Types of Face Lifts
Reviewed by Timothy R. Miller, MD
There are several different types of facelifts you can choose from based on your aesthetic goals and preferences regarding downtime and recovery, the risks involved as well as your facial anatomy. As a general rule, the different types of facelifts vary by the type of incision, number of tissue layers treated, the area of the face that is targeted, and their degree of invasiveness.
When surgeons first began performing facelift surgery, they cut the skin on the face and pulled it back. This so-called "skin only" technique wasn't exactly reliable, nor did it offer the best aesthetic results. The skin kept falling because there was no scaffolding to support its new, higher position. Over time, surgeons honed their craft by going deeper into the facial tissues, and the modern facelift took shape.
Some of the more popular facelift types are:
The Deep Plane Lift
The deep plane lift is considered the gold standard. It involves lifting, releasing and repositioning the superficial musculoaponeurotic system (SMAS). In short, the SMAS layer is located underneath the skin and surrounds the muscles of facial expression; that is, the muscles used for smiling, frowning, and other facial expressions. The deep plane lift has been shown through peer-reviewed studies to offer longer-lasting results with fewer revisions.
This more technical procedure involves inconspicuous incisions along the hairline so that the facial muscles and upper fatty tissue layers can be easily lifted and repositioned. From the hair-bearing temple area, the incisions are extended downward along natural creases, proceeding inside the ear, then along the ear lobe, and ending out of sight behind the ears.
During the deep plane lift, the facial plastic surgeon separates the skin from the SMAS layer, and then enters the "deep plane" by going underneath the SMAS layer to release attachments. It is the release of these attachments that allows the surgeon to reposition the SMAS layer, and accompanying skin, in a more youthful, natural, and tension-free position. After the SMAS is repositioned, excess and loose skin is removed, and the edges are sutured or stapled in place.
The deep plane lift is the go-to lift for people with severe facial sagging and laxity, and for those looking for a longer-lasting lift. The results of deep plane lifts are dramatic, especially in the mid-face area (the cheeks, nasolabial folds, jawline and chin). The effects last about 10 to 15 years. For information on facelift risk(s), visit our page devoted to this topic.
A deep plane lift costs between $12,000 and $15,000. For more information on the cost of the deep plane lift, check out our article on facelift costs.
The SMAS Lift
The SMAS lift affects the superficial top layers of skin and the deeper tissues of the face and neck. These tissues tend to grow lax and sag with use and advancing age.
To perform a SMAS lift, your facial plastic surgeon creates an incision at the temple, above your hairline. From there the incision is extended downward, following your skin's natural crease in front of or at the edge of the ear, below the ear lobe and behind your ear. The SMAS is then tightened using sutures, any excess or redundant skin is removed and the remaining skin is stitched up.
The SMAS lift works well for individuals with mild laxity, some jowls and mid-face sagging. There are several popular SMAS lift techniques, some more reliable than others. The length of surgery time (and recovery), placement of incisions, revision rates, and overall results differ amongst the many techniques and with the surgeons who employ them. The SMAS lift differs from a deep plane lift in that no attachments underneath the SMAS are released.
The SMAS facelift costs an estimated $5,000 to $12,000.
Short Scar Lifts
The short scar facelift is an umbrella term for several facelifts that involve abbreviated scars. One such lift involves an S-shaped incision at the temple or in front of the ear. Unlike with other types of facelifts, the short scar lift incision does not extend behind the ear. Your surgeon can still re-suspend the tissues that support your smile lines and jowls and tighten a moderate amount of your loose skin.
Another example of a short scar lift is the minimal access cranial suspension lift (MACS). With this technique, your incision stops right at your ear lobe.
Short scar lifts, whether the S-shaped or the MACS, may be options for people in their 40s and 50s with minimal to moderate excess skin. This procedure is also ideal if a shorter scar is a priority, or if you have no visible signs of aging on your neck.
Short scar lift costs can range anywhere from $6,000 to $10,000.
During endoscopic facelift procedures, your surgeon uses a pencil-shaped probe with a tiny camera attached to it (an endoscope) to transmit video images of your internal facial structures to a TV screen in the operating room. The endoscope is inserted via three or more small incisions that are often less than one inch long and can be easily hidden.
Endoscopic facelifts are usually done on an outpatient basis using local or intravenous anesthesia. The smaller incisions may result in a lower risk of nerve damage. The tradeoff is that this type of lift is effective only for cheek sagging. These types of facelifts are falling out of favor because the results do not compare to those seen with other facelifts. Neck lifts can't be done endoscopically.
The cost of an endoscopic facelift is about $6,000 to $10,000.
The Midface or Cheek Lift
These lifts target the middle third of your face. The incisions are placed in your hairline and the inside of your mouth. Your surgeon then lifts and repositions the natural fatty layer over your cheekbones.
Midface lifts improve nose-to-mouth lines and lift sagging cheeks. This area can also be treated with an SMAS or deep plane lift. An isolated mid-facelift can be done endoscopically or through the lower lid along with eyelid surgery (blepharoplasty). This lift provides a subtle freshening-up with minimal risk and downtime.
The midface or cheek lift can cost anywhere from $6,000 to 10,000.
Stem Cell Facelift
Technically, a stem cell facelift is not a true facelift. While a surgical facelift relies on lifting the skin and connective tissue to treat facial sagging, a stem cell facelift involves fat injections to the face to add volume. A stem cell facelift is a two-step process. First the fat cells (and the stem cells within them) are harvested by liposuction from areas on the body where they are plentiful (tummy, buttocks, thighs). The fat cells are then processed, with a focus on the stem cells residing in the fat cells. After, the fat and stem cells are injected into the face to contour and fill the cheeks, under-eye hollows, temples, lips and other facial areas. However, despite the interest in the press, no peer-reviewed study has yet shown that stem-cell facelifts have any more benefit over regular fat augmentation procedures.
The cost of a stem cell facelift is higher than that of a more traditional facelift. Depending on the number of areas of the face that are treated, the procedure can range from $5,500 to $15,000.
The Thread Lift (Feather Lift or Aptos Lift)
Though it's considered passé nowadays, the thread lift, or feather lift, generated a great deal of buzz a few years back. It was developed to lift sagging facial skin without invasive surgery. Most surgeons have abandoned the thread lift as a stand-alone procedure, but will use the technique in combination with other facelifts for extra tissue support.
A thread lift uses tiny suture barbs that act as a hook to gather your skin layers upward, thereby tightening the skin. The barbs are attached to a thread which remains in place following the procedure. There is no nipping or tucking. The barbs on the threads and fibrous tissue provide the lift.
About the Reviewer of this Article
Timothy R. Miller, MD, is double board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head and Neck Surgery. His practice, Facial Aesthetic Concepts, is devoted exclusively to aesthetic surgery of the face and neck. Dr. Miller has offices throughout Orange County, Calif., and has operating privileges at many area hospitals, including the Mission Regional Medical Center in Mission Viejo, Calif., Saddleback Memorial Hospital San Clemente Campus in San Clemente, Calif., and the Pacific Coast Ambulatory Surgicenter in San Clemente, Calif.
Dr. Miller received his medical degree from the University of California, Davis School of Medicine, and completed a five-year surgical residency in Otolaryngology-Head and Neck Surgery at the University of Utah School of Medicine, followed by a facial plastic and reconstructive surgery fellowship accredited by the American Academy of Facial Plastic and Reconstructive Surgery. Dr. Miller is a Fellow of the American Academy of Facial Plastic and Reconstructive Surgery and the California Society of Facial Plastic Surgery.
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