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【Part 2】There are various facelift procedures, but what's the difference?

 

Hello, everyone!

Natural and elegant rejuvenationpropose,plastic surgeonのMs. Aliceis.

 

In the first installment, we covered the overall picture of sagging treatments and...

"At what point should I consider a facelift?"

I shared that story.

 

The Final Line in Sagging Treatment: What You Should Know Before Considering a Facelift | Japan's Leading Clinic for Aesthetic and Regenerative Medicine | BIANCAGINZA

 

And one of the questions I really get asked a lot is this.

 

"There are so many types of facelifts... but what exactly makes them different?"

 

Since many skilled doctors often incorporate their own experience- and evidence-based modifications into facelifts, it's honestly difficult for other doctors or patients to know every single detail of the procedure.

But with various names for procedures, even a facelift that seems difficult at first glance need not be feared once you understand the fundamental structure and the meaning of commonly used terms.

For example, you should be able to grasp the basic mechanism behind the surgical procedure your doctor recommends!

I'll explain it in an easy-to-understand way, so please read this article all the way through! ✨

 

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■ A Conversation in the Exam Room One Day

 

A patient in their late 40s who came for counseling.

"Doctor, I'm thinking it might be time for a facelift... but which one should I choose?"

Then, looking a little uneasy, she showed me her smartphone memo.

That memo contained

“SMAS? Deep plane? Mini lift? What's the difference?”

It was written.

There are really a lot of people like this.

So I always respond like this.

 

 

■ The face is made up of “layers.” The difference is simply "which layer you move."

 

What I often draw in the examination room is an image of the layered structure of the face.

From top to bottom

 

　1. Skin

　2. Superficial fat (shallow fat)

　3. SMAS

　4. Deep Fat and Facial Muscles

　5. Deep Plane (Deep Layer of the SMAS)

　6. Periosteum and Fascia

　7. Bone

 

Sagging is not just a skin problem,

The SMAS and the deeper layers beneath it sag downward.It happens because of that.

So the reason the techniques diverge is actually very simple: it's about which layer to lift and by how much.

It may sound difficult, but this is the essence of it.

Let's take a closer look at these seven layers.

 

1. Skin

The outermost part.

This is the layer where superficial sagging occurs due to a reduction in collagen and elastic fibers in the dermis.

 

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2. Subcutaneous Fat

The layer of fat just beneath the skin.

Divided by body part (e.g., mela fat, jowl fat, etc.).

The superficial layer is where the face lift's superficial dissection is performed.

 

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3. SMAS (Superficial Musculoaponeurotic System)

A membranous structure that integrally connects facial muscles, ligaments, and fat.

The SMAS procedure produces the most significant changes to the lower facial contour.

SMAS is classified here as the “superficial musculoaponeurotic system.”

 

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4. Deep Fat Compartments and Mimetic Muscles

The deep medial cheek fat (SOOF) and other deep fat groups located beneath the SMAS, along with the facial muscles.

When this area sags, midface hollows and nasolabial folds become more noticeable.

 

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5. Deep Plane (Deep Fascia / Deep SMAS)

The layer penetrated by the Deep Plane Lift.

The deep connective tissue beneath the SMAS, a layer that allows the ligaments, deep fat, and facial muscles to move as a single unit.

The Deep Plane approach involves significantly detaching and treating this area.

 

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6. Periosteum ・Parotidomasseteric Fascia

 

The name changes depending on the body part.

　・Around the cheekbone: periosteum

　・Mandibular angle to masseter region: Masseter fascia (PM fascia)

 

The dissection in a facelift typically does not extend to this layer,

Mid-face lifts and SOOF suspension procedures may involve this layer.

 

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7. Bone

The deepest layer.

Although we do not touch them directly, the “fixation points” for facelifts are often placed on the periosteum.

 

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◆Key Terms to Know for Understanding Facelifts

 

Do you have a general idea of the layered structure now?

For those who still find it difficult, I'd like to pick out a few key terms that are important for understanding the treatment and add a little explanation to supplement the above.

 

●What is SMAS?

When researching facelifts, you'll almost always come across the term SMAS, which refers to the “fascia layer beneath the skin that supports the facial contours.”

To put it more simply,

Reinforcement Sheet The foundation for your face Something like that.

When I was young, this seat was perfectly taut,

The cheekbones and the line in front of the ears are sharply defined.

 

However, as you age, this sheet may loosen or shift downward,

This leads to nasolabial folds and marionette lines.

In a facelift, by “returning the SMAS to its proper position,”

It creates a natural, long-lasting finish without pulling only the skin.

 

●Retaining ligament

This is also a crucial structure we always keep in mind during surgery,

It refers to the ligaments that hold the skin and deep tissues of the face in place like pillars.

 

Your face has numerous ligaments,

For example, phenomena such as “cheek position dropping” or “mouth area sagging” are emphasized by this.

During surgery, by properly handling this ligament,

"Lifting from the foundation" is now possible,

This avoids the unnatural appearance of lifting only the surface.

