelift and Mask lift
A subperiosteal lift elevates the whole face at its deepest level next to the bone and lifts the entire facial “mask”. It is incredibly effective however the person looks quite different afterwards and this can take some psychological adjustment. I don’t tend to do this in cosmetic cases but perform about half a dozen cases each year for people following major accidents

Facial Implants
Many types of synthetic material are available for facial implants. Implants come preformed or may be carved intraoperatively. Locations for implants include;

• Chin
• Cheek/ malar region
• Nasal bridge
• Nasal tip
• Jaw angle

Facial liposuction
Facial liposuction may be safely performed above the platysma but in most facial types it is only of significant benefit in the submental region. Great care must be taken to avoid the marginal branch of the facial nerve.

Facial fat grafting
Fat transplantation may be performed using the Coleman technique. Fat is gently removed from another region and spun down in a centrifuge to separate out components suitable for transfer. These are injected atraumatically into separate well vascularized pockets to ensure maximal graft take.

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