Mini vs. Mid vs. Full Facelift

In decades past, having a facelift was invariably a major undertaking. There was only one type of facelift available and it was intended to dramatically overhaul the patient’s appearance. Today, however, there are a number of less intensive options available. Procedures like the mini facelift and the mid facelift give younger patients (those under the age of 45) and those with only a small amount of laxity the option of correcting the early signs of aging, without making drastic changes to their appearance.

Mini and mid facelifts have other advantages, too. They may cost less than a full facelift and take less time to complete. Some mini facelift procedures can even be completed under a lesser form of anesthesia. Depending on the extent of the procedure and the patient’s genetics and there may be less bruising and swelling allowing her or to return to normal activities more quickly. Furthermore, mini and mid facelifts  often  require less recovery time than a full facelift does. At the same time, however, it’s important to understand that mini and mid facelifts aren’t right for everyone (hence the enduring popularity of the full facelift). Here’s what you need to know about each of the most common facelift types that are in use today:

The Mid Facelift

As the name implies, a mid facelift focuses on lifting the middle area of the face: The cheekbones and the folds of skin around the nose (known as nasolabial folds). Starting in their mid-30s, many people experience a loss of facial volume that primarily affects this region. As fat recedes from the middle part of the face, the space under the cheekbones flattens and the cheeks sag downwards. This can result in the appearance of hollows both underneath the cheekbones and underneath the eyes. At the same time, people in this age group often notice more pronounced “smile lines” forming owing to the drooping of the cheek tissue as well as loss of volume.

Because most people in their 40s usually do not have significant “jowls” or loose neck skin, the above-mentioned issues can be corrected with shorter incisions. And still allow the surgeon to effectively re-position the lax tissue of the cheeks, raising it to its former position. As a result, the cheeks no longer appear droopy and hollows under the eyes and cheekbones become less evident. Best of all, most patients only need about 7 to 14 days to recover from a mid facelift (versus the two to four weeks needed to recover from a full facelift).

Contrary to popular belief, there is no one standard mid facelift procedure. Instead, the term midi facelift can be applied to a range of different more minimally-invasive facial lifting procedures While a mid facelift can do a lot to improve the overall contour of the cheeks, it does not correct the neck area and cannot actually replace lost facial volume. As such, many patients choose to also have micro-fat grafting performed on their cheeks during this procedure. To perform fat grafting, a plastic surgeon will remove a small amount of fat from another area on your body, process it, and then re-inject it into your cheeks. This will create a very natural, youthful-looking appearance around the cheekbones and diminish hollows. Alternately, some people use dermal fillers (such as Juvederm and Restylane) to achieve similar goals. Fat grafts have the advantage of being your own tissue, so there is no chance of an allergic reaction and 30-50% remains permanent, while dermal fillers produce a temporary correction and typically last only 6-9 months.

Finally, because a mid facelift does not treat the forehead area, most plastic surgeons recommend that mid facelift patients also get Dysport or Botox injections. Botox injections relax the muscles in the forehead, smoothing away wrinkles.

The Mini Facelift

Like the mid facelift, the mini facelift is ideal for people who do not yet have substantial skin laxity around the jaw or neck. Mini facelifts also pair very well with complementary volume-enhancing and wrinkle-reducing treatments like Dysport or Botox and micro-fat injections or dermal fillers. Beyond this point, however, things get a bit more diverse and complicated. Contrary to popular belief, there is no one standard mini facelift procedure. Instead, the term mini facelift can be applied to a range of different minimally-invasive and “short scar” facial lifting procedures. Some of the most common of these are outlined below:

  • The S-lift: The S-lift, sometimes also referred to as a “short scar facelift,” requires the creation of just two small S-shaped incisions at the temple (around the ears). Because of the small size of these incisions and where they are placed, they can easily be hidden by the hairline, ears, and natural folds of the skin.

Unlike a mid facelift, the S-lift, which was developed in the early 1900s and then largely abandoned because of better techniques,  targets the lower half of the face, tightening and lifting the skin around the jaw. While it will not correct distinct “jowls” or a “turkey neck,” it can address the early signs of aging in this region.  Many surgeons feel that this procedure is not long-lasting and results in less than ideal scars.