 

 

●Midface

The midface is,

The mid-face zone from under the eyes to the center of the cheeks“ about that.

If this area sags, it makes you look instantly tired, so

This is an area where thread lifts alone often prove insufficient.

 

●Deep plane

This is the "layer name".

Layers deeper than the SMAS,

The layer closest to the “core of volume” deep within the cheek ligamentsIt's easier to remember it this way.

The "Deep Plane Lift" directly targets this layer,

Because it can restore the position of the cheeks along with their roundness,

Its defining feature is the ease with which it creates a three-dimensional, youthful contour.

 

What do you think?

Just by understanding the meanings of these words in addition to their hierarchical structure, don't you think you can get a general idea of the procedure from the name "facelift"?

 

■ SMAS Lift──“The Classic Facelift”

● Operational Layer

→ SMAS layer (below the subcutaneous fat)

 

By firmly lifting this part,

• Your face line naturally becomes defined
• Improved marionette lines and sagging around the mouth
• "A rejuvenation that doesn't look overdone"

has the following characteristics.

 

In fact, the patient I mentioned earlier also looked in the mirror while...

"This area is especially concerning...!" she said, pointing to her jawline.

For those individuals, the SMAS lift is an excellent choice.

 

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■ Deep Plane Lift—Surgery to “Restore the Entire Facial Structure to Its Youthful Position”

Next, the Deep Plane Lift.

Many people assume it's stronger than SMAS just based on the name, but in reality...

● Operational Layer

→ The deep plane, a layer deeper than the SMAS

 

To lift the skin, fat, and SMAS “while keeping them intact as a single unit,”

Lift the midface (central cheek area) with a strong, three-dimensional effectYes, I can.

 

• Golgo Line
• Deep shadows along the nasolabial folds
• Lowering of cheek volume position

For those with severe concerns, this is a method with clearly noticeable effects.

However, it is also a procedure with significant downtime and where technical skill differences are easily apparent.

 

 

Also...

■ Mini Lift

　・Only deal with the shallow layer

　・For mild sagging

　・Short downtime

 

■Midface Lift

　・Focused on the midface

　・Approach from the lower eyelid side

　・Often combined with other treatments

etc.

 

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■ So, which one is the best?

 

I think I've got a general idea about the spell formula. So naturally, the question arises: which one is right for me?

The answer is,“What do you want to improve?”is determined.

 

What bothers me when I look in the mirror is

　・Face line?

　・Midface?

　・Volume?

　・Shadow?

 

Your type of sagging, desired outcome, acceptable downtime and scarring...

That makes the surgical procedure you should choose completely different.

Furthermore,Whether a facelift is truly necessaryI think it's important to reconsider things.

 

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■ Today's Summary:

 

Having so many different procedures can be confusing, but

What matters isn't the name

　・Which demographic segments are declining and by how much

　・What kind of finish do you want?

　・Naturalness? ・Three-dimensionality? ・Volume?

Along with these,

“Considering the surgery that best suits your face.

 

I was in the examination room,

I carefully explain why this ritual suits you while confirming it in the mirror.

This is because I feel it is the most important process in aesthetic medicine.

 

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I hope this article helps you understand facelifts a little better.

In the upcoming third installment,

"So what about the actual costs? The risks? The downtime?"

I'll talk about the parts you're all most curious about!

We hope you'll look forward to it.

 

 

Author: Arisu Hatade

Board-Certified Plastic Surgeon / Cosmetic Surgeon

After graduating from Kyushu University School of Medicine, he worked in plastic and reconstructive surgery and cosmetic surgery at university hospitals and affiliated facilities, obtaining board certification in plastic surgery.

With extensive experience in a wide range of cases, from facial and trunk reconstructive surgery to cosmetic surgery, I prioritize achieving natural and beautiful results based on anatomical knowledge.

Having worked as an idol during my student days, I possess a unique perspective that understands both “beauty for being seen” and “beauty as medicine.” This allows me to offer customized aesthetic medical treatments tailored to each individual patient.

In my personal life, I enjoy traveling and gourmet food, and I share information about beauty and lifestyle on Instagram.

 

career

　Graduated from the School of Medicine, Kyushu University

　New Tokyo Hospital Initial Training

　Jichi Medical University Hospital, Department of Plastic Surgery

　Luce Clinic Employment

　Shin-Koyama Municipal Hospital Plastic Surgery Department Employee

　Teikyo University Hospital Department of Plastic Surgery

　JR Tokyo General Hospital Plastic Surgery and Reconstructive Surgery Department Employee

　Ariake Hifuka Clinic Employee

 

Professional Affiliations and Qualifications

　Board-Certified Specialist, Japanese Society of Plastic and Reconstructive Surgery

 

Field of expertise

　Cosmetic surgery (eyes, jawline, gynecological procedures, etc.)

　Injection Therapy (Hyaluronic Acid, Botox, Fat Grafting)

　Laser Skin Treatment

　Regenerative Medicine and Anti-Aging Care