Double Facelift

Last updated date: 10-May-2023

Originally Written in English

Double Facelift


The look and shape of your face vary as you age due to typical age-related changes. Your skin loses elasticity and becomes looser, and fat deposits diminish in certain places of your face while increasing in others. The following age-related changes of your face may be minimized with a facelift: cheeks sagging, excess skin in the lower jawline (jowls), sagging skin and fat in the neck

A facelift is a frequent form of cosmetic surgery that involves the improvement of visible signs of aging in the face and neck. There are several sorts of facelift operations, so chat to your surgeon about what would work best for you.

A face-lift involves pulling back a flap of skin on each side of the face and surgically altering the tissues deep within the skin to restore the contour of the face to a more youthful form. Excess skin is removed before the flap is sutured closed.


Facelift Anatomy

Facelift Anatomy

Any surgeon who want to do a facelift operation must be familiar with the structure of the face. The skin is the first layer in the facelift anatomy. The blood supply to the skin and facelift flap is controlled by the dermal plexus of blood vessels. Typically, fat is left adherent to the dermal under-surface of the flap to improve its viability.

The subcutaneous layer comes next. This layer's fat is in close contact with the deeper SMAS and the superficial dermis. This layer can be securely penetrated without causing harm to the anatomic structures. The thickness of the subcutaneous layer varies depending on the area and patient. It thickens over the malar area and is held together by ligaments that go from the underlying periosteum through the malar pad and into the dermis. Because of its fibrous structure, this region, also known as McGregor's patch, creates resistance during dissecting.

The SMAS layer is the third layer. This layer separates the parotidmasseteric fascia and facial nerve branches from the subcutaneous fat. The SMAS layer is joined to the galea in the scalp, the temporoparietal fascia in the temples, and the superior cervical fascia in the neck via the galea. SMAS runs parallel to the platysma and divides two layers of fat in the face into superficial and deep layers. This plane contains all of the motor neurons for the face muscles . When this layer is stretched or pushed, the entire lateral face moves in the desired direction. In principle, this would allow the face to move more as a unit, resulting in more efficient expression.

The subSMAS plane is the fourth surgical plane. It houses the facial nerve motor branches as well as the parotid duct. The layer that covers the parotid gland and masseter muscle is known as the parotidomasseteric fascia. The facial nerve branches are protected by operating above this layer. The SMAS is an extension of the superficial cervical fascia, while the parotidomasseteric fascia is an extension of the deep cervical fascia's superficial layer into the face and the deep temporal fascia over the zygomatic arch. The risk of harm to the facial nerve branches rises with deeper and more anterior dissection under this layer.

From the anterior border of the parotid to the anterior border of the masseter, there is a subSMAS loose areolar tissue plane. Because of the blunt dissection in this plane, the deep plane facelift (DPFL) dissection can proceed safely while being virtually familiar with the underlying facial nerve branches.

The facial nerve branches travel through the buccal fat pad and innervate the mimetic muscles as they progress anteriorly. The plane beneath the parotidomasseteric fascia includes facial nerve branches, the parotid duct, the buccal fat pad, and the facial artery and vein. Although it is a safe plane, dissection over the parotid gland must be done with great caution since it may harm the facial nerve branches as they exit the parotid gland and pass the masseter muscle.

A normal facelift procedure may cause harm to several additional components. The sternocleidomastoid muscle is in close proximity to the larger auricular nerve and the external jugular vein. The earlobe and face are innervated by the greater auricular nerve. Because these two structures are usually superficial to the SMAS layer, dissecting in the subcutaneous layer may preserve them.


What is a Facelift?

What Is A Facelift?

A facelift (also known as a rhytidectomy) is a broad term for any surgical procedure that translocates or removes skin, fat, and/or muscle to reduce signs of aging in the face and/or neck. A facelift can restore the following signs of aging:

  • Face skin that is relaxed and sagging.
  • Between your nose and the corners of your lips, there are deep folds or wrinkles.
  • Facial fat that has dropped or is missing.
  • Skin drooping on your cheeks and/or jaw (known as jowls).
  • Loose skin and additional fat in your neck, which appears as a "double chin."

Facelifts are cosmetic restorative treatments that cannot fundamentally alter your look or stop the aging process. They also cannot address superficial wrinkles, UV damage, or skin colour anomalies. Facelifts are highly personalized operations that are tailored to each individual's face and desired outcome.


What is Double Face Lifting?

Double-up Face lifting

Age-related deterioration caused by face skin flexibility, continual triggering exposure to sunshine, and natural gravitational pull. Mid-face lifting is one of the most effective techniques to address this aging problem.

