How a Facial Plastic Surgeon Decides Which Is Right For You
Many of our patients visit our facial plastic surgery office in Dallas, Texas looking for ways to improve their aging appearance. Oftentimes, they are confused about whether a mini lift or a facelift is the best option for them. Sagging skin and tissue in the face and neck can be improved in various ways, so let’s look at both options.
In reality, the natural loss of elasticity occurs throughout the body as we age, but some patients show relatively more relaxation in the cheek than the neck or vice versa. Because, the platysma muscles in the neck are so active, most patients notice relaxation in the neck tissues before they notice the relaxation of the jowls around the mouth area. No matter where the relaxation shows up, the goal with a mini lift or facelift is to obtain a nice, natural result where everything fits together both functionally and aesthetically.
A “mini lift” or mini facelift in our practice lifts the cheeks up and back by elevating the skin and the underlying SMAS layer and repositioning them back in a natural aesthetic plane. The nasolabial and marionette lines are softened as the cheeks are pulled back. The jowls are improved with a cheek or mini lift, especially when the SMAS layer is repositioned onto stronger tissues overlying the cheek bones or so-called zygomatic arches.
Unfortunately, the lines that occur above the lips and around the mouth are not improved by simply pulling the cheek skin posteriorly. There is not a face lift in the world that affects those “smoker lines”. These fine lines are caused by loss of volume, or collagen. As the skin thins from the loss of collagen, the muscle activity around the mouth is more apparent because the muscles are attached to the skin. The thinner the skin becomes, the more the muscle activity is apparent. The lines above the lip can be corrected by replacing volume either by using filler, transferring fat cells taken from the abdomen or thighs, or by laser treatments to thicken the collagen. We offer all of these treatments in our Dallas office. A combination of the two is often necessary to obtain optimal results.
Patients often also want the tissues in their neck treated. The mini-lift does not target the neck area, so when patients have these issues as well, a lower cheek and neck lift, the “FreshLift facelift” is recommended.
A FreshLift facelift addresses not only the cheeks and jowls, but also the fatty tissues and muscles of the neck. The platysma muscles in the neck are very thin, wide muscles that cover the important structures of the neck like the carotid artery, the jugular vein, and the submandibular glands. It is a very active muscle that pulls the neck skin forward when we lift or strain, or even turn our head. About 15% of patients are born with the muscles in their front of their neck divided, which creates two visible lines in the front of the neck. The other 85% of patients are born with the muscles in the front of their neck fused. When their neck tissues relax, the single “waddle” or so-called “turkey neck“ appears. Either way, everyone wants the inverted “L” profile. The best way to get that is to remove any tissue between the platysma muscles if they are divided, or if they are together but droopy, we trim the anterior border of the muscles and suture them together to form a nice shelf or horizontal limb of the inverted “L”. The vertical limb of the inverted “L” is maintained by performing a back-cut to prevent the muscle from pulling the neck tissues forward when turning the head, lifting, or straining.
Our recommendations on whether to perform a mini lift vs a FreshLift facelift depends on what matters most to you. Each of our plastic surgery patients receive a thorough evaluation of the skin of the face and neck, and we present you with the options to best correct your concerns. The issues that are important to you are what we concentrate on, because we want you to get the results that you desire.