Is A Composite Facelift Longer Lasting?

Q: Dr. Eppley, What is the difference between the composite facelift using the subSMAS spaces and your technique? Do you make those incisions inside the ear cartilage behind the tragus? Can you please explain the differences between the Deep Plane facelifts? I am basically looking for the most invasive change/longest lasting facial rejuvenation change.

A: Let me provide you with some further comments and my experience with composite acelifting since this is a topic about which you have inquired.

I do not claim to have originality or unique experiences with extended SMAS or sub-SMAS facelifting  or composite facelift procedures. The principal motivation of a composite facelift is to bring a rejuvenative effort to more of the midface rather than just the neck and jowl areas. In other words, extending the lifting efforts to more of the central face area. A true composite facelift, in the purest sense of the term, works below the SMAS layer around the cheek, buccal fat pad and deep to the nasolabial fold area. The theory behind such a central dissection is that there is volume descent of the midfacial fat pads which has certainly been shown to be true by anatomic studies. This is not an area that any of the more traditional forms of facelifting strive to reach and treat. By dissecting the fat pad out and lifting and securing it vertically, midfacial descent of tissues is improved.

While this dissection can be done, and a few surgeons certainly tout it, more widespread experiences have been that the risk of injury to the buccal branches of the facial nerve, prolonged operative times, substantial and sustained edema and recovery and the sustainability of the midfacial results do not justify this type of effort in most patients. Other than a very few surgeons, the documented and proven long-term results simply do not justify that effort. The risk of buccal nerve injury, even if temporary, is very real and unsavory for any patient who sustains it.

If it is midface rejuvenation that one is striving for from a deep plane approach, there are more effective and less risky methods that can be combined with a good SMAS dissection. (e.g., subperiosteal midface lift through  an eyelid approach)

Thus one should not confuse longevity of a facelift necessarily with the deepest plane approach. There is only so much one can do with the SMAS layer and the intent of a deep plane technique is not necessarily one that ensures a more sustained result because of its  extensive SMAS manipulation.

Dr. Barry Eppley

Indianapolis, Indiana