When skin over the sides of thenose and mouth start to gather and fold, then it may be time to consider afacelift procedure. Facelift orRhytidectomy involves pulling up or cutting out a part of the underlying tissueof the face called the SMAS, to tighten it and subsequently pull up or firm upthe skin of the face. The SMAS, which supports the skin of the face, is muchlike the lining of a flimsy blouse. Pullingthe lining of a blouse in one direction will surely make the blouse move towardsthe direction of the pull. Since theeffect of gravity manifests itself on the face in the form of more “skin folds”along the sides of the nose and mouth, pulling the SMAS in the oppositedirection rejuvenates the face by repositioning the skin back to its previousyouthful location. An additional benefitnoted is the pull on the skin of the neck; wherein some, if not most, of thebands on the neck are eliminated and creates an angle between the neck and thechin.
There are different techniquesthat can be done in a facelift. Traditionally, the lines of the cut run alongthe temple of the head, within the thickness of the hair, down towards thefront of the ear, around the ear lobe, to the back of the ear, then to the backof the head. The direction of the pull on the SMAS is slightly inclined upwardand towards the back. Any excess skin due to the pull of the SMAS is cut awayand the wound edges are approximated and closed. Now a days, with the trendtowards the minimally invasive procedures, the lines of incision are shorter:running a little back to the hairline of the temple, down the front of the ear (butpartly hidden), and ends at the back of the ear lobe. I employ the short scarwith the use of the Minimal Access Cranial Suspension (MACS) lift technique;wherein, the direction of the pull on the SMAS is vertically upwards. Thistechnique also gives some volume to the face.
In some patients, replacement ofthe volume of the face through Autologous Fat Gra