Traditionally, facelifts began with the notion that facial wrinkles are equal to aging. Therefore, in the pursuit of youthful appearance, they must be removed, pulled and stretched. This practice often results in patients looking wind-swept and skeletonized. Unfortunately, these no-lifting facelifts are still being practiced in many parts of the world.
If one looks beyond wrinkles, one will invariably notice that in normal aging, all soft tissues of the body sag and deflate. The best example is seen in female breast aging. To renovate or rejuvenate a deflated and sagging breast, surgeons lift the central breast mound and the nipple vertically back to its normal position and hold it there by tailoring the surrounding skin, then they refill the volume with fat graft, implants or vascularized muscle and/or dermis.
In the human face, there are 6 major soft tissue components, i.e., the brows, central cheeks and jowls, that age just like the breasts. Today, good facelift techniques incorporate an external lift – relocating the individual sagging segments vertically to their original positions, and fixate them with internal sutures to solid underneath structures, i.e., periosteum, muscle fascia and bone. This is followed by an internal lift – re-expanding the deflated components with fat graft, implants, or tissue fillers, etc. It is amazing how, when the sagging and deflated soft tissue components of the face are lifted and filled, as an after-thought, the wrinkles are greatly reduced.
To summarize, if a facelift that does not incorporate the lifting and re-inflating of all the sagging and deflated components in its technique, then it is not a facelift.
Before and after photos of a 55 y.o. patient who had previous eyelid surgery – underwent a vertical face lift and fat graft.