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A facelift operation is the most recognizable facial rejuvenation procedure by the pubic. Medically known as a rhytidectomy, it is a lower facial procedure that works to achieve better neck-jowl contouring. It is an operation that has been around for almost a century and has evolved considerably over that time. The basic tenets of the procedure are skin flap elevation, SMAS elevation and fixation, and face and neck skin posterior repositioning and removal.

Because a facelift as traditionally performed has certain complications and a specific recovery period, the past two decades has seen the use of a variety of less invasive facelift techniques (e.g., Lifestyle lift) While appealing their use in best applied to patient with the early signs of facial aging because of their more limited effects.

A more recent trend has been the introduction of a variety of adjunctive facelift techniques, such as fat grafting, platelet-rich plasma and tissue sealants. The goals of most these promoted techniques is that they provide an improved outcome or an expedited recovery.

In the Online First Edition of the 2019 issue of JAMA Facial Plastic Surgery, an article was published entitled Advances in Face-lift Techniques, 2013-2018 A Systematic Review’. In this review paper the authors evaluated the newest and most accepted facelift techniques over the past five years and what is the evidence of their effectiveness. To answer that question, an initial search of 604 citations awere distilled down to 84 published articles relating to advancements in face-lift techniques were reviewed. The majority of the techniques evaluated were soft-tissue techniques. (51 studies) Fourteen (14) studies involved the use of implants or tissue sealants and steroids. Twelve studies (12) pertained to the use of adjunctive laser resurfacing, fat grafting or liposuction.

All the studies found their reported techniques to be effective with few complications., with similar or fewer complications compared with the literature. However, the level of evidence to support those conclusions was generally poor with case series with non-validated measures providing the ‘evidence’.

In conclusion, most of the adjunctive and new techniques in facelift surgery lack hard and proven evidence of their effectiveness due to non-scientific study methods. Improved study design and methods would provide a better assessment of these techniques. These adjunctive facelift techniques have few downsides, it is just unproven as to what their specific benefits are.

Dr. Barry Eppley

Indianapolis, Indiana

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