If you are considering a facelift, the techniques have evolved far beyond simply tightening the skin. Today’s modern procedures focus on lifting the underlying structure of the face for more natural, lasting results. In this article for The Aesthetic Appointment Journal, journalist Paola Chellew speaks to plastic surgeon Dr. Nerina Wilkinson about the SMAS and deep plane techniques, helping readers understand which option might best suit their unique anatomy and aesthetic goals.
With innovative non-surgical solutions on the rise for those who want to achieve a refreshed or rejuvenated look as they age, I think it’s fair to ask the question: is the surgical facelift on the wane for both men and women?
Less risk is definitely a benefit when it comes to opting for the “softer” solution of injectables, but I daresay that celebrities like Kris Jenner and designer Marc Jacobs are looking absolutely fabulous and openly discussing their surgical procedures. And while non-invasive solutions achieve good outcomes, we have to ask: is the surgical facelift the best modality when it comes to a truly rejuvenated lower face?
Dr. Nerina Wilkinson explains:
“In the past, facelifts primarily focused on pulling and tightening the skin, which often resulted in an unnaturally tight and stretched face. This technique, while providing initial results, didn’t address the underlying causes of ageing, leading to a less natural appearance.
“Today’s procedures aim to lift and reposition the deeper structures of the face to achieve more natural, long-lasting results. These modern techniques work with the SMAS (superficial musculoaponeurotic system), which serves as the foundation for your face, ensuring that the rejuvenation looks balanced and harmonious, avoiding an unnatural appearance.”
What is the SMAS facelift?
Dr. Wilkinson: The SMAS layer extends from the neck (where it is connected to the platysma muscle) through the midface, and all the way up to the temple. Think of the SMAS as the foundation of your face and, just like in any construction, lifting and repositioning it is crucial to achieve a natural, youthful look.
The SMAS facelift is a modern technique that focuses on lifting and repositioning the SMAS layer without dissecting beneath it. This technique aims to restore the natural structure of the face while avoiding the more invasive dissection of the deeper tissues. Surgeons use advanced SMAS plication techniques to lift, shape, and sculpt the deeper layers of the face, allowing for a more precise and natural result.
This technique can be tailor-made to address a patient’s specific areas of concern, such as sagging cheeks, jowls, or jawline, providing a customised solution for each individual’s needs.
Positives:
- Less invasive: The SMAS facelift involves less dissection, which reduces the risk of nerve damage and can shorten recovery time.
- Natural results: The SMAS facelift provides a natural rejuvenation by working with the body’s existing foundational tissue and doesn’t involve excessive skin tightening.
- Quicker recovery: As it’s less invasive, recovery could be quicker. However, in patients who have a tendency for swelling and bruising, it could take longer. Typically, the initial swelling will subside in the first 2–3 weeks, but residual swelling may persist for several weeks. Full recovery takes about 4–6 weeks, depending on the individual.
Negatives:
- Limited neck rejuvenation: While the SMAS facelift works beautifully for lifting the face and jawline, it may not be as effective in lifting the neck. For significant neck sagging or heavy necks, additional procedures may be required.
- May require additional volume restoration and skin rejuvenating procedures: For patients with visible facial deflation, combining an SMAS facelift with volume restoration techniques using their own fat cells and stem cells can provide the best results. Additionally, skin resurfacing techniques like laser treatments and chemical peels can improve skin texture, smoothness, and tone, enhancing the overall rejuvenation.
Could you describe the deep plane facelift?
Dr. Wilkinson: The deep plane facelift has gained considerable attention recently, but it’s important to note that it’s not new; it’s actually a refinement of techniques that have been used since the 1990s.
This technique focuses on separating and repositioning the SMAS layer along with the deeper tissues beneath it, such as the muscles, fat, and ligaments. By addressing both the superficial and deeper layers, it provides a more comprehensive and dramatic lift of the entire face, including the cheeks, jawline, and neck.
