Today, there are varying facelifting procedures and techniques used, all of which have evolved since their dawn in aesthetic surgery more than a century ago. These can range from more invasive traditional facelifting techniques to less invasive short-scar techniques, and though there is no consensus as to which technique is the best approach, the keys to a successful procedure remain careful patient selection, as well as techniques that work for a particular surgeon.

Dr. Niamtu

“There are many different lifting techniques used to improve lower face and neck aging. I believe that the best facelift technique is the one that works well in the hands of the specific surgeon, provides good results with low complications, and, most importantly, happy patients,” says Joe Niamtu III, D.M.D., a board-certified oral and maxillofacial surgeon with a private practice limited to cosmetic facial surgery in Richmond, Va.

Aesthetic surgeons remain at odds as to which facelifting technique is best and which can achieve superior aesthetic outcomes. Though specific techniques may vary, a more invasive traditional facelift procedure will typically involve pre- and postauricular incisions, platysmaplasty and SMAS treatment.

THE SHORT-SCAR FACELIFT Minimally invasive, so-called “short-scar,” techniques may consist of only a preauricular incision that terminates at the mastoid region with no posterior auricular and scalp incision. These lifts are also usually performed without midline platysmaplasty and frequently utilize variations of purse-string sutures. Here, an accurate assessment of the degree of lifting needed in an individual patient may ultimately direct the surgeon in choosing the appropriate technique.

“I personally do not favor minimally invasive facelifts,” Dr. Niamtu says. “It is not that I never do a short-scar facelift, but my parameters are only for young individuals with minimal aging, meaning those patients with early jowling and almost minimal neck laxity. However, even younger patients may require a larger, more comprehensive lift.”

During short-scar facelift surgery, Dr. Niamtu says he may even switch to a traditional lift and perform a conventional pre- and postauricular procedure.

“I have changed to the larger lift in mid-surgery numerous times and have been glad I did, as even patients that did not exhibit significant neck laxity actually had impressive skin excess as evidenced when the posterior auricular incision was completed,” Dr. Niamtu says.

The face of each individual patient may age in a different way. The spectrum of an aging face can range from a mere sagging of the tissues to more deflation where the fat and sub-tissues melt away.

CUSTOMIZING COUNTS While a short-scar facelift is in essence less invasive, proponents of this technique often choose this approach because they believe it can better address the individual aspects of the aging face.