What is the Subcutaneous Facelift Technique?

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Our face is the most inextricable sense of our identity. It is on this canvas that life plays out, blemishes of time, exposure to the environment and lifestyle are reflected over time. It is no wonder then that many of us seek a reset of this clock. To re-establish a sense of youth, a feeling of being refreshed and improved self-esteem. Facial rejuvenation and facelift surgery have come a long way over the course of the last half-century.

The pursuit of youth and elixir of immortality has been amongst man’s most pursued endeavours. Surgery has been the mainstay in achieving this outcome. Traditionally, facelift surgery involved pure excision of the skin. Excess skin around the face was excised through incisions that were camouflaged and were extended in and through the hairlines. Often this included incisions in to the side burn and behind the ears into the hairline. After widespread undermining of the skin was pulled as tightly as was possible prior to excision of the excess skin.

The closure of these incisions resulted in a high tension closure. One of the consequences of this technique was placing the remaining skin at higher risk of necrosis. This was mainly due to reduced blood supply of the facelift skin flaps which once closed under tension were even further compromised affecting effective wound healing. Where the wound healed, dehiscence or widening of the wound was a very common sequelae. Finally, as skin has the elastic ability to accommodate stretch over time the effects were very short lasting. More concerning, was the fact that strategically placed incisions around the earlobe and the hairlines eventually migrated to unnatural positions with repeated procedures.

Although today skin only or subcutaneous facelift surgery still has a role in tertiary and quaternary revision facelift surgery, it has lost its position as a viable option for facial rejuvenation. Our expanded knowledge of facial anatomy in the last quarter of the century has meant that anatomically more sound surgical techniques have been devised to gain more long lasting natural facelift surgery outcomes. These are variations of Superfical Musculo-Aponeurotic System (SMAS) based surgeries, the topic which we will devote time in the next few articles.

Dr Ross Farhadieh
Dr Farhadieh is an internationally renowned Australian qualified and trained Plastic Surgery. He holds fellowship qualifications in Plastic Surgery from Royal Australian College of Surgeons, Royal College of Surgeons (England) as well the European Board of Plastic Reconstructive Aesthetic Surgery. He has multiple clinical subspecialty fellowships in Cosmetic, Pediatrics as well as Microsurgery from World Leading institutes in London.
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