Gravity is the enemy of youth. Every minute of every day it is pulling on the soft tissues which comprise our face, dragging our features ever further downwards. Certain fixation points or facial ligaments act to retain some parts of our faces in their original positions; the other bits flop around them to produce further distortion.

For many years the only solution was a standard face lift operation. But in the last decade there has been an explosion of new techniques for reversing the gravitational changes of ageing:

TRADITIONAL FACE LIFT

This major procedure is in fact a face and neck lift. The skin is opened both in front of and behind the ear. Wide undermining of the facial and neck skin is performed, revealing a thin supporting membrane (called the SMAS or “superficial musculo-aponeurotic system”) which lies underneath. This membrane is then pulled upwards with sutures. Excess skin is trimmed and the wounds are closed. The resulting scars are mostly hidden in the hairline and behind the ear, although a fine scar will be visible in front of the ear.

This is still the “gold-standard” lifting procedure which produces the most dramatic and long-lasting results, but it is a major operation with a relatively long recovery time. Like all surgery, it involves some risk of complications. To reduce these problems, various less-invasive procedures have been developed.

S-LIFT

In this procedure, the skin incision is similar to the facelift, but does not extend so far behind the ear. The zone of skin undermining is much less extensive. The SMAS is nevertheless exposed and pulled upwards with sutures, just as in the standard face lift. This is a crucial step to ensure that the results persist for several years. S-lift offers a faster recovery with a lower risk of complications, and is suitable for younger patients with less severe skin excess, and those who wish to reduce risk and downtime while still achieving a long-lasting result.

MINI-LIFT AND NECK LIFT

This procedure is particularly suited to patients whose major concern is droopy jowls and neck. There is a long skin incision behind the ear, which is extended only to the top of the earlobe at front. Surgical undermining of the neck and lower face are performed through this incision. Suspension sutures are placed to the SMAS of the neck and lower face. As with the other procedures, excess skin is trimmed before closing the wound. Sometimes the midline of the neck is also tightened, through a small central incision just behind the chin. This latter technique is very effective for reducing the dreaded “turkey-gobbler” neck.

X-LIFT

For patients who wish to avoid scars altogether, this may be the ideal procedure. Long threads with unidirectional tissue-gripping “cogs” are passed through the subcutaneous tissues of the face and neck, via tiny keyhole incisions at the hairline and behind the ear. The facial and neck tissue are pulled up with these threads, which can then be anchored to deep-tissue fixation points. No skin is removed, hence there may initially be some skin puckering. This tends to resolve very rapidly thanks to facial skin’s natural elasticity.

While X-LIFT is certainly the least invasive surgical face-lifting procedure, offering the shortest recovery time and lowest overall risk, it is also less permanent than the other procedures. Typically, the effects will be gradually lost over the next 1 to 5 years. Some patients do much better than others; unfortunately, it is difficult to predict which patients will do well.