In my last blog I spoke of how long a facelift will last. As mentioned in the blog, it’s been found that patients look better after a facelift than they did before surgery for many years – 6 to 10 years in many cases. On the other hand, patients sometimes look better after a facelift, but not as good as they would like. Perhaps they looked fine for a few months after surgery, but by the time a year or so has passed, they are finding areas that are beginning to sag a bit. What can be done?
Before answering that question, let’s look at what a facelift is all about. Patients will frequently use their fingers to pull up on the cheek and neck to show the way they’d like to look after surgery. If the plastic surgeon can simply replace the fingers with sutures, things would be perfect! The problem is that if that were done, the lift would last for a few weeks or months at best. Skin simply does tend to hold the lift that well. It stretches and things drop back to where they were. Remember the “Thread Lifts” and “Feather Lifts” that were popular a few years ago? Threads were placed just beneath the skin and tightened, sometimes giving a very nice result. The problem is that these tended to last for a very short while.
For that reason plastic surgeons have used a deeper tissue called the SMAS that underlies the cheek skin to hold the lift. When the SMAS is tightened with sutures, it tends to maintain the tension. The SMAS is connected to the overlying skin and tightening it allows the skin to remain taut for a longer period of time than if sutures were used to tighten the skin only. In some cases, though, the mechanical properties of the SMAS do not allow it to hold the tension that well, which leads to a relapse or a less-than-expected result. This is particularly true in thin patients with sun-damaged skin.
In the diagram of an Extended MACS-Lift to the right, the SMAS is shown in red stripes and the loops of black dots represent the sutures used to tighten the SMAS. As these sutures are tightened, the skin that is still attached to the SMAS in front of the sutures is pulled upward and backward, producing the desired “Face Lift.”
How do we treat this type of patient? Usually a touch-up procedure with a retightening of the skin plus a few SMAS sutures is all that is required. It seems that once the skin has loosened up after the first lift and then is retightened, it holds the lift much better. Of course there are the additional expenses plus the 1-2 weeks of recovery, so if this sort of thing can be avoided, so much the better. Relapse or a less-than-expected result doesn’t happen, though, because things were not tightened sufficiently at the first operation. It happens because the body’s tissues just don’t hold the lift. I mention this possibility to all of my facelift patients before surgery, particularly those with sun-damaged, thin skin.
Should you have further questions, please contact my office.
George Sanders, M.D.