Today, the deep plane facelift offers a more advanced approach to removing heavy sagging tissues in the neck, including submandibular glands, neck muscles, and deep underlying fat layers.
This is a critical step for patients with a heavy neck and significant neck sagging, where tightening the skin is not enough to achieve a natural, youthful contour.
The repositioning of these deeper tissues allows for a more comprehensive neck lift that addresses the root causes of sagging, resulting in a smoother, more rejuvenated appearance.
Positives:
- Comprehensive lift: It targets both the skin and deeper tissues, offering a more dramatic rejuvenation, particularly beneficial for those with significant neck sagging or facial deflation.
- Neck rejuvenation: Effective for patients with a heavy or sagging neck, as it allows removal and repositioning of the deeper tissues, similar to a breast reduction, and it can reduce the size of a large, heavy neck.
- Long-lasting results: Because the technique works with deeper tissues, the results tend to last longer than those achieved by simpler skin-only procedures.
Negatives:
- Increased risk: Due to the more invasive nature of the procedure, there’s a slightly higher risk of nerve injury or complications if not performed carefully by an experienced surgeon.
- Longer recovery: While recovery can vary, swelling can be prolonged in some patients due to the deeper manipulation of facial tissues. However, in most cases, recovery from a deep plane facelift is similar to that of other SMAS manipulation techniques, with the key differences being related to the extent of the surgery.
How do age, skin quality, and lifestyle affect the decision between SMAS and deep plane facelifts?
Dr. Wilkinson: Let’s break this down into two main components:
- Skin quality: If your skin is thin or damaged, you may not be an ideal candidate for a deep plane facelift. In this case, procedures that target volume restoration techniques using your own fat cells and stem cells can be a more effective approach. These regenerative treatments restore lost volume, especially in areas like the cheeks, lips, and under the eyes, giving your face a fuller, youthful look without the need for invasive procedures. Additionally, skin resurfacing techniques like laser treatments and chemical peels can improve skin texture, smoothness, and tone, enhancing the overall rejuvenation.
- Lifestyle/health: A healthy lifestyle and good skincare habits play a significant role in the outcome and recovery of any facelift. However, for patients who smoke, all facelift procedures are contraindicated due to the negative effect smoking has on the blood supply to the skin, which can impede the healing process and lead to complications. For these patients, a regenerative facelift using their own stem cells would be the best procedure. This approach leverages the body’s natural healing properties and minimises the risk of complications often associated with smoking.
Which facelift technique is preferred and why?
Dr. Wilkinson: At my clinic, the SMAS facelift is often my preferred technique because it provides natural results while being less invasive. Additionally, I always combine the SMAS facelift with fat grafting or stem cell treatments to restore lost volume and enhance the rejuvenating effect, particularly in areas like the forehead, periocular, lips, and cheeks, as well as skin rejuvenating lasers or chemical peels.
For certain patients, I also incorporate limited deep neck muscle tightening when indicated. This step helps address sagging in the neck area without the need for more invasive procedures, providing a more defined jawline and a smoother neck contour.
However, for patients who have significant sagging and fullness in the neck or more advanced facial ageing, the deep plane facelift is a better option.
This technique offers a more dramatic lift and addresses debulking of the deeper tissues, making it ideal for face and neck lifting and reduction in volume. Patients who require removal of large visible submandibular glands are referred to surgeons with the training and expertise to perform this procedure safely.
What should facelift patients know before surgery?
Dr. Wilkinson: Before undergoing any facelift, a thorough consultation is key. Here are some things to consider:
- Stop smoking: Smoking can impair healing and increase the risk of complications, so it’s crucial to quit at least six weeks before and after surgery.
- Follow pre-operative instructions: This includes avoiding certain medications and supplements that may increase bleeding.
- Understand expectations: During your consultation, you need to discuss your realistic outcomes of each technique and make the correct decision tailored to your goals and your specific facial ageing challenges.