Double-up Face lifting is a surgical procedure that reduces deeply furrowed wrinkles while preserving the natural face musculature. Unlike general surgery, which lifts sagging skin by excising loose skin, this technique eliminates the droopy component of the Superficial Muscular Aponeurotic System (SMAS) and then concurrently stretches the SMAS and the skin to achieve long-lasting young skin.


Methods of Facelifting

Methods of Facelifting

Facelift procedures are classified according to the parts of the face and neck that are treated. Facelift procedures are classified as follows:

  1. Traditional facelift. Traditional facelift comprises incisions around your ears, hairline, and below your chin. A surgeon removes your skin from the underlying tissues and tightens the muscles and other facial and neck supporting structures. As needed, the surgeon will also remove extra fat from your neck and jowls. The surgeon next repositions your skin naturally across your face and eliminates any extra skin. This operation is often indicated for patients who desire to enhance the appearance of moderate to severe face aging.
  2. A SMAS facelift (SMAS rhytidectomy). It addresses the lower two-thirds of your face. A surgeon tightens your muscles and cuts extra skin and/or fat in your cheeks and lower face during this surgical intervention. SMAS facelifts are a kind of classic facelift.
  3. Deep plane facelift. Deep plane facelift involves a surgeon lifting the SMAS (the muscle layer of your face), fat, and skin as a single unit. Deep plane lifts often treat numerous regions of your face at once.
  4. mid-facelift. A mid-facelift surgery addresses the cheek area of your face. A surgeon will rearrange the fat in your cheek and tighten the skin around it.
  5. Mini-facelift. It focuses on raising the lower face and neck region. It is a less invasive and faster procedure than other facelift operations. Mini-facelifts are typically recommended by surgeons for persons who are younger and just show early symptoms of facial drooping.
  6. Cutaneous facelift. it involves only your skin and often target your neck and lower face.


How Do You Prepare for a Double Facelift Surgery?

Double Facelift Surgery Preparation

Your surgeon may have you do the following in preparation for double facelift surgery:

  • Get a blood test and/or a medical checkup.
  • Take specific medications or make adjustments to your current medications to control your chronic diseases (e.g. DM, HTN, Asthma) before undergoing the procedure.
  • Apply various products to your face's skin.
  • Stop smoking.
  • Certain foods and alcohol beverages should be avoided.
  • Aspirin and some anti-inflammatory medicines should be avoided since they might cause excessive bleeding.
  • Stop taking recreational drugs.

It is critical that you follow the directions given to you by your physician prior to surgery. Following their instructions will make the procedure go more easily and allow you to recover properly.

You should have someone stay with you for at least the first 48 hours after surgery. You may need to take up to three weeks off work if you get a more invasive facelift, such as a traditional facelift. Less invasive procedures, such as a mini-facelift, normally need five to seven days away from work. Make sure to discuss this with your surgeon so that you can prepare properly.

Before having facelift surgery, make sure you prepare a recovery area in your house that contains the following items:

  • Gauze, clean towels, and washcloths are recommended.
  • A mobile phone or telephone that is close to where you will be sitting or lying the most of the time.
  • Ointments or creams as prescribed by your doctor.
  • Magazines, novels, and portable games are examples of entertainment materials that may be used while relaxing.
  • A selection of loose-fitting, comfy button-down shirts.
  • A thermometer for measuring fever.
  • Ice (only if recommended by your surgeon).


How the Procedure Done?

Double Facelift Procedure

To treat aging changes of the midface (i.e., malar fat pad) and nasolabial grooves, a double facelift was proposed instead of a traditional facelift. The fundamental idea behind this approach was to reverse gravity's influence by manipulating deep soft tissues in order to achieve more pleasant changes in older patients.

Subcutaneous dissection is performed 2 to 3 mm anterior to the tragus at the start of the surgery. After a few millimeters of exposure, the SMAS layer is incised. The subSMAS plane is the dissection plane. During dissection, there are three basic reference points. The initial reference point, orbicularis oris, should not be regarded a component of the flap in this process.

By integrating the majority of the soft tissue into the flap, good cosmetic outcomes can be obtained. The second key reference point is the zygomatic major muscle. Deep plane dissection is continued superiorly to the muscle's borders. The zygomatic minor muscle is the final point of reference. The zygomatic cutaneous ligament, a key face retaining ligament, is directly lysed. To fully mobilize the midface, this ligament must be released. Skin, subcutaneous tissue, and a malar fat pad make up the final flap.

Patients with substantial midface and mentolabial fold aging are suitable candidates for this surgery. This strategy is not recommended for individuals who have unrealistic expectations and are in poor medical condition. This treatment is not appropriate for a secondary facelift unless the previous one was not a subSMAS procedure. Although it is advised in certain studies for smokers, the surgeon should be aware of the increased risk of wound healing issues.


