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Wednesday, April 20, 2022

Knowledge is Power

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When considering a “face lift,” there are several options

Social media popularity and the vast amount of information just a click away have transformed the modernday facial plastic surgery consultation. In the past, patients would come in and simply say, “I just want to look better, doc!” Now, prospective clients will present with specific requests for surgical techniques. These are great starting points for a discussion, but typically we must dive a bit deeper.

I truly appreciate when patients are informed. It makes for smoother and more meaningful discussion when they are already educated on surgical options. Some believe they “need procedure X” when it can be a bit more nuanced and complex in reality.

Similar to “there’s more than one way to skin a cat,” I like to say, “There’s more than one way to lift a face!” Right now, what is hot on social media is the “deep plane lift.” So what is a deep plane facelift? To explain what a deep plane facelift is, let’s start with what a “facelift” is.

As we age, we lose elasticity and tone of the skin. Equally important is that we develop a redundancy of the “superficial musculo-aponeurotic system,” aka “SMAS.” The SMAS is an organized fibrous network composed of the platysma muscle, parotid fascia and fibromuscular layer covering the cheek. This layer begins to droop and sag in addition to the skin, and it is the tightening of the SMAS that creates a natural and long-lasting result. Over the years, surgeons have performed many different techniques to address this layer of the face as we have found a “skin–only” facelift typically does not provide long-lasting results.

A tried and true method is called “plication,” where sutures under the skin tighten this layer. This is a very safe and lowrisk technique. Surgical time is shorter, and post-operative recovery time is faster. In a youthful face with only a small amount of aging changes, this could be a quick and easy way to freshen the lower face with lower downtime and lower cost by shortening surgical time.

As we go along the spectrum of facial rejuvenation techniques, we can also reduce the SMAS, remove the excess and restore more youthful anatomy. This is a very common technique, and depending on the amount of redundancy of the facial tissues, this could be a perfect technique for you!

So what is a “deep plane” facelift?

This procedure entails making an incision in the SMAS and dissecting below it. As we move deeper into the face, there are ligaments that will have to be released to fully reposition the soft tissues of the face back to where they used to live, higher on the face. This is a really beautiful and natural technique for an older face where all layers have begun to descend.

So which technique is right for you? To figure this out, an intimate consult is required to help identify several important factors. First and foremost, we have to discuss your aesthetic goals. What result are you trying to achieve?

Other things we have to discuss include your health. How will you tolerate anesthesia? As a facelift becomes more involved, it will require more time under anesthesia and more risks. Can you afford to take a few weeks off for recovery, or are you hoping to bounce right back? Do you have other health considerations that may affect wound healing?

And lastly, what is your budget? A longer surgery requires more anesthesia time and operating room time, increasing cost. Once we discuss all of these considerations, we can decide what technique is best for you, as your surgical satisfaction has everything to do with your goals, anatomy and lifestyle.

Paige Bundrick, MD, Facial Plastic and Reconstructive Surgery, Shreveport Plastic Surgery Center.

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