- Select the correct surgeon: It’s crucial to ensure that you select a surgeon who is experienced in the specific technique best suited for your needs. A skilled surgeon will customise the procedure to your goals, ensuring the best possible outcome. Make sure the surgeon is a member of APRASSA (Aesthetic and Reconstructive Plastic Surgery Society of South Africa), which ensures they adhere to the highest professional and ethical standards.
Does post-procedure protocol impact the outcome?
Dr. Wilkinson: Yes, proper post-operative care is vital for the success of your facelift. After surgery, you’ll need to:
- Follow aftercare instructions: It is important that your surgeon provides guidelines on how to care for your face, manage swelling, and use prescribed medication.
- Rest and elevate: Keeping your head elevated in the first few days helps reduce swelling and speeds up healing.
- Attend follow-up appointments: Regular check-ups are essential to monitor healing and address any concerns early on.
Making the right choice for your rejuvenation
As Dr. Wilkinson explains, both techniques are excellent, with their own benefits: the deep plane facelift yields dramatic results, but is more refined than the 1990s version; the SMAS facelift is less invasive, with more natural results combined with volume restoration and skin quality treatments.
Each patient is unique: anatomy, lifestyle, age, and skin concerns are all taken into account when deliberating on which technique to use. As it will be a collaborative process, it is vitally important to select the surgeon who will work with you to choose the approach that best enhances your natural beauty, giving you lasting and harmonious results.
About the author
Paola Chellew is a freelance journalist and regularly writes for a number of publications. A former professional contemporary dancer, she has always loved the arts in all their forms. She has been a freelance writer for many years and has been published in various magazines including Live Out Loud, Private Life and Do It now magazines. Her passion for beauty and skincare started in her teens, when she would read every beauty editor’s picks and reviews. Serious about skincare, she has researched medical-grade products for over ten years, as well as aesthetic treatments to restore and repair skin to look its best. Having turned 60 last year, she has dedicated her blog to the “over 50s and beyond Club”, shining a spotlight on a generation that is seemingly side-lined by the beauty industry. “There is no age limit for when you stop being beautiful – a gorgeous lipstick, a sexy fragrance, radiant skin- these are not synonymous with youth- they are just things that add an extra sparkle to my day”.
📸 Profile photo credited to Lerissa Kemp Photography
MBChB FCS (Plast SA) Plastic and Reconstructive Surgeon
Dr Nerina Wilkinson is an Aesthetic Plastic Surgeon with over 20 years of clinical experience. Recognised by her peers and industry experts as a facial specialist with surgical, skin science, and aesthetic experience, she occupies a unique position when it comes to holistic facial rejuvenation techniques. Her innovative treatments combine surgical and non-surgical modalities and are based on in-depth scientific knowledge and her experience.
She is also the founder and director of Dr Nerina Wilkinson + Associates. Her private Aesthetic Couture Clinic is based in the prestigious V&A Waterfront. Here, she has assembled a group of clinicians and skin care specialists, each of them experts in their field, to be able to deliver the highest standards of care and state-of-the-art, evidence-based procedures. She is an active researcher in the field and has pioneered industry-changing minimally invasive rejuvenation techniques such as the StemCell4DLift™, EyeLight360™, and Natural-Lift™.
Using her detailed knowledge and surgical experience, she trains medical staff in the latest aesthetic treatments and how to deliver them with optimal, yet safe results. Dr Nerina Wilkinson is frequently invited to present her work at Plastic Surgery Conferences, educational forums, and women’s events and has also been highly represented in the media throughout her career where her opinion on current matters in Plastic Surgery and Aesthetic medicine is often sought.
Memberships:
- Association of Plastic and Reconstructive Surgeons South Africa (APRASSA full member)
- International Association of Aesthetic Plastic Surgeons (ISAPS full member)
- Fellow of the College of Surgeons South Africa (CMSA)
- AAMSSA (Aesthetic and Anti-Ageing Medicine Society of South Africa|). Active Board Member since 2012