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The facelift is one of the most recognized facial plastic surgery procedures. Despite  this public recognition it is also a facial rejuvenation procedure that is rife with many misconceptions about it. One of the most basic of those misconceptions is what it actually does or accomplishes. It primarily improves the lower third of the face, not the entire face, which is why it is can also be referred to as jowl-neck lift.

The jowl-neck lift has numerous techniques as to how it is performed. It is easy to get caught up (and confused) by technical maneuvers done in the procedure (e.g., SMAS flap) or in how it is marketed. It is better to think of it in levels or degrees of invasiveness based on what anatomic structures of the jawline and neck to be improved. Not surprisingly lower facelift levels are influenced by the amount of aging changes present.

The ‘entry’ level facelift (type 1) is often the most unrecognized. It is for the earliest signs of aging which include the presence of jowls/loose skin along the jawline and some mild central neck fullness. Its value is often overlooked because it competes with many non- or minimally invasive facial rejuvenation techniques such as skin tightening devices and various thread lift materials. The aesthetic improvements seen between a type 1 facelift and skin tightening/threadlifts are not comparable. But the latter has a role for those not ready to commit to a definitive surgical procedure, not because their degree of facial improvements is similar.

The type 1 facelift is better referred to as a Jowl Tuck Up because of what it does. In this limited facelift the incision are both in front and behind the ear. But the incision in front of the ear is always retrotragal. (behind the tragus) To keep the preauricular tuft of hair (in a female) from getting too elevated, particularly if it not low, a hair blocking technique is used with a v-shaped skin incision around it. On the back of the ear the incision is completely hidden in the sulcus with a limited extension towards the occipital hairline. It usually stays within the shadow of the ear helix. This incisional approach is in effect a double z-plasty which is why it heals extremely well with minimal scarring.

Facial skin flaps are widely raised into the neck and up to the nasolabial fold and mouth corners for maximal skin movement. A SMAS flap is raised, not SMAS imbrication or plication. This has a better tissue lifting effect.

The neck may or may not be treated as part of a jowl tuck up depending upon its central neck fullness for which liposuction is usually sufficient.

Between the SMAS flap and the skin movement a bidirectional facial lifting effect is seen. This cleans up the jawline making it more distinct, gets rid of jowls and softens the inferior end of the nasolabial fold.

The scar healing from the double z-plasty effect becomes nearly invisible by 6 to 8 weeks after the surgery.

The type 1 facelift is for the younger patient, usually in their 30s and 40s with the onset of modest facial aging changes. It is also the basic techniques that is used for secondary facelifts to keep the original procedure looking fresh and maintained. 

Dr. Barry Eppley

Indianapolis, Indiana

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