In a face lift, the lateral, or the sides of the face, are treated. For example, an incision is made along the temporal hairline, around the temples near the eyes, and in front of the ear. The facial skin is dissected from the underlying tissue and the excess fat is removed. Muscles are tightened and the skin is redraped so that the excess skin can be trimmed off and removed. The skin incision is then sutured closed, leaving a very minimal scar that will blend in with the hairline. However, when only the lateral aspect of the face is treated, a patient may still have unresolved wrinkles and issues in the submental or brow area. This is why some people will choose to have a brow lift combined with a face lift.
When a brow lift is combined with a face lift, an incision is made throughout the entire scalp line, unless laparoscopy is used, in which smaller incisions are placed at intervals on the upper scalp. The facial and forehead skin is dissected from the underlying tissue, and as in the face lift alone, the muscles are tightened and the excess skin will be removed.
However, not everyone needs a brow lift combined with a face lift. If the problem areas include only the brow line and forehead, then a brow lift without the face lift may be a better option. In such cases, a laparoscopic or regular incision is made along the top of the hair line. The fat is removed and the muscles are tightened. The forehead skin is trimmed and sutured to the hairline incision. No cheek work is done and usually is not necessary in these cases. The brow lift alone is less invasive, and will still significantly reduce the signs of aging.
Many people will want several signs of aging reversed, if possible. To target not only the lateral and superior aspects of the face, but also recreate a more youthful jowl, and SMAS facelift may be considered. In a SMAS (superficial musculoaponeurotic system) face lift, the SMAS is isolated from the rest of the tissue and is pulled up along the sides of the face. The skin can then be trimmed from the side of one ear to the side of the other ear along the hairline. The frown lines will disappear and, in the case of a SMAS facelift, the jowls are brought up in order to make the face look as long as possible.
There are some patients who will choose to have additional procedures done with a brow lift with face lift, such as rhinoplasty, and mentoplasty so that the neck, cheeks, nose, and forehead are modified. Others have a blepharoplasty done at the same time as the brow lift combined with face lift. In the case of a blepharoplasty, the eyelid crease serves as a separate incision line along with the line that runs adjacent to the lower eyelashes. The skin is dissected from the underlying tissue and excess fat is removed from the eyelids. Muscles are tightened if necessary. The trimmed skin is removed and the remaining skin is sutured with very tiny sutures. They are removed within 4-5 days. It should be noted that when a brow lift combined with face lift along with any other procedures, the patient will require a bit longer time for healing compared to a simple face lift. Please note, as with any surgical procedure, there is a minor risk of bleeding, swelling, infection, and hematoma formation — all of which may delay the healing process. Most issues are minor and are self-resolving, and the patient can normally go back to work in a couple of weeks. The more extensive the procedures are, the more time that will be needed for healing. The risks and benefits will be discussed between you and your surgeon to determine what procedures will be the best for you.