Face and neck lift

Facelift has maintained its place among the most popular aesthetic surgeries for decades. Despite the industry's introduction of various injection treatments, laser, radiofrequency and ultrasound devices, various lifting wires and a variety of face-lifting treatments, there is no winner in the face and neck lift surgical market.  

A facelift usually means a simultaneous surgical lift of the lower face and neck. A minilift, on the other hand, refers to a smaller procedure that is limited to the face area.

Tightening and lifting procedures can also be performed on just the neck without touching the face, in which case we refer to a neck lift. I have written a separate blog post about forehead lifts , but of course the forehead can also be combined with the above-mentioned procedures if necessary. 

Aging of the face and neck  

The reason for the continued popularity of facelifts can actually be explained by looking at the changes that occur with aging. Contrary to popular belief, the skin is not the most important target of a facelift. The most important thing in a facelift is to restore volume to the right place; the skin follows more or less automatically.  

As we age, the deeper fat pads in our face and neck begin to atrophy, i.e., disappear and settle lower. As a result, the cheeks typically develop so-called "hamster bags," deep furrows between the corners of the mouth and the sides of the nose (nasolabial folds), and a "double chin" on the neck. The upper part of the face, the cheeks, and the lower eyelids often lose volume, changing the shape of the face from a V-shape to an I-shape. Some of the changes in volume can also be explained by the thinning of the bones due to aging. 

The aim of a modern facelift is to correct the above-mentioned changes in volume in different parts of the face and neck. The skin is tightened only as much as is necessary after the lift. 

Different techniques for volume correction 

Face lift techniques can be roughly divided into two categories, also with regard to the neck: a more superficial lift performed at the SMAS level and a deeper lift, known as a deep plane lift.  

SMAS refers to the muscle and muscle membrane structure of the face, which is tightened in various ways to lift the tissues into their correct position. The deep plane technique, on the other hand, is based on releasing the tissues deeper into the facial fat pads and lifting those fat pads into the correct position. In the neck, deep plane also refers to procedures performed under the more superficial platysma muscle. Volume correction may also involve, for example, reduction of the salivary glands. 

No superiority has been demonstrated between the techniques. What is more important is that the surgeon really knows what they are doing, regardless of the technique used.  

Both techniques are usually combined with fat transfer to areas that have lost volume, which is an essential part of modern facelift surgery. In some cases, volume loss is also corrected with a small permanent implant. The most commonly used implant is placed at the tip of the chin (known as genioplasty), which emphasizes the profile of the lower face. 

Duration of the procedure and recovery  

The surgery is long, especially if combined procedures are performed, and often takes up the entire day – approximately four to six hours.  

The surgery can be performed under sedation, but any treatment of deeper areas requires anaesthesia. You can go home either the same evening or the next day, depending on the extent of the surgery. Otherwise, recovery is very individual in terms of swelling, bruising, etc. However, a couple of weeks after the surgery, you will usually be in a condition that is, so to speak, "presentable." 

My personal view  

When it comes to the face, I don't think it matters much whether the surgery is performed at a deep or more superficial level. What is more important is that the aforementioned volume changes are corrected. When it comes to the neck, however, I think that deep plane is a good option for most clients in order to lift and tighten the neck to support the face.  

Other procedures performed in conjunction with a facelift – forehead lift, lower and upper eyelid surgery, fat transfer, chin implant, laser resurfacing of the mouth area – are considered individually for each client. I almost always recommend fat transfer to hollow areas in conjunction with a facelift.  

At the end of the operation, I also create a so-called hemostatic net (Auerswald's net) on the patient's face, in which the lifted tissues are supported at their base by suturing them through the skin with large stitches. The net looks quite dramatic for the first two days, with the skin resembling a netted ham. However, the net is removed just two days after the procedure, leaving no traces behind. Clients tolerate the net quite well; it is not painful and actually feels like external support in the surgical area.

The technique significantly reduces the risks associated with the procedure, such as swelling and bleeding, thereby speeding up recovery. It is also thought to have a positive effect on the end result, as swelling does not put as much pressure on the lifted areas after surgery.

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Atte Manninen  

Plastic surgeon 

Specialist in ear, nose, and throat diseases