  • MACS lift: MACS stands for Minimal Access Surgery also referred to as a short-scar facelift (like other facelift procedures, there are variations of the MACS lift).Through incisions in the hairline or in front of the ear looping sutures reposition the deeper tissue in a vertical direction and a small amount of excessive skin is removed. MACS may work well in younger patients, but will not result in a good cosmetic result in patients with more laxity.
  • The subcutaneous facelift: The subcutaneous facelift is designed to only remove loose skin from the face. It does not alter the underlying musculature of the face, nor does it re-position any facial fat. This procedure is usually used on patients who either have excellent underlying musculature or who have had a previous full facelift. It’s an excellent “touch up” procedure or   “maintenance facelift” for prior facelift patients who have noticed some additional skin laxity becoming evident 5 to 12 years after their prior lift.  Many prior facelift patients, who are appropriate candidates, prefer this procedure to another full facelift because it boasts a shorter recovery time (about 7 to 14 days). At the same time, however, you should be aware that it’s very important to choose a skilled surgeon when having this procedure. The subcutaneous facelift can create a “pulled” look when it is not administered carefully. Indeed, the prevalence of this procedure in decades past is what gave rise to facelifts being associated with a “windswept” appearance.
  • The” weekend facelift”: While the term “weekend facelift” is often used to refer to any type of mini facelift (or a specific set of injectable treatments that are meant to emulate a facelift), most clinicians agree that it was originally used to denote a specific type of less-invasive lower necklift and is a false and deceptive marketing term. During a “weekend facelift”, only one small incision is made usually underneath the chin. Working through the incision, the plastic surgeon will perform chin liposuction (if needed), the neck muscles may be slightly adjusted, and a laser treatment will be used to firm up the skin under the chin and on the neck. Some patients also choose to have a small chin implant placed in order to further define their jawline. This process can sometimes be completed under just local anesthesia, allowing the patient to resume many of his or her normal activities quickly. There have been significant disastrous results in some patients with this procedure

The term “weekend facelift” is also sometimes used to describe a type of facelift procedure where no incisions are made at all. Instead, permanent sutures are placed in strategic locations around the hairline and pulled tight, lifting the face slightly. This type of lift, which some people call a “thread Lift”, “feather lift” or “suspension lift “, has in large part fallen into disrepute because of lack of efficacy and problems. Additionally, because it cannot address skin laxity, its application is at best limited.

In reality, there is no such thing as a reliable, safe, effective “weekend facelift”.  ‘Beware of any facelift claim of  “no incisions and no downtime”.

The Full Facelift

As alluded to previously, most “full” facelifts used to be extensive subcutaneous lifts. Today, however, most plastic surgeons use much more effective techniques that address not only skin laxity, but also problems with the underlying structure of the face. After all, it’s not just our skin that droops with age—our muscles and connective tissues also loosen. These procedures are the SMAS facelift and the “deep plane” lift .

SMAS facelifts, which are the “gold standard” for modern facelifts specifically target a sheet of tissue under the cheek skin known as the Superficial Muscular Aponeurtoic System. Age-related sagging of the SMAS contributes to the appearance of jowls and deep “smile lines.” Thus, by lifting the SMAS, surgeons can correct these problems without creating a “stretched” look (as the skin is not stretched during this process; proper muscle contour is simply restored) Many SMAS facelifts are made more comprehensive by the addition of an eyelid rejuvenation, brow lift and neck lift. Older patients who have droopy eyelids and/or a distinct neck “wattle” will need these extra surgical steps in order to produce a uniformly lifted result. Dr. Singer performs a modern multi-vector underlying support facelift that is individualized for your needs and is more precise, more natural, and longer lasting. The supporting deeper tissue – the SMAS is tightened, lifting the underlying muscle layers of the cheek and the neck. The fat in the cheek is contoured into an improved position or sculpted if it is excessive.

During a “deep plane facelift”, the surgeon makes a deep incision that allows him or her to access the musculature below the skin.        Deep plane facelifts may be effective at re-positioning the entire structure of the face, including the skin, fat, and muscle. These tissues are lifted in unison and then “draped” over the face. Many plastic surgeons no longer perform this procedure because they feel that the recovery from a deep plane procedure may take months rather than weeks and that there is a greater chance of injury to the facial nerve. In addition, there is no valid data to support the claim that the results of this procedure lasts longer than a SMAS facelift

Full facelifts remain the “gold standard” in facial rejuvenation for a reason: No other procedure can so dramatically turn back the clock on facial aging. The only caveat to be aware of with full facelifts is the fact that, like all variations of facelifts, they cannot restore lost facial volume. To accomplish this, you will need to also have fat grafting performed, have facial implants inserted, or use injectable treatments.

Choosing the Facelift Method That’s Right for You

Many people understandably wish to get a mid or mini facelift rather than a full facelift. Not only because of cost but also a potential briefer recovery period—things most people find very appealing. However, it’s extremely important to remember that these less invasive procedures produce much more subtle results than a full facelift and the results do not last as long. If you have significant skin laxity or other issues that only a full facelift can truly address, then you probably won’t notice a profound change in your appearance after having a mini facelift. There will be some improvement, of course, but probably not enough to create true satisfaction.

What is more important than the specific technique is the training, experience and artistry of the plastic surgeon. Artistic natural results need to be individualized depending on the patient’s anatomy, since every individual is unique. What is appropriate for one person to get a good cosmetic result may not be best for another.

Ultimately, you should aim to get the most possible value and longevity out of your surgical experience. The best way to achieve satisfaction is to have the appropriate individualized procedure performed by an artistic experienced board certified plastic surgeon, who is ideally a member of the American Society for Aesthetic plastic Surgery (ASAPS).

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