Benefits of Double Facelift

Benefits of Double Facelift

  • Stretching the SMAS and skin layer to enhance skin quality and smooth mid-face wrinkles
  • V-line form and face reduction
  • Due to the little incision, the healing period is quick, and scarring is minimal to non-existent.
  • There is little risk of nerve injury.
  • A stable surgical method based on a broad range of surgical knowledge of bone contouring.
  • Improves the cause of skin sagging and has long-term effects.
  • Expression that is naturalized.


Complications & Side Effects of Double Facelift

Side Effects of Double Facelift

Face-lift surgery might result in problems. Some are treatable with proper care, medications, or surgical intervention. While long-term or chronic problems are uncommon, they might cause dramatic changes in appearance. Among the risks are:

  • Hematoma. The most common complication of face-lift surgery is a collection of blood (hematoma) under the skin that causes swelling and discomfort. Hematoma production, which normally happens within 24 hours after surgery, is addressed with surgery as soon as possible to avoid harm to the skin and other tissues.
  • Scarring. Face-lift incision scars are permanent, however they are usually hidden by the hairline and natural curves of the face and ear. Incisions can occasionally result in elevated, red scars. To enhance the look of scars, corticosteroid injections or other therapies may be utilized.
  • Nerve damage. Nerve damage, while uncommon, can have a temporary or permanent effect on nerves that govern sensation or muscles. A few months to a year can pass between acute paralysis of a specific muscle, resulting in an uneven facial look or expression, or temporary lack of feeling. Surgical therapies may provide some relief.
  • Loss of hair. Hair loss at the incision sites may be transient or permanent. Permanent hair loss can be treated surgically by transplanting skin with hair follicles.
  • Skin breakdown. A facelift can occasionally disrupt the blood circulation to your facial tissues. This can lead to skin loss (sloughing). Sloughing is treated with drugs, wound care, and, if necessary, a scar-reduction operation.


Other important considerations include:

  • Facelift surgery outcomes typically endure seven to ten years, and you will continue to age after your procedure.
  • Facelift operations cannot significantly alter your overall look.
  • Facelifts cannot address superficial wrinkles, UV damage, or skin colour anomalies.
  • If you decide to have a facelift, make sure you see a board-certified surgeon.


When to Call Your Doctor?

Call Your Doctor

If you've had a facelift, you should contact your doctor or surgeon right away if you notice any of the following symptoms or experiences:

  • Bleeding.
  • Extreme swelling.
  • Fever.
  • Pus or other abnormal discharge from the incision site(s).
  • Extreme pain.
  • Signs of infection (e.g. cellulitis)
  • Your sutures have come out before they were supposed to be removed.


Does Insurance Cover Double Facelift Surgery?


Because most insurance companies do not cover cosmetic or elective surgery, you will most likely have to pay for facelift surgery out of cash. Ensure that all of your surgeon's fees are in written. It's a good idea to get precise prices for anesthetic, follow-up treatment, any needed medicines, and so forth.


Can I Have Multiple Facelifts?

There is no technical limit or "magic number" to how many facelifts may be performed. However, as previously said, we aim to ensure that your results are as natural as possible. Too many procedures might give your face the appearance of being "pulled" or "worked on," which is not always attractive. 


What is the Best Age for Double Facelift?

Double Facelift

When signs of aging begin to develop in their 40s, 50s, or 60s, most individuals receive a facelift. Because everyone ages differently due to variables including as genetics, lifestyle, and environment, there is no "ideal age" to receive a facelift. Keep in mind that facelifts often last seven to 10 years. Some people receive a facelift in their mid-40s to early-50s, followed by a second "upgrade" in their 60s.


How Long Does Double Facelift Last?

Because everyone matures differently, the outcomes vary from patient to patient. Of course, having a qualified board-certified face plastic surgeon is essential, as they know how to employ novel treatments to keep your skin lifted for longer. If a deep plane or SMAS facelift is performed correctly, the effects can persist for 7 to 10 years or longer. Natural aging will always have an effect on your skin.



Double Facelift surgery

A facelift, as the name suggests, lifts sagging skin on the face and neck. Facelift surgery is performed as an outpatient operation under general anesthesia or IV sedation.

Depending on their age, skin condition, and aesthetic goals, patients may have a small, short scar, mid-face, lower face, or complete face and neck facelift. Hanging jowls, loose neck skin, nasolabial creases, mid-face drooping, and a double chin are just a few of the typical yet irritating signs of aging that may be addressed with this unique procedure.

Facelifts are cosmetic restorative treatments that cannot fundamentally alter your look or stop the aging process. They also cannot address superficial wrinkles, UV damage, or skin colour anomalies. Facelifts are highly personalized operations that are tailored to each individual's face and desired outcome.