Dr. Renato Calabria Explains Which Facelift Techniques Is Right for You

Hi, I am Renato Calabria, Beverly Hills Plastic Surgeon.

What I’d like to try today, in a few minutes, is to try and explain to you different facelift techniques and help you to understand them a little bit and to try to see which one is good for you. Again, in my opinion, a one-technique-fits-all is the wrong concept. I think the facelift needs to be custom-made to your needs. A 30, 35, 40 year-old-patient is not the same as a 60, 70-year-old. So every facelift technique needs to be custom-made according to the needs of the patient. So, let’s review a little bit, the major technique in a few words the way I understand them. And then let’s see if we can make some sense of picking what’s best for you. All these techniques have very esoteric names. We name them. We’re plastic surgeons, very egocentric, and we name a technique according to some little modification that we made.

I’m guilty as anybody else with my vertical facelift and one-stage facelift. And again, let’s see if we can shed some light about all these techniques. Now, the facelift started in the 1920s, 30s, and it was just the skin only facelift with an incision in front. It was very rudimental, and we just pulled the skin up tight horizontally. This technique lasted for a long time till the 60s and mid-70s when it was discovered a tiny, thin layer over the muscle called SMAS. And this is a layer over the musculoskeletal of the face. Now, after that discovery, we start doing SMAS facelift. I’ve done it in the past when I trained. And basically what you do is basically detach the SMAS over the muscle and undermine this thin layer of fibers and then reposition this SMAS in different vectors in different directions.

Now this is basically what most plastic surgeons do, a SMAS facelift. Then the SMAS has evolved with what we call a composite facelift or a deep plane facelift. A deep plane facelift, what it does is goes underneath the SMAS, which is this thin layer over the muscle, and also partially underneath some of the muscle like the zygomaticus muscle, the orbicularis muscle. This is called composite facelift. And, then, they reposition the muscle and remove the excess skin. So, we talked about the SMAS, composite or deep plane facelift.

And then we have a subperiosteal facelift that is basically a facelift done under the muscle and underneath the cheek area, detaching the entire layers of muscle, skin, and fat and repositioning them. We’ve all done that in the past, and we found that it caused a lot of swelling. The recovery was very long, so most of us that have some gray hair have abandoned that technique. Now, in the early to mid-90s, we came up with an endoscopic technique that we actually inherited from general surgery, the laparoscopy with tiny cameras and scopes. We applied it to the face, to the breast, et cetera.

Now that endoscopic technique, I touched bases a few videos ago, is basically done through a little tiny incision inside the hair in the temple area in the face.

And the beauty of that technique is that it’s scarless. So, basically, there are no scars in front of the ear. You can actually make a pocket underneath going under the muscle, pull the muscle up and leave it scarless. It’s a great technique that I’ve done. I was one of the pioneers doing it, but it doesn’t work for everybody. And it works best for younger patients.

In fact, I have an article that I just saw that I think is very helpful, done by a German plastic surgeon called Dr. Hofner. It talks about the temporal endoscopic mid-face lift, rejuvenation without facial scars. And the point he makes is exactly the point I was trying to make the other day. He basically said that for young patients without severe sagging and deflation of the mid-face or without severe jowling and neck problems, these scar-saving procedures seem to be the best. And then he goes by saying, “Older patients with significant skin excess of the jaw and the neck are better suited for conventional lower facial surgery.”

Again, this is reporting the literature. I’m not the only one who states this concept. And it’s important because again, as I said before, endoscopic plastic surgery of the face is great. We are all doing it. We all do brow lift in an endoscopic fashion. We do mid-face suspension in the endoscopic fashion. But keep in mind that when the skin is relaxed over the jawline, if you don’t pull the skin as well and excise the excess skin, the results are not long-lasting. And that’s the point I was trying to make.

So at a certain age, you are going to need to have a facelift done by removing the excess skin. Some of the surgeons out there combine the two and make you think that maybe just by doing endoscopic work, you get the best. But then in the neck, they combine a neck lift together with the mid-face.

That’s a good combination. But again, it’s not just an endoscopic mid-face suspension, but it’s a neck lift. And in fact, the result, you can see in these doctors that have done this procedure, is that the results are long lasting in the neck but not in the face. So remember again, my point to make is that your facelift procedure needs to be custom-made. And just because somebody is not going to make you the scar in front of here doesn’t mean that this technique is good for you.

The one that I develop, I do different grades of facelift according to the age, from the endoscopic mid-face to the one-stitch procedure to the mini vertical lift to the full vertical face and neck lift to the endoscopic brow.

So, that’s why combining the entire technique and pioneering some of the vertical repositioning of the tissue, I think is the key. So pick and choose. Don’t think one technique is superior to the other. At the end, is the skill of the plastic surgeon and his ability to incorporate it. All this technique is one that gives you the best result.

So don’t go for the glamor, don’t go for the magic potion, don’t go for whatever is too good to be true. Don’t believe it. Look at the result, the best thing. If I had my face done, I would go on the website or Instagram and look at their results. Look at them and make sure they’re. Some of the surgeons out there post results at one, two, three, six months. The swelling is there and so you can’t really see the final result. So have long-lasting results. Again, some of the results are a mish-mash of two techniques and some people do a mid-face and then they do a regular neck lift. So they show you the profile view and you see that the neck lift that was done traditionally is the one that is lasting the longest. But the face that was done endoscopically doesn’t last that long.

Okay, take care. Bye.