Featured Experts : Dr. Jacob Steiger, a board-certified facial plastic surgeon in Boca Raton, Florida Dr. J. Randall Jordan, a board-certified facial plastic surgeon in Ridgeland, Mississippi Dr. Sam Rizk, a board-certified facial plastic surgeon in New York City
The facelift trend is gaining momentum, with more individuals opting for this procedure at earlier stages of life. According to the 2024 American Academy of Facial Plastic and Reconstructive Surgery survey, the annual number of facelifts has surged by 60% since 2017. Notably, the number of patients aged between 35 and 55 has also seen a significant increase. Dr. Jacob Steiger, a renowned board-certified facial plastic surgeon in Boca Raton, Florida, suggests that this surge in popularity is driven by a dual concern: the fear of an overly filled appearance and a shift in societal attitudes towards cosmetic procedures. "People are increasingly wary of looking overly augmented, leading them to move away from fillers. Moreover, the term 'facelift' no longer carries the stigma it once did, thanks to advancements that ensure natural-looking results," he explains.
The evolution of new, sophisticated techniques has made facelifts more tailored to individual needs. "Each surgeon likely has their own unique approach to facelifts," quips Dr. J. Randall Jordan, a board-certified facial plastic surgeon in Ridgeland, Mississippi. While this diversity might seem overwhelming, it largely boils down to marketing nuances, with facelifts generally falling into four primary categories. Here, experts elucidate the differences among these types and identify the ideal candidates for each.
SMAS facelift
Known as the traditional facelift, this procedure focuses on the SMAS, a layer of fascial tissue beneath the skin. Introduced in the 1970s, this technique transformed the field of facelifts, as noted by Dr. Steiger. Prior to this, facelifts merely involved skin cutting and pulling, resulting in an unnatural, stretched appearance. By manipulating the SMAS through cutting, lifting, and tightening, this method elevates the skin and slightly improves the loose ligaments contributing to a drooping face, he details.
However, a significant limitation of SMAS facelifts is their inability to address midface or cheek issues, as highlighted by Dr. Jordan. "Ideal candidates for an SMAS lift are typically in their 40s, exhibiting mild to moderate jowling and neck laxity," says Dr. Sam Rizk, a board-certified facial plastic surgeon in New York City. If your concerns include sagging cheeks or deep nasolabial folds, an SMAS facelift might not be the optimal choice.
Additionally, smokers are not recommended for SMAS lifts. "Even a month-long cessation of smoking before and after surgery is insufficient to mitigate the risks associated with SMAS lifts," cautions Dr. Rizk. "These procedures disrupt the skin's blood supply, and smokers already have compromised vascular health."
Deep plane facelift
Considered the most effective type, deep plane facelifts differ significantly in both surgical technique and the areas addressed. As the name suggests, this method involves a deeper dissection and release of facial ligaments, enabling more vigorous tissue mobilization and elevation, explains Dr. Jordan. "This approach allows for a more substantial overall lift, with a particular emphasis on midface elevation," he adds.
The procedure addresses the cheeks, jowls, and neck—areas that Dr. Steiger notes are typically of concern for most facelift candidates. "Sagging usually starts in the cheeks, progresses to the jawline as jowls, and finally manifests as neck laxity," he says. By the time jowling appears, the cheeks likely require attention as well, and a standard SMAS lift may not suffice. "I often perform deep plane facelifts on patients who have previously undergone an SMAS lift and now seek midface harmonization," he notes.
The advantage of this surgery lies in its ability to lift deep tissues and ligaments, restoring them to their original positions, according to Dr. Steiger. Dr. Rizk agrees, highlighting that deep plane facelifts yield the most impressive results, accounting for approximately 80% of his facelift procedures.
Cheek lift
Given that the cheeks are the first facial area to show signs of sagging, a cheek lift, or mid-facelift, offers a more focused treatment. This procedure involves lifting the fat pads and tightening the underlying muscles. Endoscopic cheek lifts are an alternative, involving a small incision near the brow instead of one in front of the ear, which could result in scarring. "Finding suitable candidates for a cheek lift is rare, as most individuals exhibit jowling along with midface looseness," says Dr. Rizk. Additionally, excessive lifting in this area without skin removal can distort facial features, making the eyes appear narrower.
Dr. Jordan identifies good candidates as those genetically predisposed to heavy, sagging cheeks without jowling, or those with a "bulldog-like" appearance. Dr. Steiger adds that most cheek lift patients are in their mid- to late 30s but often find non-surgical options like fillers sufficient. "I frequently advise patients to explore other methods and postpone facelifts until more extensive sagging is evident," he says. Due to the deep manipulation involved, cheek lifts can result in significant swelling and a recovery period of up to six weeks, longer than even deep plane facelifts.
Mini facelift
Interestingly, the term mini facelift does not appear in medical textbooks. This term is a marketing success, as Dr. Steiger points out, "Everyone wants a mini procedure with maximum results." A mini facelift refers to the length of the incision and the corresponding amount of skin removed, hence why it's often called a short scar facelift. The incision begins similarly to a regular facelift—in front of the ear, at the temple—but stops at the earlobe level, avoiding the extension behind the ear and towards the hairline and neck. Both SMAS and deep plane facelifts can be performed with shorter scars, notes Dr. Steiger. "The extent of neck laxity dictates the length of the scar," he explains. Dr. Jordan concurs, noting that individuals aged 35 to 50 with minimal loose neck skin are typically the best candidates for short scar or mini facelifts.
What facelifts don’t address
Extensive neck issues
While SMAS and deep plane facelifts manage some degree of neck laxity, many patients require a concurrent neck lift (platysmaplasty) to address neck banding, says Dr. Rizk. "A small incision under the chin grants access to deeper neck structures, allowing us to address the separation of platysma muscles that cause prominent bands or cords," he explains. Approximately 50% of his facelift patients also need this procedure. Additionally, bulging fat and muscles can be addressed during neck contouring, enhancing the overall facelift outcome.
The upper part of the face
Facelifts do not address the forehead and brow area. "Many patients are unaware that when surgeons refer to a complete facelift, they mean the lower two-thirds of the face. A brow lift is a separate procedure," says Dr. Jordan, emphasizing that many patients need both.
Skin texture
"The term 'rhytidectomy,' meaning wrinkle removal, is ironic because facelifts don't actually remove wrinkles," says Dr. Jordan. "They manage soft tissue and sagging skin but do not address textural aging signs," he points out. Combining a resurfacing procedure—such as a deep chemical peel or CO2 laser—with a facelift can yield a stunning final result. "Think of a facelift as rebuilding the foundation and the secondary treatment as the finishing paint," he suggests.